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HomeMy WebLinkAbout02 CA 2011-006, ORD. NO. 1407-BODY ARTAgenda Item 2 Reviewed: AGENDA REPORT City Manager Finance Directo N/A MEETING DATE: NOVEMBER 1, 2011 TO: WILLIAM A. HUSTON, INTERIM CITY MANAGER FROM: COMMUNITY DEVELOPMENT DEPARTMENT SUBJECT: CODE AMENDMENT 2011-006 (ORDINANCE NO. 1407) -BODY ART SUMMARY: On September 9, 2010, the Ninth Circuit Court of Appeals decided Anderson v. City of Hermosa Beach and held that the process and business of tattooing are pure forms of expression fully protected by the First Amendment. According to the Court, although the City of Hermosa Beach had significant health and safety interests in regulating the tattoo parlors, a complete prohibition was unreasonable because it was substantially broader than necessary to achieve the city's health and safety goals. Tattoo establishments are not currently listed as permitted uses in the Tustin Zoning Code. Because of the practical and legal constraints placed upon the City by the Anderson v. City of Hermosa Beach case, Code Amendment 2011-006 is proposed to establish body art facilities, including tattoo establishments, as permitted uses within the City of Tustin Retail Commercial (C-1 ), Central Commercial (C-2), Heavy Commercial (C-3), and Commercial General (CG) Zoning Districts, subject to operational requirements, and establish that all body art practitioners practicing at such facilities shall be licensed. RECOMMENDATION: That the Tustin City Council introduce and have first reading of Ordinance No. 1407, approving Code Amendment (CA) 2011-006, amending Tustin City Code Section 4140 to regulate the inspection of body art facilities; amending Section 3141 to add definitions pertaining to body art; amending Sections 3651-3654 pertaining to a body art permit; and, amending Section 9232b to permit body art facilities in certain commercial zones (Attachment A). FISCAL IMPACT: Ordinance No. 1407 is aCity-initiated project. There are no direct fiscal impacts anticipated as a result of adopting this ordinance. BACKGROUND On September 9, 2010, the Ninth Circuit Court of Appeals decided Anderson v. City of Hermosa Beach (Attachment B). In brief, the Court held that the process and business of tattooing are pure forms of expression fully protected by the First Amendment and that Hermosa Beach's total ban on tattoo parlors in the city was an unconstitutional restriction on free expression because it was not a reasonable "time, place, and manner" restriction. According to the Court, CA 2011-006 (Ordinance No. 1407) November 1, 2011 Page 2 although the city had significant health and safety interests in regulating the tattoo parlors, a complete prohibition was unreasonable because it was substantially broader than necessary to achieve the city's health and safety goals. Tattoo establishments are not listed as permitted uses in the Tustin Zoning Code, and the Tustin City Code contains no specific provisions regulating the location, development, or operational characteristics of establishments where tattoos are placed on individuals. In this regard, the provisions of Tustin's Code are similar to those of Hermosa Beach's municipal code found unconstitutional by the Ninth Circuit in Anderson v. City of Hermosa Beach. To prevent the establishment of unregulated tattoo establishments while staff and the City Attorney analyzed and evaluated the impacts of this decision and potential regulatory options, the City Council approved Interim Urgency Ordinance No. 1392 on February 1, 2011, and enacted a temporary moratorium on the establishment and operation of tattoo establishments within the City for a period of 45 days. On March 1, 2011, the Tustin City Council adopted Interim Urgency Ordinance No. 1396, which extended Interim Urgency Ordinance No. 1392 for an additional period of ten (10) months and fifteen (15) days. Currently, permanent cosmetics facilities are the only type of body art facility permitted within the City of Tustin. On March 20, 2007, the Tustin City Council adopted Ordinance No. 1324 to enable the inspection and regulation of permanent cosmetics facilities within the City of Tustin by the Orange County Health Department. As noted previously, other types of body art facilities, which include tattoo establishments and body piercing facilities, are not listed as permitted uses in the Tustin Zoning Code, and the Tustin City Code contains no specific provisions regulating the location, development, or operational characteristics of establishments where tattoos or body piercings are placed on individuals. Pursuant to existing state law, every person engaged in the business of tattooing, body piercing, or permanent cosmetics is required to register with the county in which the business is located, obtain a copy of the county's sterilization, sanitation, and safety standards, and pay cone-time registration fee. According to the Orange County Health Care Agency, there are about 150 body art facilities registered in the county. Many of these facilities are inspected on an annual basis through health services agreements with cities by two (2) County inspection officers who devote a portion of their time to the inspection of body art facilities. On October 9, 2011, Assembly Bill No. 300, or the Safe Body Art Act, was signed by the Governor (Attachment C). Beginning on July 1, 2012, Assembly Bill No. 300 will provide minimum statewide standards for the regulation of persons engaged in body art businesses. These standards are intended to protect the practitioner and the client from the transmission of infectious diseases through the application of proper body art procedures and the control of cross-contamination of instruments and supplies. The bill will also require the owner of a body art facility to obtain and annually renew a health permit from the local health agency and to maintain the body art facility in a specified manner. These proposed requirements will be more regulatory in nature than the current county registration requirement. Assembly Bill No. 300 authorizes cities to adopt more stringent body art regulations, such as the requirement for practitioners to obtain a City Body Art Permit. The proposed code amendment would establish body art facilities, including body piercing, tattooing, or the application of permanent cosmetics, as a permitted use within the City of Tustin CA 2011-006 (Ordinance No. 1407) November 1, 2011 Page 3 Retail Commercial (C-1 ), Central Commercial (C-2), Heavy Commercial (C-3), and Commercial General (CG) Zoning Districts, subject to operational requirements, and establish that all body art practitioners practicing at such facilities shall be licensed by the City. In addition, under existing Code provisions body art facilities could be permitted in other zoning districts if the Community Development Director and/or Planning Commission were to determine that a body art facility is similar to another permitted use. In consultation with the City Attorney, it is recommended that body art facilities be listed as a permitted use rather than a conditionally permitted use because of the practical and legal constraints placed upon the City by the Anderson v. City of Hermosa Beach case. If a conditional use permit were required, denial would be difficult to justify in individual cases, and the grounds for denial would need to be based on health and safety matters that would be covered by the County health permit. The proposed amendment to the Tustin City Code is necessary to: 1) enable the inspection and regulation of body art facilities within the City of Tustin by the Orange County Health Care Agency; 2) establish a body art permit for body art practitioners; and 3) permit body art facilities subject to operational requirements necessary and appropriate to protect the health and safety of body art facilities. The proposed amendments are consistent with the City of Tustin General Plan and comply with Goal 4 of the Public Safety Element to reduce the risk to the community's inhabitants from exposure to hazardous materials and wastes. ENVIRONMENTAL ANALYSIS Proposed Code Amendment 2011-006 is not subject to the California Environmental Quality Act ("CEQA") pursuant to CEQA Guidelines Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) (Title 14, of the California Code of Regulations) because it has no potential for resulting in physical change to the environment, directly or indirectly; it prevents changes in the environment by requiring the approval of body art permits for body art practitioners and imposing operational conditions on body art facilities. PUBLIC NOTICE, CHAMBER OF COMMERCE REVIEW, PLANNING COMMISSION RECOMMENDATION ON CA 2011-006 A public notice was published in the Tustin News on October 20, 2011, informing the public of proposed Code Amendment 2011-006. Copies of the staff report and proposed ordinance were transmitted to the Tustin Chamber of Commerce. At the March 1, 2011, City Council meeting, Councilmember Gavello requested additional outreach; therefore, copies were also sent to individuals who have expressed interest in body art facilities and to body art industry representatives. Two industry representatives have expressed support for the proposed ordinance and requested specific technical changes to the proposed ordinance, some of which were considered by the Planning Commission and some of which (Attachment D) have been incorporated into the ordinance to be considered by the City Council. The proposed ordinance was also reviewed by a representative of the Orange County Health Care Agency. CA 2011-006 (Ordinance No. 1407) November 1, 2011 Page 4 On September 13, 2011, the City of Tustin Planning Commission continued the noticed public hearing on Code Amendment 2011-06 to September 27, 2011, at which time the Planning Commission unanimously adopted Resolution No. 4181, recommending that the Tustin City Council approve Code Amendment 2011-06 (Ordinance No. 1407), which was confirmed by the Planning Commission as part of the Consent Calendar on October 11, 2011 (Attachments E and F). Scott Reekstin Senior Planner izabeth A. Binsack Director of Community Development S:\Cdd\ccreport\CA 2011-006 Body Art.doc Attachment A: Ordinance No. 1407 Attachment B: U.S. Court of Appeals Ninth Circuit Court Decision: Anderson v. City of Hermosa Beach Attachment C: Assembly Bill No. 300 Attachment D: Correspondence Attachment E: Planning Commission Resolution No. 4181 Attachment F: Excerpts from Planning Commission Minutes: 9/13/11, 9/27/11, and 10/11/11 ATTACHMENT A ORDINANCE NO. 1407 ORDINANCE NO. 1407 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TUSTIN, AMENDING PART 4 OF CHAPTER 1 OF ARTICLE 4 OF THE TUSTIN CITY CODE REGULATING THE INSPECTION OF BODY ART FACILITIES BY THE ORANGE COUNTY HEALTH CARE AGENCY; AMENDING PART 4 OF CHAPTER 1 OF ARTICLE 3 ADDING DEFINITIONS PERTAINING TO BODY ART; AMENDING PART 5 OF CHAPTER 6 OF ARTICLE 3 PERTAINING TO A BODY ART PERMIT; AND AMENDING SECTION 9232b OF PART 3 OF CHAPTER 2 OF ARTICLE 9 TO PERMIT BODY ART FACILITIES. The City Council of the City of Tustin hereby ordains as follows: Section I. The City Council finds and determines as follows: A. That the proposed amendment to the Tustin City Code is necessary to: 1) enable the inspection and regulation of body art facilities within the City of Tustin by the Orange County Health Care Agency and the City of Tustin; 2) establish a body art permit for body art practitioners; and 3) permit body art facilities subject to operational requirements necessary and appropriate to protect the health and safety of body art facilities. B. That permanent cosmetics facilities are currently the only type of body art facility permitted and regulated within the City of Tustin. Other types of body art facilities include tattoo establishments and body piercing facilities. C. Tattoo establishments and body piercing facilities are not listed as permitted uses in the Tustin Zoning Code, and the Tustin City Code contains no specific provisions regulating the location, development, or operational characteristics of establishments where tattoos or body piercings are placed on individuals. D. In a recent case, Anderson v. City of Hermosa Beach, the Ninth Circuit Court of Appeals ruled that the City of Hermosa Beach's total prohibition on the establishment and operation of tattoo parlors within the city was unconstitutional, and that cities may only impose reasonable "time, place, and manner" regulations on such activities. The Ninth Circuit held that a tattoo, the process of tattooing, and the business of tattooing are pure forms of expression fully protected by the First Amendment to the United States Constitution, and that the City of Hermosa Beach's total ban on tattoo parlors was not a reasonable °time, place, or manner" restriction. The Ninth Circuit's decision calls into question the effectiveness of the Tustin City Code in regulating the act and/or business of tattooing and addressing land uses related to tattooing. 