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Home My WebLink AboutLicense - Massage Establishment Renewal - Council Oak Spa1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS April 8, 2025 Ms. Yingna Cai Council Oak Spa 3302 Portage Ave., Suite A South Bend, IN 46628 Yinjznacai 1006(ab mail.com RE: Approval — License Renewal of Massage Establishment Dear Ms. Cai: At its April 8, 2025 meeting, the Board of Public Works approved your request for the renewal of the Massage Establishment at 3302 Portage Ave., Suite A. If you have any further questions, please call this office at (574) 235-9251. Sincerely, /s/ Theresa Heffner Theresa Heffner, Clerk Enclosures TH/hh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BREANA N. MIcou INTEROFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: 02/26/2025 TO: Brad Rohrscheib, Police Department St. Joseph County Health Department - see attached Derek Erquhart, Fire Department Kari Myers, Zoning Department FROM: Theresa Heffner, Clerk SUBJECT: RENEWAL - MASSAGE ESTABLISHMENT LICENSE RECOMMENDATION BUSINESS NAME: COUNCIL OAK SPA ADDRESS: 3302 PORTAGE AVE, SUITE A PLEASE INSERT YOUR RECOMMENDATIONS IN THE APPROPRIATE FIELD BELOW, BASED ON THE FOLLOWING CRITERIA FROM MUNICIPAL CODE SEC. 4-35: 1. The applicant and his/her partners have not been convicted of any crime involving unlawful deviate conduct, deviate sexual conduct, or unlawful sexual conduct within three (3) years prior to the date of application. (Verified by PD). 2. The applicant is a minimum of 18 years of age. (Verified by PD) 3. The applicant has passed an inspection from the St. Joseph County Health Department. 4. The massage establishment as proposed by the applicant would comply with all applicable laws, including but not limited to the City's building, zoning, health, fire and safety regulations. (Fire and Zoning, please verify) 5. A recognizable and legible sign shall be posted at the main entrance identifying the establishment as a massage establishment. (PW — please verify) POLICE: Favorable Recommendation FIRE: Favorable Recommendation (passed fire inspection) COMMUNITY INVESTMENT: A massage establishment is a permitted primary use in the C Commercial district. Far ali municipal business license questions, contact: City of South Bend • Oepartmentof Community Investment 227 West Jefferson Blvd • Suite 1400 S ►South Bend, Indiana 46601 * 574.235.5912 + F: 574.235.9021 LICENSE APPLICATION FOR -MASSAGE ESTABLISE� �TT��a� MUNICIPAL CCDE SECTION -4-35 [? t7o I. APPLICATION TYPE Check One: New Renewal II, BUSINESS DATA f - A. Business Name: LiN SJu� Li B. Business Address: City: OL V�jt(;4cj C. Mailing Address (If different from above): City: :p: D. Business Telephone Number. ?7_tL± E. Business FaxNumber: F. E-Mail Address: yl'Inana Cf.,s 1006 C vlrl f . com G. Zoning of Business Location: e!i: i , l H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked by any governing municipality within three (3) years prior to the date of this application: YES NO C I. If yes, what was the reason: Z. If yes, what was the business occupation following the suspension/revocation: I. Describe the nature and scope of the business: AL . I- 1 e n. _ For Office Use Only Application Filed FEB 2 4 ?02 Public Safety Approval Application Fee Paid{ p R 2 It 202 License Fee Paid I_ PR �� 4 � F Sent to Dept. R 2: 4 7ii75 _ License Number ra CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved Reason` Elizabeth A. Maradik, President Joseph R. Molnar, Vice President �— Gary A. Gilot, Member .4 79't.A�-, L/1• l� Breana�Miicou, Member ' "/v Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: April 8, 2025 For all municipal business Ikense questions, contact: OW of South Bend • Department of Community Investment 22J WeAJcf emmn aFA Suite IqW 5 South Send, Incline 46WI • 574.Z5.5912 • F. 57knS9021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 III.OWNERSHIP A. Type of ownership (check one): X Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Corporation (If rorporation, proceed to 3). 