Attachment A
CITY OF SIGNAL HILL
2175 Cherry Avenue Signal Hill, CA 90755-3799
Application for a permit to operate an Institutional Business in the City of Signal Hill, California, pursuant to Chapter 8.16 of the Signal Hill Municipal Code.
Select one: New Application Renewal Application
Select type: Home for the Aged Mental Institution Private Day School Day Nursery Private Boarding School/Children’s Boarding Home
Business Name:
Business Address: Business Phone:
On-Site Contact Name: Contact Phone:
Applicant Name: Applicant Phone:
Name/Address/Phone of Partners/Officers/CEO:
Emergency Contact: Emergency Phone:
Emergency Email:
Describe Business Operation:
Person/Title Responsible:
Investigation Fee based on number of accommodations:
1 – 10 children/persons: $10.00 51 – 100 children/persons: $75.00 11 – 25 children/persons: $20.00 101 or more children/persons: $100.00 26 – 50 children/ persons: $40.00
I __________________________ hereby affirm that the statements made in this application are true and correct.
Applicant Signature Title Date
************************************************************************************************************* For office use only: Finance code: 100-32-4632
Courtyard Care Center 1880 Dawson Ave. (562) 494-5188 Jonah Bagsic (562) 494-5188 Courtyard Care Center (562) 494-5188 Jonah Bagsic (310) 938-3789 [email protected] Long-term and short-term rehabilitation Jonah Bagsic/Administrator Courtyard Care Center Administrator 9/17/2024