777346.3 Ordinance No. 1407 Page 2 E. Tattooing is an activity that, if undertaken in unsanitary conditions, can lead to the transmission of infectious diseases, including hepatitis, syphilis, tuberculosis, and HIV. Based upon the experience of other cities, it is reasonable to conclude that similar negative effects could occur in the City of Tustin as a result of the establishment or operation of tattoo establishments that do not meet minimum sterilization, sanitation, and safety standards. F. The City has received inquiries regarding the permitting and establishment of tattoo establishments within the City. The issuance or approval of any business license, permit or other entitlement for the establishment or operation of tattoo establishments is a threat to the public health, safety, and welfare in that there currently are no specific standards or regulations in the Tustin City Code that comprehensively address the potential negative effects associated with the location and operation of such facilities. Absent reasonable time, place, and manner regulations governing tattoo establishments, such uses could be established in areas of the City where they are inconsistent and/or incompatible with the surrounding land uses and/or operated under unsanitary conditions, thereby increasing the risk of transmission of infectious diseases. G. The City has completed a study, which is incorporated in the City Council Report dated October 4, 2011, regarding appropriate operational requirements necessary to protect the public health, safety, and welfare of the community and employees of body art facilities from impacts associated with the operation of body art establishments. H. That the proposed amendment will establish body art facilities, including body piercing, tattooing, or the application of permanent cosmetics, as a permitted use within the City of Tustin Retail Commercial (C-1), Central Commercial (C-2), Heavy Commercial (C- 3), and Commercial General (CG) Zoning Districts, subject to operational requirements established below, and establish that all body art practitioners practicing at such facilities shall be licensed as required herein. I. That on March 20, 2007, the Tustin City Council adopted Ordinance No. 1324 to enable the inspection and regulation of permanent cosmetics facilities within the City of Tustin by the Orange County Health Department. J. That on February 1, 2011, the Tustin City Council adopted Interim Urgency Ordinance No. 1392 relating to the establishment or operation of tattoo establishments. K. That on March 1, 2011, the Tustin City Council adopted Interim Urgency Ordinance No. 1396, which extended Interim Urgency Ordinance No. 1393 for an additional period of ten (10) months and fifteen (15) days. 777346.3 Ordinance No. 1407 Page 3 Section II. PART 4 L. That the proposed amendment is not subject to the California Environmental Quality Act ("CEQA") pursuant to CEQA Guidelines Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) (Title 14, of the California Code of Regulations) because it has no potential for resulting in physical change to the environment, directly or indirectly; it prevents changes in the environment by requiring the approval of body art permits for body art practitioners and imposing operational conditions on body art facilities. M. That on September 27, 2011, the Tustin Planning Commission held a public hearing on proposed Code Amendment 2011-006 and adopted Resolution No. 4181 recommending that the Tustin City Council approve Code Amendment 2011-006, subject to confirmation by the Planning Commission as part of the Consent Calendar on October 11, 2011. N. That on November1, 2011, a public hearing was duly noticed, called, and held before the City Council concerning Code Amendment 2011- 006. O. That the proposed amendments are consistent with the City of Tustin General Plan and comply with Goal 4 of the Public Safety Element to reduce the risk to the community's inhabitants from exposure to hazardous materials and wastes. Part 4 of Chapter 1 of Article 4 is hereby amended to read as follows: BODY ART FACILITIES 4140.010 DEFINITIONS 4140.020 EXPOSURE CONTROL TRAINING 4140.030 INFECTION PREVENTION AND CONTROL PLAN 4140.040 BODY ART FACILITIES 4140.050 PREEMPTION 4140.060 CLEANING, STERILIZATION, AND HOUSEKEEPING 4140.070 EQUIPMENT PURCHASED PRE-STERILIZED 4140.080 CLIENTS 4140.090 PRACTITIONER 4140.100 SKIN PREPARATION 4140.110 TATTOO AND PERMANENT COSMETIC APPLICATION 4140.120 BODY PIERCING 4140.130 SHARPS DISPOSAL 4140.140 TEMPORARY BODY ART FACILITIES 4140.150 MOBILE BODY ART FACILITIES 4140.160 ENFORCEMENT AUTHORITY 4140.170 REGISTRATION 4140.180 PERMIT AND FEE REQUIREMENTS 4140.190 PENALTIES 4140.200 PERMIT SUSPENSION OR REVOCATION 4140.210 HOURS OF OPERATION 777346.3 Ordinance No. 1407 Page 4 4140.220 4140.230 4140.010 DEFINITIONS MANAGEMENT OF OPERATIONS NUISANCE As used in this Chapter, unless the context otherwise requires, the following terms shall have the meanings ascribed to them respectively: (a) "Antiseptic" means a liquid orsemi-liquid substance that is approved by the U.S. Food and Drug Administration, as indicated on the label, to reduce the number of microorganisms present on the skin and on mucosal surfaces. (b) "Bloodborne pathogen(s)" means disease causing microorganisms that, when present in the blood, can be transmitted to humans. These microorganisms include, but are not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). (c) "Body art" means the practice of physical body adornment including, but not limited to, the following techniques: body piercing, tattooing or application of permanent cosmetics. (d) "Body art facility" means the area within a building or other location in which a practitioner performs body piercing, tattooing or application of permanent cosmetics, including the preparation and procedure area, as defined in this Chapter. (e) "Body piercing" means the creation of an opening in the human body for the purpose of inserting jewelry or decorative objects. This includes, but is not limited to, piercing of an ear, lip, tongue, nose, belly button, cheek, forehead or eyebrow. Body piercing does not, for the purpose of this Chapter, include piercing the leading edge or earlobe of the ear with a sterile, disposable, single-use stud or solid needle that is applied using a mechanical device to force the needle or stud through the ear. (f) "Client" means any individual who receives a body piercing, tattoo or application of permanent cosmetics from a practitioner as defined in this Chapter. (g) "Disinfectant" means a product that is approved by the U.S. Environmental Protection Agency, as indicated on the label, to reduce or eliminate the presence of disease causing microorganisms. (h) "Health Officer" means the Orange County Health Officer or designee (i) "Instrument" means any tattooing, body piercing or permanent cosmetics equipment or device that comes into contact with intact skin, non-intact skin, or mucosal surfaces. Such equipment includes, but is not limited to, needles, needle bars, needle tubes, forceps, hemostats, tweezers, razors, razor blades, or other tools and devices used to insert pigment or pierce the skin or mucosal surfaces of the human body. Such equipment also includes studs, hoops, rings or other decorative jewelry, materials or apparatuses inserted into any part of the body for the intended purpose of placement in a hole resulting from the piercing. 777346.3 Ordinance No. 1407 Page 5 (j) "Permanent cosmetics" means the application of pigments inserted into or under the surface of human skin for the purpose of permanently changing the color or appearance of the skin. This includes, but is not limited to, permanent eyeliner, eye shadow, or lip color. (k) "Permanent cosmetics facility" means the area within a building in which a practitioner performs the application of permanent cosmetics, including the preparation and procedure area, as defined in this Chapter. (I) "Practitioner" means an individual who performs tattooing, body piercing, or who applies permanent cosmetics as defined in this Chapter. (m) "Preparation Area" means a room or a designated portion of a room that is used to clean and sterilize reusable instruments that are used for tattooing, body piercing, or permanent cosmetics. (n) "Procedure area" means a room or a designated portion of a room where tattooing, body piercing or the application of permanent cosmetics is performed. (o) "Proprietor" means the person having general control and management over the conduct of business at a body art facility, or the person operating such establishment, whether or not such person is the legal owner of the premises or the business. (p) "Purchased pre-sterilized equipment" means any individually packaged, single-use instruments, devices and/or needles that are obtained after processing to render them free of all microbial life forms. Each package shall have the manufacturer's processing identification number and date of expiration. (q) "Sharps waste" means any instrument or object, including but not limited to needles or razor blades, that has been used to penetrate the skin or mucosa to perform tattooing, body piercing or the application of permanent cosmetics, or otherwise contaminated by coming into contact with blood or surfaces that have not been disinfected or sterilized. (r) "Sterilization" means the complete destruction of all microbial life forms including spores. ~ 'snr~rrtieror~ .vv o+h....r ..F ~n ~~_~;~-care--steriiar~. (s) "Tattooing" means to pierce or puncture the human skin with a needle or other instrument for the purpose of the application of pigments or the inserting of pigment under the surface of the skin; the application of pigments or inks inserted into or under the skin for the purpose of producing a mark or by production of scars. 4140.020 EXPOSURE CONTROL TRAINING (a) Prior to registration as a body art practitioner with the Orange County Health Care Agency, all body art practitioners shall complete and submit proof of completion to the Health Officer , of an Exposure Control Training Program that meets or exceeds the requirements of this Chapter. 777346.3 Ordinance No. 1407 Page 6 (b) The person conducting the training shall be knowledgeable in the subject matter covered by the elements defined in section 4140.020(d). (c) The organization providing the Exposure Control Training shall provide appropriate written training materials to each trainee. (d) The content of the Exposure Control Training Program shall include: (1) California Occupational Safety and Health Administration Bloodborne Pathogens Standard and other applicable standards and regulations with pertinent explanations. (2) The causes, control, and symptoms of the diseases caused by bloodborne pathogens. (3) The modes of transmission of bloodborne pathogens. (4) A discussion of risks involved in the application of body art and how they may lead to exposure to bloodborne pathogens for the client or body art practitioner. (5) The use of personal protective equipment such as disposable gloves and an explanation of the limitations of the equipment. (6) The importance of hand washing and a demonstration of the hand washing process as described in Section 4140.090. (7) The types, proper technique and order of tasks before and after putting on and removing gloves to avoid cross-contamination. (8) Activities that compromise a disinfected work area, .,- an ase tic procedure site, inks and pigments, sterile instruments and d~^}~ clean skin area. (9) Choosing, using and storing disinfectants and antiseptics. (10) Signs required for contaminated materials and the importance of labeling chemicals and supplies. (11) Information on Hepatitis B vaccine, including its efficacy, safety and method of administration. (12) What constitutes a bloodborne pathogen exposure incident, including: a. How the exposure occurred and what actions are to be taken to prevent or minimize future exposures. b. Risk of infection following a bloodborne pathogen exposure incident. c. Procedures to be followed after an exposure incident, including medical follow-up. 777346.3 Ordinance No. 1407 Page 7 d. Opportunity for interactive questions and answers with the instructor. 4140.030 INFECTION PREVENTION AND CONTROL PLAN (a) Each proprietor shall establish, maintain and follow, at each body art facility, a written Infection Prevention and Control Plan. (b) The Infection Prevention and Control Plan shall include, at a minimum, the following: (1) Procedures for cleaning and disinfection of surfaces in the preparation and procedure areas. (2) Procedures for maintaining the sterility or integrity of instruments, equipment and other material used during tattooing, body piercing, or permanent cosmetics. (3) Procedures for cleaning, packaging, sterilizing, and storing reusable instruments, and equipment. (4) Procedures for safe handling and disposal of sharps waste. (5) Inventory (names, manufacturers, container size) of all chemicals and disinfectants and their intended use. (c) The Infection Prevention and Control Plan shall be revised by the proprietor whenever changes in practices or procedures are made, within thirty (30) days of a change in practices or procedures. (d) The proprietor shall be responsible for ensuring that the Infection Prevention and Control Plan is followed. 4140.040 BODY ART FACILITIES (a) The health permit shall be posted in a conspicuous place in the lobby of the body art facility. (b) Body art facilities shall not be used as a food establishment, for human habitation or any other use which may cause contamination of instruments or equipment used for body art activities. (c) The floors, furnishings and equipment of body art facilities shall be kept clean and sanitary at all times during business hours. (d) Adequate lighting and ventilation shall be provided in the preparation and procedure areas. (e) Adequate toilet facilities, as required by the Tustin City Code, shall be available. Toilet rooms and bathrooms shall not be used for the storage of instruments, or other supplies used for body art activities, and shall be kept clean and sanitary at all times. 