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Ordinance No. 1970 <br />Page 6 of 17 <br />under penalty of perjury that such applicant shall not personally engage in the practice of <br />massage is exempt from the educational requirements set forth in this Section. <br />6.24.060 Massage Establishment Permit Application. <br />A. Each applicant for a massage establishment permit shall file a written application <br />with the Police Chief on a form provided by the Police Chief. <br />B. Each applicant shall submit the following information in the application under <br />penalty of perjury: <br />1. The full, true name under which the business is to be conducted. <br />2. The present or proposed address where the business is to be conducted. <br />3. The applicant's full, true name, including all other names used presently or in <br />the past, date of birth, valid California driver's license number or identification number, social <br />security number, present residence address and telephone number, gender, height, weight, <br />color of hair, and color of eyes. <br />4. The applicant's two (2) most recent street addresses and the dates of <br />residence at each address. Addresses from post office boxes and non-street mailboxes may not <br />be used. <br />5. The name, street address, and telephone number of each business in which <br />the applicant has been employed within the past ten (10) years along with the dates of <br />employment, positions held by the applicant, and a contact person at each location. Applicant <br />shall provide proof that within the ten (10) years preceding submission of the application, the <br />owner, operator, manager, and/or responsible managing officer/employee has not: <br />a. Had a massage establishment, massage technician, offsite <br />massage, special event, or other similar permit or license denied, suspended, or revoked by the <br />City, or any other federal, state, or local agency; <br />b. Engaged in, conducted, or operated a massage or similar <br />establishment in a manner that would be grounds for denial, suspension, or revocation of a <br />permit under this Chapter; or <br />6. A statement of the permit history of the applicant by identifying whether or not <br />such person has ever held a professional or vocational license or permit related to massage, <br />other than is required under this Chapter, issued by any agency, board, city, county, territory, <br />state, or other jurisdiction; the date of issuance of such permit or license; whether or not the <br />permit or license is still in effect; if the permit or license is no longer in effect, whether or not it <br />was revoked or suspended, and if so, the reason(s) therefor. The name and location of the <br />jurisdiction or agency which suspended or revoked such license, certificate, permit, or other <br />authorization shall also be included. <br />7. The name and street address of any other massage establishment or similar <br />business operated or managed by the applicant during the last ten (10) years. <br />8. A statement whether the applicant intends to personally provide massage <br />