1. Sole Proprietor Name: Residen(ntlal'�A� '2 d'ress: City: swtL F]ratd State: L Zip: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: State: Zip: Name #2: Residential Address: City: State: Zip: 3. Corporation Legal name of corporation: Date and state of incorporation: List officers and directors who own 1S% or more of stock: Name #1: Title: I Business Address: City: State: Zip: Residential Address: City: State: Zip: Name #2: Title: Business Address: City: State: Lp: Residential Address: City: State: Lp: 2 For BitmunicipalWou al business license queitbrq, mntatt' City ofsauM Bend. aD Wenrerhrson BW • suite I4w S: •S',, Ba ntl, Indiana vecartmem areomme,;; WS01 •s)4.Tgs9 2. 57,.V Inv>> s a 1 LICENSE APPLICATION FOR — Mq ESTAB.so MUNICIPAL CODE SECTTIONIOIV ESTABLISHMENT , q•35 III. OWNERSHIP (Continued) 3. Corporation (Continued) Name #3: Business Address: IV. PERSONAL DATA A. Applicant's Legal B. Reside...:.a C. Residential Telephone Number state: Zip; D. Residential Fax Number: E. Cellphone Number: F. E-Mail Address: _ G. Position with business: Omar H. Please list all criminal convictions (if any), excluding trafficviolatlons: Nature of Conviction City State Date (Attach additional sheets If necessary) I. Please list all addresses for three 3 - ( ) Vears prior to Street Address application date: City State Dates -�^rt�cflf� yL/U �6- _ JpSbony mttti6; pN I south Bend• nepaltmentot CAmmunlN5.9021 eiR For allmunklpal business Bl "S541t 1aW S•5outh Bend, Intllana 46601.514.135.5911•F.9A195.9021 lttweidIeHers(n ere•pe MASSAGE ESTABLISHMENT LICENSE XppLLICAATI PALORDE SECTION - 4-35 N. PERSONAL DATA (Conrinued) N_Phninorsnki / (/d 1 I I ( d to I tlln apPlRClrVrl. .n ,ee P! Ye > P o lu a Dates Crty, state Address OM any aI4�,.�I'��t,//i (Attach additional sheeu rf necessary) lication. V. INCLUDE WITH APPLICATION: hotostaken within 6 months of apP Three (3) Passport P APPLICATION Vt. I INCL UDESS.00 PROCESSING AGE HER PIST EMPLOYED By ESTADLISHii VIL INCLUDE P.LIST OF ALL MASS VIII INCLUDE A LIST OF SERVICES AVAILABLE AND THE COST OF SUCH SERVICES IX. AFFIRMATION iven In this application is true and that all of the information 1 have g e I further ce ttly that l have in no way attemptedto 1, hereby, certify and affirm known to me. I agree to cooperate with any accurate to the hest of my kn abed"Ie b hcaiipn 6yomittingfacis including permission to enter and mislead the Clty Inths als Procedures, review conducted pursuant to the IicensmB P an person who does not inspect the Plate of business and umed ai this establishment by h Y revlew. 1 certify that I will no 6 the regulations theraPY to be P sage th rst gclst e. have read d allow massage in the City Of outh Rend Mn cipalt e currentm possess Establishmen Cot and/orTherap dIli I)4 Codee Sr eRbn4-35. Date �Y1 n Signature 4 Half hour Swedish massage : W Half hour Deep Tissue massage: $50 One hour massage: $60 90 minutes massage: $90 Hot stone Free S �0.9 (�IW [� 5 �h L3 S T Cy W g b0 .Q C 7 a m V t a m a a c_ uyeCC 3 $. E m Cm c n�R nN y Np 9 c N COC �� \ Olt, 9 ! � \t j\ kk \) !§ \$ )\ � ! \- ' i! a �! ' \k} w � \ ! a)( & (« � \�) !°:|! } - ! 2 | F S M T B FEDERATION STATE MASSAGE THERAPY BOARDS MBLEx age & Bodywork Licensing Examination Unofficial Result CAI CANDIDATE ID: O0ou0uuuu1411475 EXAMINATIONDATE: December 6, 2018 Ei(AMINATTON RESULT: PASS -- -- rk Licensing Examination Congratulations! You have Passed the Massage & Bodywork (MBLEx). result is one component in the licensure process. l YOU PLEASE NOTE: A passing MBLEx tense are required to contact Your State Licensing Board or Agency to apply forYour to practice. s and Agencies websltes can be found at fsmtb.org. A list of State Licensing Board TAonk you far ollowing us to assist you as you pursue your professional career goals FSMTB - SUPPORTING E MISSION I SIO OF3 26LIC PROTECTION 0 �I tt R I l N fA V O N o d C ¢o r 2 v o m c o N O m > U G a U � m o d m y o U R 0 ' a Evergreen Training Ltd. 9 Certificate of Continue Education ! p 127 E Lake St S1e 300, Sb Wgdale. IL $0108 THISACIOlOVVIIDO6 THAT Yingna Cai M NOT line � IIIOID9ei SUCCESSFULLY COMPLETED THE FOLLOWING CE COUPSES(ALL INLLASS) _ a Gwrx: EMka Hours:2 P , pL MQ4 p Course fton a tMadetlm Ha :5 Dare: ESM=4 Gwrsc.NvnelMraw Hours:S OaM: 09Po3/2029 I Course 9eNwl HarrasN�re�[Prewa�tlon TremEn. Tbur:1 Dab:O&P1 , Cwrsa.5elECeR Hours:B Dale:09N42024 � Caurse:0em xscue k�dWpuas Hou�e:8 MY:89Ub2824 O NOBTMBR1570 R wnrwa«rrro�munavru _ p