777346.3 Ordinance No. 1407 Page 8 (f) Rooms used for tattooing, body piercing or permanent cosmetic procedures shall be separated by a wall or partition from those areas used for nail, hair and other activities. (g) All sinks shall be supplied with hot (110°F minimum) and cold running water. (h) A sink that is readily accessible to the body art practitioner shall be provided and equipped with liquid soap and single use paper towels dispensed from wall-mounted dispensers that protect the supply from contamination. (i) Pets or other animals shall not be allowed in the body art facility, except for trained guide or assistance animals for the disabled. No trained guide or assistance animal shall be allowed in the procedure or preparation area. (j) No person shall utilize or maintain in a body art facility equipment that does not comply with the requirements of this Chapter. (k) The proprietor shall maintain the body art facility and the general premises under the control of the proprietor in a clean and sanitary manner. (I) All solid surfaces and objects in the procedure areal aid preparation area and the decontaimination and sterilization area that have come into contact with the client of the materials used in erformin the bod art. includin but not limited to chairs armrests tables counterto s and tra s shall be immediately cleaned and disinfected after each use with an appropriate bleach solution or other disinfectant. Manufacturer's instructions for concentration, contact time, and disposal requirements for all disinfectants must be observed. (m) The practitioner shall wear disposable gloves on both hands when touching, cleaning or handling a surface or object soiled or potentially soiled with blood. Disposable gloves worn by the body art practitioner shall be promptly removed, and hands immediately washed whenever the practitioner leaves a procedure or preparation area. (n) Each procedure and preparation area shall have waste receptacles, which are lined with plastic bags manufactured for use in waste containers that fold over the top margin of the waste container. 4140.050 PREEMPTION The provisions of this Chapter are intended to supplement applicable state law and to be in addition to, and not in conflict with such laws. Each provision shall remain in effect until the enactment of state laws or the promulgation of state regulations that conflict with or otherwise preempt the authority of the County of Orange or the City of Tustin to control the conduct described in this Chapter. 4140.060 CLEANING, STERILIZATION, AND HOUSEKEEPING (a) Instruments that pierce the skin or touch non-intact skin that will be reused shall be cleaned, packaged in appropriately labeled sterilizer pouches and sterilized prior to reuse. 777346.3 Ordinance No. 1407 Page 9 (b) Used instruments that will be sterilized and reused shall be transported dry and then placed in a container of water, disinfectant or enz matic soakin r~ oduct until cleaned and sterilized. Used instruments must be kept physically separated from sterilized or unused disposable instruments. Disposable instruments must be disposed of directly into a sharps container or into the appropriate trash receptacle after use and shall be disposed of as required herein. (c) Ultrasonic cleaners shall be available, maintained and operated according to manufacturer's instructions. (d) Clean instruments to be sterilized shall be first placed in sterilizer pouches that contain either a sterilizer indicator or internal temperature indicator. Each pack shall contain instruments for not more than one client. The outside of the pack shall be labeled with the name of the instrument, date sterilized and initials of the person operating the equipment. (e) Instruments must be repackaged and re-sterilized if the pouch is torn or otherwise compromised, if the indicator shows that adequate temperature was not reached or if the item is not used within 6 months of the date of sterilization. (f) Sterilized instruments must be maintained and stored in sterilized pouches until use. (g) Sterilizers shall be operated according to manufacturer's instructions. If manufacturer's instructions cannot be obtained, steam sterilization shall be accomplished in an autoclave with at least 15 pounds of pressure per square inch at a temperature of 250 degrees Fahrenheit for at least 30 minutes or as instructed by the local Health Officer should the standards for sterilization change from time to time. (h) Liquid sterilants shall not be used to sterilize instruments. (i) Sterilized instruments shall be placed in clean, dry, labeled containers or stored in a labeled cabinet that is protected from dust and water contamination. (j) Sterilization equipment shall meet the following requirements: (1) Only sterilizers intended for medical instruments shall be used. Sterilization equipment shall be cleaned, and maintained according to manufacturer's instructions. (2) Sterilization equipment shall be tested after the initial installation, after any major repair, and at the frequency recommended by the manufacturer. If no manufacturer's recommendation can be found, then the unit shall be tested at least weekly utilizing a biological monitoring system appropriate for the sterilizer type. (3) Biological indicator test results shall be maintained on site and available for review for a period of two years subsequent to the date of the results. 777346.3 Ordinance No. 1407 Page 10 (I) A written log of each sterilization cycle shall be maintained on-site and available for review for a period of two years, and shall include the following information: (1) Date of load. (2) The contents of the load. (3) The exposure time and temperature. (4) The results of the chemical indicator. 4140.070 EQUIPMENT PURCHASED PRE-STERILIZED (a) A practitioner using only purchased, disposable, single use and pre-sterilized instruments shall not be required to have sterilization equipment. (b) Invoices for the purchase of all pre-sterilized instruments must be maintained onsite and available for review for a period of two years after purchase. Required invoices include but are not limited to combo couplers, needle chambers, barrels, casings, tips and needles. 4140.080 CLIENTS (a) No body art procedure shall be performed on skin surface areas containing any rash, pimples, boils, or infection or otherwise manifesting any evidence of unhealthy conditions including but not limited to any evidence of inflammation, such as redness, swelling, infection, or open or draining lesions. (b) Prior to receiving a tattoo, body piercing or permanent cosmetics, the client shall read, sign and receive a copy of an informed consent form and post-procedure instructions appropriate to the procedure. (c) A copy of the signed informed consent form and post procedure instructions for all body art procedures must be maintained onsite and available for review for a period of two years after the procedure is performed. (d) The consent form and post-procedure instructions shall include at a minimum, the following: (1) Record of information from the client's picture identification showing the name, date of birth, gender, address of client, and driver's license or identification card number. (2) A summary, including the date, location and description of the procedure. (3) What to expect following the procedure, including any medical complications that may occur as a result of the procedure. (4) A statement regarding the permanent nature of body piercing, tattooing or permanent cosmetics. 777346.3 Ordinance No. 1407 Page 11 (5) A questionnaire regarding a client history of herpes, diabetes, allergic reactions to latex or antibiotics, hemophilia or any other bleeding disorder or the use of anticoagulants, which may prevent the healing of the site where the tattoo or permanent cosmetics were applied, and of cardiac valve disease or of being prescribed antibiotics prior to dental or surgical procedures. (6) Post-procedure instructions on the care of the site of the tattoo, body piercing, or permanent cosmetics. (7) Post-procedure restrictions on activities such as bathing, swimming, gardening or contact with animals. (8) Information regarding signs and symptoms of infection and to immediately consult a physician if any of the listed signs and symptoms of infection occur. 4140.090 PRACTITIONER (a) No body art operation shall be performed unless the practitioner is free of pustular skin lesions and any communicable diseases that could be transmitted in the normal practice of body art. (b) No practitioner shall eat, drink or smoke while performing a body art procedure (c) No practitioner shall perform a body art procedure with unclean hands. For purposes of this section, hands shall not be considered clean unless they have been thoroughly washed with soap from a single service dispenser and warm water vigorously rubbing all surfaces of lathered hands for at least ten (10) seconds, followed by thorough rinsing under a stream of water. Hands shall be dried using single service towels from a sanitary dispenser or hot air blower. Practitioners shall wear new, disposable exam gloves for every client during the procedure. Gloves shall be discarded between each client, and hands shall be washed each time gloves are changed. If a glove is pierced, torn, or contaminated by coming into contact with any other person, or contaminated surface, both gloves shall be removed and discarded. A single pair of gloves shall not be used on more than one person. 4140.100 SKIN PREPARATION No body art operation shall be performed unless the skin is adequately prepared prior to the operation. For purposes of this section, skin shall be considered properly prepared if it is thoroughly cleaned with an antiseptic according to manufacturer's instructions. If necessary, the skin shall be shaved with a new, single use disposable razor. 4140.110 TATTOO AND PERMANENT COSMETICS APPLICATION (a) All inks, pigments, petroleum jellies, soaps, and other reusable products used in a procedure shall be dispensed from containers in a manner to prevent contamination of the original container and its contents. (b) Pigments shall be placed into clean single use cups or caps that shall be disposed of immediately in an appropriate waste receptacle upon completion of the procedure. 777346.3 Ordinance No. 1407 Page 12 (c) Only single-use rinse cups shall be used with procedures, and they shall be disposed of immediately upon completion of the procedure. (d) All inks, dyes or pigments used shall be commercially manufactured for the procedure and shall be used according to manufacturer's instructions. (e) All products applied to the skin including stencils shall be single use and disposed into a waste receptacle after the procedure. (f) Needles and needle bars shall be sterilized prior to tattooing or application of permanent cosmetics or shall be purchased pre-sterilized. Needles shall be used only once and then disposed of in a sharps container. (g) If a rotary pen, or traditional coil machine that reuses components is used, then the use of sterilization equipment shall be required for sterilization of the reusable parts that make contact with the client or blood. (h) All rotary pens and other devices used to apply pigments must be designed and used to prevent backflow of pigments into the machine. 4140.120 BODY PIERCING (a) All jewelry or other objects to be placed in newly pierced skin shall be sterilized, or purchased pre-sterilized, be in good condition, and be designed and manufactured for insertion into the intended body part. (b) Only jewelry or other objects made of ASTM F138 ISO 5832-1, and AISI 316E o_r AISI 316LVM implant grade stainless steel, solid 14K through 2418K gold, niobium, ASTM F 136 6A4V titanium, platinum or other materials determined to be equally bio- compatible shall be placed in newly pierced skin. 4140.130 SHARPS DISPOSAL (a) Each procedure area shall have a container for the disposal of sharps (needles, razor blades, etc.) waste that is rigid, puncture resistant, leak proof and that is closeable and sealable so that when sealed, the container cannot be reopened without great difficulty. The container must be labeled with the words "sharps waste" or with the international biohazard symbol and the word "BIOHAZARD." (b) All sharps waste produced during the process of tattooing, body piercing and permanent cosmetics shall be disposed of by one of the following methods: (1) Steam sterilized on-site and disposed of as solid waste. If this method is utilized, a chemical indicator strip or tape that indicates that the container has been treated must be affixed prior to sterilization, and shall stay affixed to the container when it is disposed. (2) Treated on-site by a method approved by the Health Officer, and disposed of as solid waste. 777346.3 Ordinance No. 1407 Page 13 (3) Removal and disposal through use of a Registered Medical Waste Hauler in accordance with the provisions of the California Medical Waste Management Act. Tracking documents must be maintained on-site and be available for review for a period of two years from the date of removal from the body art facility. 4140.140 TEMPORARY BODY ART FACILITIES Temporary body art facilities shall be prohibited in the City of Tustin. 4140.150 MOBILE BODY ART FACILITIES Mobile body art facilities shall be prohibited in the City of Tustin. 