Att A - Permit Applications — Signal Hill City Council, December 9, 2025

SIGNAT

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: Cole Vocational Services
Business Address: 2798 Junipero Ave Signal Hill, CA 90755 _ Business Phone: (562) 912-7340 On-Site Contact Name: Summer Nguyen _ Contact Phone:

Applicant Name: Summer Nguyen _ Applicant Phone
Name/Address/Phone of Partners/Officers/CEO: _
Emergency Contact: Summer Nguyen _ Emergency Phone:

Emergency Email: [email protected]
Describe Business Operation: Day Program for adults with disabilities Person/Title Responsible: Program Director
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
| Summer Nguyen hereby affirm that the statements made in this application are true and correct.

Program Director 10/9/25
Title Date
**************************************›******************************** For office use only: Finance code: 100-32-4632
Attachment A

OF SIGNAL HILL
CLIE

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: Courtyard Care Center
Business Address: 1880 Dawson Ave. Business Phone: (562)494-5188 On-Site Contact Name: Fernan Tolentino Contact Phone:

Applicant Name: Courtyard Care Center _ Applicant Phone:

Name/Address/Phone of Partners/Officers/CEO: _
Emergency Contact: Fernan Tolentino Emergency Phone:

Emergency Email: [email protected]
Describe Business Operation: Long-term and short-term rehabilitation Person/Title Responsible: Fernan Tolentino/Administrator 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
| Courtyard Care Center hereby affirm that the statements made in this application are true and correct.

Fernan Tolentino Administrator 10/29/2025
Applicant Signature Title Date
************************************************************************************************************* For office use only: Finance code: 100-32-4632

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 t 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 X Day Program for Developmentally Disabled Adults Business Name: Dungarvin California, LLC
Business Address: 695 East 7th Street, Signal Hill, CA 90755 _ Business Phone: (562) 270 - 6416 On-Site Contact Name: Juan Zepeda _ Contact Phone:

Applicant Name: Jesse Hansen Applicant Phone:

Name/Address/Phone of Partners/Officers/CEO: Lori Kress, CEO, Emily Sheevel, CFO, 1444 Northland Drive, Suite 200, Mendota Heighs MN 55120, 651-699-0206 Emergency Contact: Jesse Hansen Emergency Phone:

Emergency Email: [email protected]
Describe Business Operation: Day program assisting individual with daily living skills, accessing community activities, skill development, and employment training. Program offers a morning session (8a-1p) and an afternoon session (2p-6p) M-F.

Person/Title Responsible: Jesse Hansen - State Director Investigation Fee based on number of accommodations:
1 - 10 children/persons: $10.00 • 51 - 100 children/persons: $75.00 L 11 - 25 children/persons: $20.00 • 101 or more children/persons: $100.00 L 26 - 50 children/ persons: $40.00
| Jesse Hansen hereby affirm that the statements made in this application are true and correct.

State Director 10/17/2025
Applicant Signature Title Date
*******************- ******************
For office use only: Finance code: 100-32-4632
SIGN

AL HILI

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: Long Beach Community Improvement League
Business Address: 2399 California Avenue, Signal Hill, CA 90755 Business Phone: 562-989-5766 On-Site Contact Name: Jan Blair Contact Phone:

Applicant Name: Dr. Farah Naz Khaleghi Applicant Phone:

Name/Address/Phone of Partners/Officers/CEO: Dr. Farah Naz Khaleghi, CEO 2222 Olive Avenue, Long Beach, CA 90806
Emergency Contact: Lois Thomas Emergency Phone:

Emergency Email: [email protected]
Describe Business Operation: State Subsidized Child Care Center, Preschool (ages 2 to5)& After School Programs (ages 6 to 13) for low income children
Person/Title Responsible: Laura Sidney, Site Director
Investigation Fee based on number of accommodations:
1 - 10 children/persons: $10.00 • 51 - 100 children/persons: $75.00 • 101 or more children/persons: $100.00
11 - 25 children/persons: $20.00
26 - 50 children/ persons: $40.00
| Dr. Farah Naz Khaleghi hereby affirm that the statements made in this application are true and correct.

Farahnaz Khaleghi Executive Director 10/30/2025
Title Date
Applicant Signature
Finance code: 100-32-4632
For office use only:

CITY

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: Unlimited Quest Long Beach
Business Address: 3350 Olive Ave., Signal Hill, CA 90755 Business Phone: (562) 595-0730 On-Site Contact Name: Alexis Duran Contact Phone:

Applicant Name: Alexis Duran Applicant Phone
Name/Address/Phone of Partners/Officers/CEO: Philip Kaufman, CEO 6600 France Ave. S. Ste 350, Edina, Minnesota, 55435
Emergency Contact: Alexis Duran Emergency Phone:

Emergency Email: [email protected]
Describe Business Operation: This is a day program for adults with disabilities that specializes in working with individuals that has behaviors.

Person/Title Responsible: Alexis Duran, Day Program Manager 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
1 Alexis Duran hereby affirm that the statements made in this application are true and correct.

Alexis Duran Day Program Manager 10/23/2025
Applicant Signature Title Date
************************************************************************************************************* For office use only: Finance code: 100-32-4632

Signal Hill City CouncilDecember 9, 2025

Signal Hill City Council
December 9, 2025