4140.160 ENFORCEMENT AUTHORITY The Health Officer or his or her designee is charged with the enforcement of this Chapter, except for Sections 4140.210, 4140.220 and 4140.230. The City of Tustin Police Department and the City of Tustin Code Enforcement Officer are also authorized to enforce this ordinance. The Health Officer may, during the establishment's hours of operation and other reasonable times, enter, inspect, search and secure samples, photographs, or other evidence from any body art facility, or any location suspected of being a body art facility, for the purpose of enforcing this Chapter. It is a violation of this Chapter for any person to refuse to permit entry or inspection, the taking of samples or other evidence, or access to the facility in order to copy any record as authorized by this Chapter, or to conceal any samples or evidence, or withhold evidence concerning them. A written report of the inspection shall be made and a copy shall be supplied or mailed to the proprietor or practitioner of the body art facility. 4140.170 REGISTRATION (a) Every practitioner as defined in this Chapter shall register with the Health Officer and shall have on display so as to be readily visible to the public proof that shows that the practitioner has registered, as specified in Health and Safety Code Section 119303. (b) Registration of all practitioners is required every three years. 4140.180 PERMIT AND FEE REQUIREMENTS A body art facility shall not be open for business without: (1) at least one valid body art permit issued by the Director of Community Development to a practitioner practicing body art at that location during operating hours, (2) a valid City business license, and (3) a valid County health permit. The Health Officer shall issue a health permit when inspection has determined that the proposed body art facility and its method of operation will conform to the requirements of this Chapter. A health permit, once issued, is nontransferable. Ahealth permit shall be valid only for the proprietor and location approved. The Orange County Board of Supervisors shall adopt fees for the health permit, practitioner registration, and related services. Fees shall be sufficient to cover the actual expenses of administering and enforcing this program. 4140.190 PENALTIES 777346.3 Ordinance No. 1407 Page 14 Violation of any section of this Chapter by the proprietor o~ practitioner shall constitute a misdemeanor and upon conviction thereof shall be punishable by a fine not to exceed one thousand dollars ($1,000.00) per day per violation or by imprisonment in the county jail for a term not exceeding six (6) months, or both such fine and imprisonment. Each day the violation continues and is not corrected shall be a treated as a separate and distinct violation. 4140.200 PERMIT SUSPENSION OR REVOCATION (a) Whenever the Health Officer finds that a body art facility is not in compliance with the requirements of this Chapter, a written inspection notice shall be issued to the proprietor. If the proprietor fails to comply within the noted timeframe, the Health Officer shall issue to the proprietor, a notice of violation setting forth the acts or omissions with which the proprietor is charged. Failure to comply with the Notice of Violation within the noted timeframe may result in health permit suspension. (b) If any immediate danger to the public health or safety is found, unless the danger is immediately corrected, the Health Officer may temporarily suspend the permit and order the body art facility immediately closed. Immediate danger means any condition, based upon inspection findings or other evidence that may cause disease transmission, including, but not limited to: (1) Unclean or unsanitary floors, furnishings, toilet facilities, and equipment of the body art facility; (2) Inadequate sterilization of equipment; (3) Lack of appropriate disposal receptacles and methods; (4) Sewage contamination; (5) Lack of potable water supply; (6) Or any other condition, which in the opinion of the Health Officer, causes immediate danger to public health and safety and requires temporary suspension as noted above. (c) Whenever a health permit is suspended as the result of an immediate danger to the public health or safety, the Health Officer shall issue to the proprietor a notice setting forth the acts or omissions with which the proprietor is charged. (d) Any body art facility for which the health permit has been suspended shall close and remain closed until the health permit has been reinstated. (e) Where grounds for denial, suspension, non-renewal or revocation of a health permit exist, the Orange County Sheriff, Health Officer or Code Enforcement Officer shall serve the applicant or permit holder with a notice which shall state the reasons for the proposed action, the effective date of the action, and of the right to appeal the action. 777346.3 Ordinance No. 1407 Page 15 (f) Appeal shall be made by filing a written notice of appeal setting out the action appealed from, the grounds of the appeal and the facts upon which the appeal is based. The notice of appeal shall be filed with the Clerk of the Board of Supervisors not more than thirty (30) days after service of the notice of proposed action. A copy of the notice appealed shall be attached to the notice of appeal. Notice of the date, time, and place of the hearing on the appeal shall be mailed at least ten (10) days prior to the date of the hearing by certified mail, return receipt requested, with proof of service attached, addressed to the address on the permit. (g) Hearing on the appeal shall be conducted by a Hearing Officer who shall preside over the hearing, take evidence on the appeal and determine whether, on the basis of a preponderance of the evidence, the appealed action shall be upheld. The Hearing Officer shall render a written decision not less than forty-five (45) days after the date of the appeal hearing. The decision of the Hearing Officer shall be final. 4140.210 HOURS OF OPERATION (a) No body art facility shall operate except between the hours of 8 a.m. and 10 p.m. Sunday through Thursday and between 8 a.m. and 12 a.m. on Friday and Saturday. (b) The hours of operation shall be posted in a conspicuous place in the lobby of the establishment and in a window or other location visible from the outside. 4140.220 MANAGEMENT OF OPERATIONS (a) Each body art facility shall have a manager on the premises during all hours of operation who shall be responsible for the operations and maintenance of the facility, for compliance with all licensing requirements and to observe and supervise the actions of all persons on the premises. (b) Each body art facility shall provide a lobby or other seating area where customers and other invitees of the business may be seated while waiting or otherwise not having body art applied. (c) No body art facility shall knowingly permit loud, boisterous, lewd, violent or threatening behavior by clients or staff while in the facility or in any parking lot or other adjacent area under the control of the body art facility. 4140.230 NUISANCE (a) No body art facility shall be operated in a manner which constitutes a nuisance. (b) Operation of a body art facility in violation of this Chapter or applicable penal or health statute of the State of California shall constitute a public nuisance. (c) A body art facility may be found to be a nuisance on the basis of multiple violations of this Chapter, or any penal or health statute of the State of California or of multiple complaints which have not been resolved against the proprietor. 777346.3 Ordinance No. 1407 Page 16 (d) Nuisance determinations and abatement shall be made and performed in the manner set forth in Sections 3-14-2 and following of the Codified Ordinances of the County of Orange. Section III. Section 3141 of Part 4 of Chapter 1 of Article 3 is hereby amended to add the following definitions: Body art. The practice of physical body adornment including, but not limited to, the following techniques: body piercing, tattooing or application of permanent cosmetics. Body art facility. The area within a building or other location in which a practitioner performs body piercing, tattooing or application of permanent cosmetics, as defined in this Chapter, including the preparation and procedure area. ' Body piercing. The creation of an opening in the human body for the purpose of inserting jewelry or decorative objects. This includes, but is not limited to, piercing of an ear, lip, tongue, nose, belly button, cheek, forehead or eyebrow. Body piercing does not, for the purpose of this Chapter, include piercing the leading edge or earlobe of the ear with a sterile, disposable, single-use stud or solid needle that is applied using a mechanical device to force the needle or stud through the ear. Tattooing. To pierce or puncture the human skin with a needle or other instrument for the purpose of the application of pigments or the inserting of pigment under the surface of the skin; the application of pigments or inks inserted into or under the skin for the purpose of producing a mark or by production of scars. Section IV. Part 5 of Chapter 6 of Article 3 is hereby amended to read as follows: Part 5 BODY ART 3651 PERMIT REQUIRED No person shall engage in the business of applying body art without obtaining a body art permit issued by the Director of Finance. No person shall engage in the business of applying body art except at aduly-licensed body art facility specified in the County health permit registration form and in the City body art permit as required herein. This Part does not restrict the activities of any physician or surgeon licensed under Chapter 5 (commencing with Section 2000) of Division 2 of the Health and Safety Code. 3652 PREREQUISITES TO OBTAINING PERMIT No person shall be eligible to receive a body art permit until such person has obtained a valid County health permit for a body art facility or until such person is employed by a body art facility with a valid County health permit. Any person who wishes to obtain a body art permit to engage in the business of applying body art shall provide proof of: (1) registration with the Health Officer, (2) payment of an annual County inspection fee, and (3) address(es) where the business is to be conducted pursuant to Health and Safety Code Section 119303. 777346.3 Ordinance No. 1407 Page 17 3653 APPLICATION REQUIREMENT In addition to providing the information required on the City's application form, the applicant shall provide evidence that a complete set of fingerprints of the applicant was taken through the Livescan service. 3654 OPERATIONAL REGULATIONS Every body art facility shall be open for inspection by any officer of the City of Tustin at all times during which body art services are being provided. A permittee shall not: (1) Do business at any location not specified in the County's registration form or City permit; or (2) Violate the sterilization, sanitation, and safety standards adopted by the State Department of Health Services. Section V. Section 9232a.2. of Part 3 of Chapter 2 of Article 9 is hereby amended to sequentially reletter item numbers (d) through (s) and include body art facilities as item (d) as follows: (d) Body art facilities (as defined in section 3141, and subject to the requirements of Part 4 of Chapter 1 of Article 4) Section VI. If any section, subsection, sentence, clause, phrase, or portion of this ordinance is for any reason determined to be invalid or unconstitutional by the decision of any court of competent jurisdiction, such decision shall not affect the validity of the remaining portions of this ordinance. The City Council of the City of Tustin hereby declares that it would have adopted this ordinance and each section, subsection, sentence, clause, phrase, or portion thereof irrespective of the fact that any one or more sections, subsections, sentences, clauses, phrases, or portions be declared invalid or unconstitutional. PASSED AND ADOPTED by the City Council of the City of Tustin, at a regular meeting on the 1g` day of November, 2011. JERRY AMANTE Mayor ATTEST: PAMELA STOKER City Clerk 777346.3 Ordinance No. 1407 Page 18 STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS CITY OF TUSTIN CERTIFICATION FOR ORDINANCE NO. 1407 PAMELA STOKER, City Clerk and ex-officio Clerk of the City Council of the City of Tustin, California, does hereby certify that the whole number of the members of the City Council of the City of Tustin is 5; that the above and foregoing Ordinance No. 1407 was duly and regularly introduced at a regular meeting of the Tustin City Council, held on the 1 g` day of November, 2011 and was given its second reading, passed, and adopted at a regular meeting of the City Council held on the 15~' day of November, 2011 by the following vote: COUNCILMEMBER AYES: COUNCILMEMBER NOES: COUNCILMEMBER ABSTAINED: COUNCILMEMBER ABSENT: PAMELA STOKER City Clerk 777346.3 ATTACHMENT B U.S. COURT OF APPEALS NINTH CIRCUIT COURT DECISION: ANDERSON V. CITY OF HERMOSA BEACH FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT JOHNNY ANDERSON, Plai-rtiff-Appellant, No. 08-56914 D.C. No. ~' 2:07-cv-05923- CITY OF HERMOSA BEACH, a CAS-E California Municipal Corporation, OPINION Defendant-Appellee. Appeal from the United States District Court for the Central District of California Christina A. Snyder, District Judge, Presiding Argued and Submitted May 7, 2010-Pasadena, California Filed September 9, 2010 Before: John T. Noonan, Richard R. Clifton and Jay S. Bybee, Circuit Judges. Opinion by Judge Bybee; Concurrence by Judge Noonan 13739 ANDERSON V. HGRMOSA BL'ACH 13743 COUNSEL Robert C. Moest, Law Offices of Robert C. Moest, Santa Monica, California, for the plaintiff-appellant. John C. Cotti, Jenkins & Hogin, LLP, Manhattan Beach, Cali- fornia, for the defendant-appellee. OPINION BYBEE, Circuit Judge: We address a question of first impression in our circuit: whether a -nunicipal ban on tattoo parlors violates the First Amendment. Although courts in several jurisdictions have upheld such bans against First Amendment challenges, see, e.g., Hold Fast Tattoo, LLC v. City of North Chicago, 580 F. Supp. 2d 656, 659-61 (N.D. I11. 2008); Yurkew v. Sinclair, 495 F. Supp. 1248, 1253-55 (D. Minn. 1980); State v. Bradv, 492 N.E.2d 34, 39 (Ind. Ct. App. 1986); People v. O'Sullivan, 409 N.Y.S.2d 332, 333 (App. Div. 1978); State v. White, 560 S.E.2d 420, 423-24 (S.C. 2002); Blue Horseshoe Tattoo, [! Ltd. v. City of Norfolk, 72 Va. Cir. 388, 390 (Cir. Ct. 2007), we respectfully disagree. We hold that tattooing is purely expressive activity fully protected by the First Amendment, and that a total ban on such activity is not a reasonable "time, place, or manner" restriction. L BACKGROUND Petitioner-Appellant Johnny Anderson seeks to establish a tattoo parlor in Defendant-Appellee City of Hermosa Beach 13744 A:JDERSON V. HERSIOSA BEACH (the "City"), but Hermosa Beach Municipal Code ("Code") § 17.06.070 effectively bans tattoo parlors. Anderson sued the City under 42 U.S.C. § 1983, alleging that § 17.06.070 is facially unconstitutional under the First and Fourteenth Amendments. The parties filed cross-motions for summary judgment, and the district court denied Anderson's motion and granted the City's motion. Anderson now appeals this decision. We begin with the relevant background information, start- ing with a brief explanation of the process and health implica- tions of tattooing,' followed by a summary of the laws regulating tattooing in the State of California and its subdivi- sions, and ending with a more detailed description of the facts and procedural history in Anderson's particular case. A. Tattooing A declaration provided by the City sums up well the pro- cess of tattooing: A tattoo is created by injecting ink into a person's skin. To do this, an electrically powered tattoo machine, often called a gun, moves a solid needle up and down to puncture the skin between 50 and 3,000 times per minute. The needle penetrates the skin by about a millimeter and deposits a drop of insoluble ink into the skin with each puncture. The ink is deposited in the dermis, which is the second layer of skin.... Because the skin has been punctured many times, the end result is essentially an open wound. 'Throughout most of this opinion, we use "tattooing" as shorthand to refer not only to the process of tattooing but also to the business of tattooing-that is, the procedure under which the tattooist injects a tattoo into a person's skin in exchange for money. In Part III.A, however, we break down tattooing into each of its component parts: the tattoo itself, the physical process of tattooing, and the business of tattooing. f~NDE:RSON V. HERMOSA BEACH 13745 Tattooing carries the risk of infection and transmission of disease "if unsanitary conditions are present or unsterile equipment is used." Yurkew, 495 F. Supp. at 1252. The City's declarations establish that tattooing can result in the transmis- sion of such diseases as hepatitis, syphilis, tuberculosis, lep- rosy, and HIV. Reports from the Centers for Disease Control and Prevention and the Food and Drug Administration con- firm the significant health risks of tattooing. See Centers for Disease Control and Prevention, Body Art: Tattoos and Pierc- ings (Jan. 21, 2008), available at http://www.cdc.gov/ features/bodyart (last visited May 25, 2010) (noting risks of infection, tuberculosis, hepatitis B and C, and HIV); United States Food and Drug Administration, Tattoos & Permanent Makeup (Nov. 29, 2000), available at http://www.fda.gov/ cosmetics/productandingredientsafery/productinfotmation/ ucm 108530.htm (last visited May 25, 2010) (discussing risks of infection, removal problems, potential allergic reactions, and MRI complications). In general, however, "tattooing is a safe procedure if per- formed under appropriate sterilized conditions." Yurkew, 495 F. Supp. at 1252. "[T]attoo artists protect themselves and their clients when following safe and healthy practices," including "using sterile needles and razors, washing hands, wearing gloves, and keeping surfaces clean." Centers for Disease Con- trol and Prevention, supra; see also Mayo Clinic, Tattoos: Understand Risks and Precautions (Feb. 16, 2010), available of http://www.mayoclinic.com/hcalth/tattoos-and-piercings/ mc00020 (last visited May 25, 2010) (providing a list of ques- tions aperson should ask "[t]o make sure [his] tattoo will be applied safely"). B. Tattooing Regulations Because of the potential health concerns implicated by tat- tooing, the State of California requires "[e]very person engaged in the business of tattooing ... [to] register ...with the county health department of the county in which that busi- 13746 ANDERSON V. HERMOSA BEACH Hess is conducted," CAL. HEALTH 8c SAFETY CODE § 119303(x), and requires these county health departments to inspect the registered tattoo parlors, id. § 119304. A person engaged in a tattooing business "who fails to register as provided by Sec- tion 119303... [is] subject to a civil penalty of five hundred dollars ($500) per violation." /d. § 119306. Moreover, Cali- fornia makes it illegal to "tattoo[ ] or offer[ ] to tattoo a per- son under the age of 18 years." CAL. PGNAL CODE § 653. The City of Hermosa Beach lies within the County of Los Angeles ("the County"). According to a declaration by Claro Cartagena, an inspector of tattoo establishments for the County, there are nearly 300 tattoo establishments in the County and over 850 tattooists. However, Cartagena is the only inspector in the County monitoring the parlors. Many tat- too parlors have never been inspected and are subject to no regulations other than the requirement to register with the County. Thus, it is largely up to the owner of the tattoo estab- lishment to sterilize his equipment and follow sterilization procedures. According to Cartagena, "While most tattoo establishments are clean and sanitary, others are not.... As in any field, there are those practitioners that are unscrupulous or incompetent and do not follow the proper sterilization pro- cesses strictly. This poses a risk for infection." Cartagena has also received complaints about illegal underage tattooing. Although Los Angeles County generally permits tattooing businesses, the City of Hermosa Beach does not. Hermosa Beach Municipal Code § 17.06.070 provides: "Except as pro- vided in this title, no building shall be erected, reconstructed or structurally altered, nor shall any building or land be used for any purpose except as hereinafter specifically provided and allowed in the same zone in which such building and land is located." The Code provides zoning for a wide variety of commercial uses, including movie theaters, restaurants, adult businesses, bars, fortune tellers, gun shops, and youth hostels. HERMOSA BEACH MuN. CODE § 17.26.030. No provision of the zoning code, however, permits tattoo parlors, and as a result, ANDERSON V. HLR~IOSA BEACH 13747 these facilities are banned from Hermosa Beach under section 17.060.070. Indeed, on November 20, 2007, the City's Plan- ning Commission adopted a resolution against amending the Code to permit tattoo parlors. C. Fncts and Procedural History Plaintiff-Appellant Johnny Anderson presently co-owns a tattoo parlor in the Ciry of Los Angeles, and seeks to establish a tattoo parlor in the City of Hermosa Beach. Anderson describes his own approach to tattooing in a declaration he submitted to the district court: The tattoo designs that are applied by me are indi- vidual and unique creative works of visual art, designed by me in collaboration with the person who is to receive the tattoo. The precise design to be used is decided upon after discussion with the client and review of a draft of the design. The choices made by both me and by the recipient involve consideration of color, light, shape, size, placement on the body, literal meaning, symbolic meaning, historical allu- sion, religious import, and emotional content. I believe my designs are enormously varied and com- plex, and include realistic depictions of people, ani- mals and objects, stylized depictions of the same things, religious images, fictional images, and geo- metric shapes and patterns.... Sometimes, several kinds of images are combined into a single tattoo or series of tattoos.... I have studied the history of tat- tooing, and [draw significantly on traditional Ameri- cana tattoo designs and on Japanese tattoo motifs in creating my images, while all the while trying to add my own creative input to make the designs my own. On August 14, 2006, Anderson brought a 42 U.S.C. § 1983 action against the City in the Central District of California, alleging that Hermosa Beach Municipal Code ~ 17.06.070 is 13748 ANDERSON V. HERti1OSA BEACH facially unconstitutional under the First and Fourteenth Amendments, and seeking declaratory relief, injunctive relief, attorney's fees, costs, and any other relief the court deemed appropriate. The district court initially dismissed Anderson's claim for lack of ripeness because Anderson had not sought permission to operate a tattoo parlor under the administrative procedures provided in the Code, which allow the community development director to permit a commercial use not listed in the zoning code if this use "is similar to and not more objec- tion[able] than other uses listed." HERMOSA BEACF{ MUN. CODE § 17.26.040. [n May 2007, Anderson filed a request with the City's community development director seeking such a find- ing of "similar use" so that he could open a tattoo parlor. By a letter dated June 2l, 2007, the request was denied, and therefore Anderson was prohibited from opening a tattoo par- lor in the City. On September 12, 2007, Anderson filed the instant action (similar to the first) in the Central District of California. Anderson and the City filed cross-motions for summary judg- ment on September 22, 2008. On October 27, 2008, the dis- trict court issued a written decision granting the City's motion for summary judgment and denying Anderson's motion. The court "conclude[d] that the act of tattooing is not protected expression under the First Amendment because, although it is non-verbal conduct expressive of an idea, it is not `suffi- ciently imbued with the elements of communication' " to receive First Amendment protection under the Supreme Court's decision in Spence v. f~ashington, 418 U.S. 405, 409 (1974) (per curiam). The court reasoned that "the customer has ultimate control over which design she wants tattooed on her skin" and, therefore, "the tattoo artist does not convey an idea or message discernible to an identifiable audience." Hav- ing determined that the act of tattooing is not protected under the First Amendment, the court applied rational basis review to the City's ordinance and held that, "[g]iven the health risks ANDERSON V. HER'v10SA BEACEi 13749 inherent in operating tattoo parlors, ...the City has a rational basis for prohibiting tattoo parlors." Anderson timely appealed.2 II. FIRST AMENDMENT FRAMEWORK [ 1 ] The First Amendment, applied to the states through the Fourteenth Amendment, prohibits laws "abridging the free- dom of speech." U.S. CONST. amend. I. The First Amendment clearly includes pure speech, but not everything that commu- nicates an idea counts as "speech" for First Amendment pur- poses. The Supreme Court has consistently rejected "the view that an apparently limitless variety of conduct can be labeled `speech' whenever the person engaging in the conduct intends thereby to express an idea." United States v. O'Brien, 391 U.S. 367, 376 (1968) (analyzing a prosecution for the sym- bolic burning of a draft card to protest the draft); see also Cohen v. California, 403 U.S. l5, l8 (1971) (noting the important distinction between "a conviction resting solely upon `speech' "and one based "upon ...separately identifi- able conduct which allegedly was intended . . . to be per- ceived by others as expressive of particular views but which, on its face, does not necessarily convey any message"). [2[ Thus, although pure speech is entitled to First Amend- ment protection unless it falls within one of the "categories of speech ...fully outside the protection of the First Amend- ment," United States v. Stevens, l30 S. Ct. 1577, 1586 (2010); see also Chaplinsky v. New Hampshire, 315 U.S. 568, 571-72 (1942), conduct intending to express an idea is constitution- ally protected only if it is "sufficiently imbued with elements of communication to fall within the scope of the First and Fourteenth Amendments," which means that "[a]n intent to ="We review do novo a grant of summary judgment and must determine whether, viewing the evidence in the light most favorable to the nonmov- ing parry, there are any genuine issues of material fact and whether the district court correctly applied the relevant substantive law." Lopez v. Smhh, 203 F.3d 1122, 1 l31 (9th Cir. 2000) (en bane). 13750 ANDERSON V. HER~tOSA BEACH convey a particularized message [is] present, and ...the like- lihood [is] great that the message w[ill] be understood by those who view[ ] it," Spence, 418 U.S. at 409-1 1. And even where conduct expressive of an idea is protected by the First Amendment, "[t]he government generally has a freer hand in restricting expressive conduct than it has in restricting the written or spoken word." Texas v. Johnson, 491 U.S. 397, 406 (1989). Restrictions on protected expressive conduct are ana- lyzed under the four-part test announced in O'Brien, a less stringent test than those established for regulations of pure speech.' ~3~ Accordingly, our analysis proceeds as follows. Our first task is to determine whether tattooing is (1) purely expressive activity or (2) conduct that merely contains an expressive component. In other words, we must determine whether tattooing is more akin to writing (an example of purely expressive activity) or burning a draft card (an exam- ple of conduct that can be used to express an idea but does not necessarily do so). See D'Brien, 391 U.S. at 370, 376; Coheir, 403 U.S. at 18. If tattooing is purely expressive activity, then it is entitled to full First Amendment protection and the City's regulation is constitutional only if it is a reasonable "time, place, or manner" restriction on protected speech. Ward v. Rock Against Racism, 491 U.S. 781, 791 (1989).` [f, on the ~In O'Brien, the Court held that a regulation of protected expressive conduct is constitutional: [1] if it is within the constitutional power of the Government [2] if it furthers an important or substantial governmental interest; [3] if the governmental interest is unrelated to the suppression of free expression; and [4] if the incidental restriction on alleged First Amendment tieedoms is no greater than is essential to the fur- therance of that interest. 391 li.S. at 377. `Anderson does not contend that the City's regulation is a content-based restriction on speech. And with good reason, as the City bans all tattoo parlors, not just those that convey a particular kind of message or subject matter. Thus, we do not subject the regulation to strict scrutiny. At,'DERSON V. HER~IOSA BEACH 13751 other hand, tattooing is merely conduct with an expressive component, then it is entitled to constitutional protection only if it is "sufficiently imbued with elements of communication to fall within the scope of the First and Fourteenth Amend- ments." Spence, 418 U.S. at 409. If so, then the constitutional- ity of the ordinance is governed by the O'Brien test. if tattooing is conduct that is not "sufficiently imbued with ele- ments of communication," id, then we must determine only whether the City's zoning regulation is rationally related to a legitimate governmental interest, see Sc{rad v. Borough of Mount Ephraim, 452 U.S. 61, 68 (1981). With this complex legal framework in mind, we turn to Hermosa Beach Municipal Code § 17.06.070. I[I. ANALYSIS We hold that Ilermosa Beach Municipal Code § 17.06.070 is facially unconstitutional to the extent that it excludes tattoo parlors. First, we hold that tattooing is purely expressive activity rather than conduct expressive of an idea, and is thus entitled to full First Amendment protection without any need to resort to Spence's "sufficiently imbued" test. Second, we hold that the City's total ban on tattooing is not a constitu- tional restriction on protected expression because it is not a reasonable "time, place, or manner" restriction. A. Tattooing as First Amendment Expression The district court assumed that the process of tattooing is at most "non-verbal conduct expressive of an idea" rather than speech itself. This determination is consistent with cases from other courts that have emphasized the distinction between the product and the process of tattooing and have held that the physical process of tattooing is conduct subject to Spence's "sufficiently imbued" test. See, e.g., Hold Fast Tattoo, 580 F. Supp. 2d at 660 (analyzing tattooing under Spence's framework based on the premise that "[t]he act of 13752 ANDERSON V. HERMOSA BEACH tattooing is one step removed from the actual expressive con- duct"); Yurkew, 495 F. Supp. at 1253-54 (regardless of "whether ...the image conveyed by the tattoo[ ] is an art form or amounts to art," "the process of tattooing is undeni- ably conduct" that is subject to the Spence test). These courts then held that tattooing fails the Spence test. See, e.g., Ho/d Fast Tattoo, 580 F. Supp. 2d at 660 (holding that "[t]he act of tattooing ...itself is not intended to convey a particular- ized message"); Yurkew, 495 F. Supp. at 1253-54 (holding that "the actual process of tattooing is not sufficiently com- municative" to come within the First Amendment, because "there has been no showing that the normal observer . . would regard the process of injecting dye into a person's skin through the use of needles as communicative"); White, 560 S.E.2d at 423 ("Unlike burning [a] flag, the process of inject- ing dye to create [a] tattoo is not sufficiently communicative to warrant [First Amendment] protection[ ]."). Similarly, the City argues that "[t]he process of injecting dye into a person's skin through the use of needles," in contrast with "any mes- sage conveyed by the tattoo image, is non-expressive conduct that must, in order to acquire First Amendment protection [under Spence], carry with it an intent to convey a message that will be understood by those who viewed it." For the reasons set forth below, we disagree with the basic premise underlying the conclusions of both the City and the lower courts that have considered this issue. The tattoo itself, the process of tattooing, and even the business of tattooing are not expressive conduct but purely expressive activity fully protected by the First Amendment. 1. The Tattoo (4] There appears to be little dispute that the tattoo itself is pure First Amendment "speech." The Supreme Court has con- sistently held that "the Constitution looks beyond written or spoken words as mediums of expression." Hurlev v. Irish- American Gay, Lesbian and Bisexual Group of Boslon, 515 ANDERSON V. HERMOSA BEACH 13753 U.S. 557, 569 (1995). Accordingly, the Supreme Court and our court have recognized various forms of entertainment and visual expression as purely expressive activities, including music without words, Ward, 491 U.S. at 790; dance, Schad, 452 U.S. at 65-66; topless dancing, Doran v. Salem Inn, Inc., 422 U.S. 922, 932-934 (1975); movies, Joseph Burstyn, lnc. v. Wilson, 343 U.S. 495, 501-02 (1952); parades with or with- out banners or written messages, Hurley, 515 U.S. at 568; and both paintings and their sale, White v. City of ~ Sparks, 500 F.3d 953, 956 (9th Cir. 2007). We have afforded these expres- sive activities full constitutional protection without relying on the Spence test. See Hrirlev, 515 U.S. at 569 ("[A] narrow, succinctly articulable message is not a condition of constitu- tional protection, which if confined to expressions conveying a 'particularized message,' would never reach the unquestion- ably shielded painting of Jackson Pollack, music of Arnold Schoenberg, or Jabberwocky verse of Lewis Carroll." (cita- tion omitted) (quoting Spence, 418 U.S. at 411)). WSJ Tattoos are generally composed of words, realistic or abstract images, symbols, or a combination of these, all of which are forms of pure expression that are entitled to full First Amendment protection. Tattoos can express a countless variety of messages and serve a wide variety of functions, "in- cluding: decorative; religious; magical; punitive; and as an indication of identity, status, occupation, or ownership." Mark Gustafson, The Tattoo in the Later Roman Empire and Beyond, in WRITTEN ON THE BODY: TILE TATTOO IN EUROPEAN AND AMERICAN HISTORY 17 (lane Caplan ed., Reaktion Books 2000); see also Alan Govenar, The Variable Context ojChi- Cano Tattooing, in MARKS OF CIVILIZATION 209 (Arnold Rubin ed., Regents of the University of California 1988) (discussing the religious, social, and political purposes of tattooing); Clin- ton R. Sanders, Drill and Frill: Clieirt C{mice, Client Typolo- gies, and Interactional Control in Commercial Tattooing Settings, !n MARKS OF CIVILIZATION, sr~pra, at 222-23 (discuss- ing the "wide variety of reasons" people choose to get a tat- too, including symbolization of an interpersonal relationship, 13754 ANDERSON V. HERMOSA BEACH participation in a group, representation of key interests and activities, self-identification, and making a decorative or aes- thetic statement). We do not profess to understand the work of tattoo artists to the same degree as we know the finely wrought sketches of Leonardo da Vinci or Albrecht Durer, but we can take judicial notice of the skill, artistry, and care that modem tattooists have demonstrated. (6( The principal difference between a tattoo and, for example, apen-and-ink drawing, is that a tattoo is engrafted onto a person's skin rather than drawn on paper. This distinc- tion has no significance in terms of the constitutional protec- tion afforded the tattoo; a form of speech does not lose First Amendment protection based on the kind of surface it is applied to. It is true that the nature of the surface to which a tattoo is applied and the procedure by which the tattoo is cre- ated implicate important health and safety concerns that may not be present in other visual arts, but this consideration is rel- evant to the governmental interest potentially just~ing a restriction on protected speech, not to whether the speech is constitutionally protected. We have little difficulty recogniz- ing that a tattoo is a form of pure expression entitled to full constitutional protection. 2. The Tattooing Process Our next task is to determine whether the process of tattoo- ing is purely expressive activity. We hold that it is. Spence's "sufficiently imbued" test has been reserved for processes that do not produce pure expression but rather produce symbolic conduct that, "on its face, does not necessarily convey a mes- sage." Cohen, 403 U.S. at 18. Burning a flag, see Johnson, 491 U.S. at 411, burning a draft card, see O'Brien, 391 U.S. at 370, and wearing a black armband, see Tinker v. Des Moines Indep. Cmty. Sch. Dist., 393 U.S. 503, 505-06 (1969), can be done for reasons having nothing to do with any expres- sion, and so require an interpretive step to determine the expressive elements of these processes. ANDERSON V. HER~tOSA BEACH I37SS [7J However, neither the Supreme Court nor our court has ever drawn a distinction between the process of creating a form of pure speech (such as writing or painting) and the product of these processes (the essay or the artwork) in terms of the First Amendment protection afforded. Although writing and painting can be reduced to their constituent acts, and thus described as conduct, we have not attempted to disconnect the end product from the act of creation. Thus, we have not drawn a hard line between the essays John Peter Zenger published and the act of setting the type. Cf. Minneapolis Star & Tri- bune Co. v. Minn. Comm'r of Revenue, 460 U.S. $7$, $82 (1983) (holding that a tax on ink and paper "burdens rights protected by the First Amendment"). The process of expres- sion through a medium has never been thought so distinct from the expression itself that we could disaggregate Picasso from his brushes and canvas, or that we could value Beetho- ven without the benefit of strings and woodwinds. In other words, we have never seriously questioned that the processes of writing words down on paper, painting a picture, and play- ing an instrument are purely expressive activities entitled to full First Amendment protection. (S~ Tattooing is a process like writing words down or drawing a picture except that it is performed on a person's skin. As with putting a pen to paper, the process of tattooing is not intended to "symbolize" anything. Rather, the entire purpose of tattooing is to produce the tattoo, and the tattoo cannot be created without the tattooing process any more than the Declaration of Independence could have been created without a goose quill, foolscap, and ink. Thus, as with writing or painting, the tattooing process is inextricably intertwined with the purely expressive product (the tattoo), and is itself entitled to full First Amendment protection. We are further persuaded by the fact that the process of tat- tooing is more akin to traditional modes of expression (like writing) than the process involved in producing a parade, which the Supreme Court has held cannot be meaningfully 13756 ANDERSON V. HERMOSA BEACH separated from the parade's expressive product in terms of the constitutional protection afforded. See Kt~rley, 515 U.S. at 568 (holding that "[p]arades are ... a form of expression, not just motion," and noting "the inherent expressiveness of marching"). Thus, we have no difficulty holding that the tat- tooing process is entitled to the same First Amendment pro- tection as the process of parading. Moreover, it makes no difference whether or not, as the dis- trict court determined, "the customer has [the] ultimate con- trol over which design she wants tattooed on her skin." The fact that both the tattooist and the person receiving the tattoo contribute to the creative process or that the tattooist, as Anderson put it, "provide[s] a service," does not make the tat- tooing process any less expressive activity, because there is no dispute that the tattooist applies his creative talents as well. Under the district court's logic, the First Amendment would not protect the process of writing most newspaper articles- after all, writers of such articles are usually assigned particu- lar stories by their editors, and the editors generally have the last word on what content will appear in the newspaper. Nor would the First Amendment protect painting by commission, such as Michelangelo's painting of the Sistine Chapel. As with all collaborative creative processes, both the tattooist and the person receiving the tattoo are engaged in expressive activity. 3. The Business of Tattooing ~9) Finally, the fact that the City's ban relates to tattooing businesses rather than the tattooing process itself does not ST'he City does not actually ban tattooing as such but simply does not permit tattoo parlors in its zoning regulations. In other words, so far as we can tell, the Code contains no provision that would prevent a person from performing a tattoo on a family member in his house for free. And the City's restrictions may not apply to cosmetic tattooing that may be per- formed in a doctor's office, clinic, or beauty parlor. ANDERSON V. HERMOSA BEAC}} 13757 affect whether the activity regulated is protected by the First Amendment. In City of Sparks, we held that even "an artist's sale of his original artwork constitutes speech protected under the First Amendment." 500 F.3d at 954 (emphasis added). We first emphasized the inherent expressiveness of the painting itself-in particular, that a painting "conveys [the artist's] sense of form, topic, and perspective[,] ...may express a clear social position ... [or] the artist's vision of movement and color, ... [and] holds potential to `affect public attitudes' by spumng thoughtful reflection in and discussion among its viewers." Id. at 956 (citation omitted) (quoting Joseph Burs- tyn, 343 U.S. at 501). We then rejected "the city's argument that [plaintiff's] sale of his paintings removes them from the ambit of protected expression." Id.; .see also City of Lakewood v. Plain Dealer Publ'g. Co., 486 U.S. 750, 756 n.5 (1988) ("[T]he degree of First Amendment protection is not dimin- ished merely because the [protected expression] is sold rather than given away."); Riley v. Nat'l Fed 'n of the Blind of N. C., Inc., 487 U.S. 781, 801 (1988) ("It is well settled that a speak- er's rights are not lost merely because compensation is received; a speaker is no less a speaker because he or she is paid to speak."). The Second Circuit reached a similar conclusion in Bery v. City of New York, 97 F.3d 689 (2d Cir. 1996), where the court held that the sale of visual artwork is expression fully pro- tected by the First Amendment. Id. at 695. The court rejected the city's argument that, unlike the production of art, "the sale of art is conduct" and should therefore be subject to Spence's test. Id. The court held that "[t]he sale of protected materials is also protected," id. (citing Lakewood, 486 U.S. at 756 n.5), reasoning that "without the money, the plaintiffs would not have engaged in the protected expressive activity," id. at 696. [10~ City of Sparks and Bery stand for the proposition that because the sale of a painting is intertwined with the process of producing the painting, the sale is entitled to full constitu- tional protection without any need to resort to the Spence test. 13758 ANDERSON V. HGRMOSA BEACH The same logic applies to the business of tattooing. Thus, we conclude that the business of tattooing qualifies as purely expressive activity rather than conduct with an expressive component, and is therefore entitled to full constitutional pro- tection without any need to subject it to Spence's "sufficiently imbued" test. The business is subject to reasonable time, place, or manner restrictions (as explained in the next sec- tion), but the fact that the tattoo is for sale does not deprive it of its First Amendment protection. B. The Citv's Ban as a Time, Place, or Manner Restriction Having determined that tattooing is protected by the First Amendment, our next inquiry is whether the City's total ban on tattooing is a constitutional restriction on free expression. A regulation that restricts protected expression based on the content of the speech is constitutional only if it withstands strict scrutiny, see United States v. Plavbov Entm 't Group, Inc., 529 U.S. 803, 813 (2000), meaning that it "is necessary to serve a compelling state interest and that it is narrowly drawn to achieve that end," Perry Educ. Ass 'n v. Perry Local Educators' Ass'~r, 460 U.S. 37, 45 (1983). However, Ander- son does not contend that Hermosa Beach Municipal Code § 17.06.070 is a content-based restriction on speech. See .supra n.4. Rather, he argues that the City's regulation is an unconstitutional restriction on a means of expression. Accordingly, we must determine not whether the City's regulation survives strict scrutiny but whether the City's regu- lation is a reasonable "time, place, or manner" restriction on protected speech. Ward, 491 U.S. at 791 ("Our cases make clear ...that ...the government may impose reasonable restrictions on the time, place, or manner of protected speech ...."). This determination requires an inquiry into whether the restriction: (1) is `justified without reference to the con- tent of the regulated speech"; (2) is "nanowly tailored to serve a significant governmental interest"; and (3) "leave[s] ANDERSON V. HERMOSA BEACH 13759 open ample alternative channels for communication of the information." Clark v. Cmty. for Creative Non-Violence, 468 U.S. 288, 293 (1984). Before turning to this inquiry, we first emphasize that the Supreme Court "ha[s] voiced particular concern with laws that foreclose an entire medium of expression," because "the danger they pose to the freedom of speech is readily apparent -by eliminating a common means of speaking, such mea- sures can suppress too much speech." City of Ladue v. Gilleo, 512 U.S. 43, 55 (1994). A long line of Supreme Court cases indicates that such laws are almost never reasonable "time, place, or manner'' restrictions. See, e.g., id. at 54-55 (invali- dating anordinance forbidding the display of signs on private property); Schad, 452 U.S. at 75-76 (ban on all live entertain- ment); Martin v. City of Struthers, Ohio, 319 U.S. 141, 145- 49 (1943) (ban on door-to-door distribution of literature); Jamison v. Texas, 3 l8 U.S. 413, 416 (1943) (ban on distribut- ing handbills on the public streets); Lovell v. City of Grim, 303 U.S. 444, 451-52 (1938) (ban on distribution of pam- phlets within the municipality); but see Kovacs v. Cooper, 336 U.S. 77, 89 (1949) (upholding a ban on sound trucks). The interplay between the Court's often rigid statements about total bans on modes of expression and its traditional "time, place, or manner" test is not entirely clear. However, we need not determine whether the City's regulation is per se unconstitutional as a total ban of a means of expression or whether it is subject to a particularly stringent test, because we hold that it fails under even the traditional "time, place, or manner" test. We proceed now to that test. 1. Justified without Reference to Content Anderson does not dispute that the City's regulation may be "justified without reference to the content of the regulated speech," Clark, 468 U.S. at 293. The City's regulation bans all tattoo parlors, not just those conveying a particular kind of 13760 ANDERSON V. HERMOSA BEACH cnessage or subject matter, and is purportedly justified based on health and safety concems. ?. Narrowly Tailored (11J A reasonable "time, place, or manner" restriction must also be "narrowly tailored to serve a significant govern- mental interest." Id In Ward, the Supreme Court clarified the meaning of this requirement: [A] regulation of the time, place, or manner of pro- tected speech must be narrowly tailored to serve the government's legitimate, content-neutral interests but ... it need not be the least restrictive or least intrusive means of doing so. So long as the means chosen are not substantially broader [han necessary to achieve the government's interest, .. . the regulation will not be invalid simply because a court concludes that the government's interest could be adequately served by some less-speech-restrictive alternative. 491 U.S. at 798, 800 (emphasis added). Anderson does not dispute that the City has a significant interest in regulating tattooing because of the health and safety concerns implicated by this process. Rather, Anderson argues that the regulation is substantially broader than neces- sary to achieve this interest because the interest could be achieved by regulations ensuring that tattooing is performed in a sanitary manner rather than outright prohibition of tattoo- ing. The City disagrees, pointing out that Los Angeles County has only one health inspector for nearly 300 tattoo establish- ments and over 850 tattooists, and that there are no statewide regulations relating to sterilization, sanitation, and standards for tattooists. "Put simply," the City argues, "there are insuffi- cient resources to monitor the 8[5]0 tattooists operating in Los ANDERSON V. HER~tOSA BEACH 13761 Angeles County, including the many who, like Plaintiff, are self-taught and operating in backrooms and basements." (12J As other courts have found, "tattooing is a safe proce- dure if performed under appropriate sterilized conditions." Yurkew, 495 F. Supp. at 1252; .see also Centers for Disease Control and Prevention, supra. Tattooing is now permitted (subject to regulation) in all fifty states, with Oklahoma becoming the last to lift its ban as of November 1, 2006. Janice Francis-Smith, OK Governor Henry Signs Tattoo legalization into Law, OKLA. CITY J. REC. (May l 1, 2006), available at http://findarticles.com/p/articles/mi_gn4182/ is 20060511/ai_n16412421 (last visited May 30, 2010). The City has presented no evidence that tattooing in the City could not be regulated in such a way that addresses the City's legiti- mate public health concerns. Rather, it simply argues that cur- rently, there are insufficient resources in place to address these concerns. But the provision ve! non of such resources is a matter within the City's control. Without more, we cannot approve a total ban on protected First Amendment activity simply because of the government's failure to provide the resources it thinks are necessary to regulate it. ~13~ In sum, although a total ban on tattooing might be the most convenient way of addressing the City's health con- cerns, the City has given us no reason to conclude that these concerns cannot be adequately addressed through regulation of tattooing rather than a total ban on tattoo parlors. Thus, particularly in light of the Supreme Court's historical "con- cern with laws that foreclose an entire medium of expres- sion," City of Ladue, 512 U.S. at 55, we have little difficulty concluding that the City's ban is "substantially broader than necessary to achieve the [City's] interest," Ward, 491 U.S. at 800. 3. Alternative Channels J14J Even if the City's regulation were narrowly tailored to serve its health and safety interests, a reasonable "time, place, 13762 ANDERSON V. HER4IOSA BEACH or manner" restriction on protected speech must also "leave open ample alternative channels for communication of the information." Clark, 468 U.S. at 293. The City argues that, although its regulation restricts tattooists' ability to apply images to human skin via the injection of ink, there are alter- native means available for applying the exact same words, images, and symbols to skin, such as airbrushing or the use of natural henna paste to create temporary tattoos. The City also points out that the tattooist could render his designs "on a traditional canvas or other media," such as a T-shirt. In other words, the City believes that "[t]here is nothing inher- ently or distinctly expressive about rendering ...designs on the skin" using the ink-injection method. We disagree. [n City ojLadue, the defendant city made an argument similar to the one the City makes here. The City argued that its ban on signs on private property was "a mere regulation of the time, place, or manner of speech because residents remain free to convey their desired messages by other means, such as hand-held signs, letters, handbills, flyers, telephone calls, newspaper advertisements, bumper stickers, speeches, and neighborhood or community meetings." 512 U.S. at 56 (quotation marks and emphasis omitted). The Supreme Court was not persuaded that adequate substitutes exist for the important medium of speech that Ladue has closed off.... Displaying a sign from one's own residence often carries a message quite distinct from placing the same sign someplace else, or conveying the same text or picture by other means. Precisely because of their location, such signs provide information about the identity of the `speaker[,]' [which] is an important component of many attempts to persuade. /c1. (emphasis added). The Court held the ordinance unconsti- tutional because the city had "completely foreclosed a venera- ANDERSON V. HER~IOSA BEACH 13763 ble means of communication that is both unique and important." Id. at 54. [15) As in City of'Ladue, the Ciry of Hermosa Beach has "completely foreclosed a venerable means of communication that is both unique and important." /d. at 54. Like music, tat- tooing is "one of the oldest forms of human expression," bVard, 491 U.S. at 790, as well as one of the world's most uni- versally practiced forms of artwork. See Jane Caplan, Intro- dUCtion, In WRITTEN ON THE BODY, Supra, at X1 ("Physical evidence for the practice [of tattooing] survives from the late fourth millennium BC in Europe and from about 2000 BC in Egypt, and tattooing can be found in virtually all parts of the world at some time."). And it has increased in prevalence and sophistication in recent years. See Juliet Fleming, The Renais- sance Tattoo, in WRITTEN ON THE BODY, supra, at 61 ("[F]or the last quarter-century the West has been enjoying a `tattoo renaissance'; a movement characterized by refinements of conception ... ; by technical developments ... ;and by the refinement of procedure and equipment ...."); Susan Ben- son, /nscriptiorr.s of the Self Reflections on Tattooing and Piercing in Contemporary Euro-America, In WRITTEN ON THE BODY, supra, at 240 (discussing how the "tattoo community" has "bec[o]me more visible and more organized," and noting that "over the past 30 years the number of tattoo establish- ments has grown rapidly in absolute terms, both in Europe and America"). According to a 2006 survey by the Pew Research Center, 36 percent of people from ages 18-25, 40 percent of people from ages 26-40, and 10 percent of people from ages 41-64, had or once had at least one tattoo. The Pew Research Center for the People & the Press, Ho-v Young Peo- ple view Their Lives, Futures and Politics: A Portrait of "Generation Next " 21 (Jan. 9, 2007), available at http://people-press.org/reports/pdf/300.pdf (last visited May 30, 2010). Most importantly, a permanent tattoo "often carries a mes- sage quite distinct" from displaying the same words or picture 13764 ANDERSON V. HERMOSA BEACH through some other medium, and "provide[s] information about the identity of the `speaker.' "City of Ladue, 512 U.S. at 56. A tattoo suggests that the bearer of the tattoo is highly committed to the message he is displaying: by permanently engrafting a phrase or image onto his skin, the bearer of the tattoo suggests that the phrase or image is so important to him that he has chosen to display the phrase or image every day for the remainder of his life. The relative permanence of the tattoo can also make a statement of "autonomy and self- fashioning"-"of ownership over the flesh" and a "defen[se ofJ the embodied self against external impositions." Benson, supra, at 251-52 (quotation marks omitted); see also id. at 251 ("[T]he permanence of the tattoo establishes ... an instantia- tion of the will in defiance of process and time: `you can never get it off.' "); rd. at 250-251 (discussing how "the idea of the permanence of the tattoo is critical" in that it is linked "to ideas of the body as property and possession ...indeed as the only possession of the self in a world characterized by accelerating commodification and unpredictability"). Finally, the pain involved in producing a permanent tattoo is signifi- cant to its bearer as well: "Pain, like the tattoo itself, is some- thing that cannot be appropriated; it is yours alone; it stands outside the system of signification and exchange that threat- ens the autonomy of the self." Id. at 251. These elements are not present-or, at least, not nearly to the same degree-in the case of a temporary tattoo, a traditional canvas, or a T- shirt. Thus, we disagree with the City that "[t]here is nothing inherently or distinctly expressive about rendering ...designs on the skin" using the ink-injection method. The City analogizes this case to Kovacs, the only case in which the Supreme Court has upheld a total ban on a medium of communication. In Kovacs, the Court upheld a Trenton, New Jersey, ordinance banning sound trucks-vehicles with attached sound amplifiers-on public streets. 336 U.S. at 89. The Court emphasized Trenton's interest in preventing "dis- tractions ...dangerous to traffic" and preserving "the quiet and tranquility" of the residential areas. /d at 87. The Court ANDERSON V. HER~tOSA BEACH 13765 also reasoned that the fact "[t]hat more people may be more easily and cheaply reached by sound trucks ... is not enough to call forth constitutional protection." Id. at 88-89. The City argues that tattooing is just like a sound truck-it might be a more effective means to disseminate a message to the public, but the same message may be transmitted by other means. Cf. Hold Fast Tattoo, 580 F. Supp. 2d at 660 ("The act of tattoo- ing is one step removed from actual expressive conduct, which is similar to a sound truck, which enables each cus- tomer to express a particularized message, but the sound truck vehicle itself is not expressive."). The analogy to sound trucks is flawed. As discussed above, a tattoo is not merely a "more effective" means of communi- cating amessage; rather, the tattoo "often carves a message quite distinct" from other media. City of Ladue, 512 U.S. at 56 (emphasis added). In light of the long line of cases in which the Supreme Court has invalidated total bans on a medium of communication, it cannot be true that any medium of communication may be banned based on the reasoning that it is merely a "more effective" means of communicating a message; by this logic, after all, a canvas could be considered merely a "more effective" means of displaying a painting than lined paper. Seeming to recognize that its reasoning was in some tension with its earlier cases, the Kovacs Court explained that its judgment also rested on the fact that no one within range of the sound truck could avoid the broadcast: While this Court ...has invalidated an ordinance forbidding a distributor of pamphlets or handbills from summoning householders to their doors to receive the distributor's writings, this was on the ground that the home owner could protect himself from such intrusion by an appropriate sign that he is unwilling to be disturbed.... The unwilling listener is not like the passer-by who may be offered a pam- phlet in the street but cannot be made to take it. In his home or on the street he is practically helpless to 13766 ANDERSON V. HER~tOSA BEACH escape this interference with his privacy by loud speakers except through the protection of the munic- ipality. Kovacs, 336 U.S. at 86-87 (quotation marks and footnote omitted) (citing Martin, 3l9 U.S. at 143, 148). (16] [n this sense, the case at hand is easily distinguishable from Kovacs and indistinguishable from the Court's other cases involving total bans on modes of expression. A tattoo does not force "unwilling listener[s]" to heed its message any more than the expletive-laden jacket at issue in Cohen. A tat- too is displayed passively on the person's body, such that a member of the general public can simply avert his eyes if he does not wish to view the tattoo (assuming the tattoo is visible to the public at all). In other words, a tattoo effects no addi- tional intrusion of privacy on members of the public beyond other types of expression clearly protected by the First Amendment. Thus, the City's tattoo regulation is subject to the principle in Martin, Schad, and City ojLadue, which, read alongside Kovacs, indicate that if a unique and important mode of expression does not force unwilling listeners to heed its message in an intrusive manner, the government may not ban it regardless of the availability of alternative (and less dis- tinctive) means of communicating a similar message. IV. CONCLUSION ]17] In sum, we hold that the tattoo itself, the process of tattooing, and the business of tattooing are forms of pure expression fully protected by the First Amendment. We fur- ther hold that the City's total ban on tattoo parlors in Hermosa Beach is not a reasonable "time, place, or manner" restriction because it is substantially broader than necessary to achieve the City's significant health and safety interests and because it entirely forecloses a unique and important method of expression. Moreover, no genuine issue of material fact exists with respect to the constitutionality of the regulation. Thus, ANDERSON V. HERMOSA BEACH 13767 we hold that Hetmosa Beach Municipal Code § 17.06.070 is facially unconstitutional to the extent that it excludes tattoo parlors, and we reverse the district court's order granting sum- mary judgment in favor of the City and remand with instruc- tions to grant Anderson's motion for summary judgment and enjoin the City to include tattoo parlors in its zoning regula- tions. REVERSED. NOONAN, Circuit Judge, concurring: I concur in the holding of the court, and I agree with Judge Bybee's robust defense of the values protected by the First Amendment. I write to state that tattooing may be purely expressive, not that it always is. Any text may be expressive but is not invari- ably so. A laundry list is normally not protected by the First Amendment, but William Carlos Williams made a grocery list into a poem. Context is all. A tattoo punitively affixed is unprotected. Accepting the fact that a tattoo may qualify as protected speech, I note that creation of a tattoo may involve danger to the health of its recipient, so that tattooing requires regulation for health different from regulation, say, of a press. Tattooing as a business may also require regulation to assure that it does not attract minors. Finally, while we are bound to protect the First Amendment value at issue, we are not bound to recog- nize any special aesthetic, literary, or political value in the tat- tooist's toil and trade. ATTACHMENT C ASSEMBLY BILL NO. 300 Assembly Bill No. 300 CHAPTER 638 An act to repeal and add Chapter 7 (commencing with Section l 19300) of Part l5 of Division 104 of the Health and Safety Code, relating to body art. (Approved by Governor October 9, 201 L Filed with Secretary of State October 9, 201 I . ~ LEGISLATIVE COUNSEL'S DIGEST AB 300, Ma. Safe Body Art Act. Under existing law, every person engaged in the business of tattooing, body piercing, or permanent cosmetics is required to register with the county in which that business is conducted, obtain a copy of the county's sterilization, sanitation, and safety standards, as established by the California Conference of Local Health Officers and distributed by the State Department of Public Health, as specified, and pay aone-time registration fee of $25. Existing law allows the county to charge an additional fee, if necessary to cover the cost of registration and inspection, and allows a county to adopt regulations that do not conflict with, or are more comprehensive than, standards adopted by the department. Under existing law, a person who fails to register or who violates the sterilization, sanitation, and safety standards is liable for a civil penalty of up to $500, to be collected in an action brought by the prosecuting attorney of the county or city and county in which the violation occurred. This bill would, as of July 1, 2012, repeal these provisions and, instead, enact the Safe Body Art Act. The act would prohibit a person from performing body art, as defined, without registering annually with the local enforcement agency. The bill would require practitioners to comply with specified requirements, including, among other things, client information and questionnaires, vaccination, bloodborne pathogen training, and sanitation. The bill would also require the owner of a body art facility, as defined, to obtain and annually renew a health permit from the local enforcement agency, as specified, and to maintain the body art facility in a specified manner. This bill would exempt from the definition of body art the piercing of an car with a disposable, single-use, presterilized stud or solid needle that is applied using a mechanical device to force the needle or stud through the car, but would impose specified requirements on that practice. The bill would authorize a local enforcement agency to require facilities performing car piercing in that jurisdiction to submit a notification form, as provided, with the local enforcement agency. 93 Ch. 638 - 2 - The bill would authorize the local enforcement agency to charge a one-time facility notification fee in an amount between $25 and $45, but not in excess of the amount required to cover the actual costs of administering and enforcing the program. The bill would authorize a county, after December 31, 2015, to charge a different fee, established by local ordinance, so long as an increased fee amount is necessary to cover the actual costs of administering and enforcing the provisions. This bill would regulate the performance of body art in vehicles, temporary booths, and at body art events. The bill would require a person sponsoring a body art event to obtain a permit and fulfill specified requirements and would authorize a local enforcement agency to establish reasonable regulatory fees, including, but not limited to, a fee for body art events in an amount not to exceed, but sufficient to cover, the costs of enforcement. The bill would authorize specified inspection by an enforcement officer, and would provide for the suspension or revocation of a certificate of registration or a health permit in specified circumstances. The bill would make performing body art without being registered, operation of a body art facility without a health permit, or operation of a temporary body art event without a permit a misdemeanor and would authorize the local enforcement agency to assess an administrative penalty, in an amount not less than $25 and not more than $1,000, for violating a provision of the bill. The bill would also authorize the local enforcement agency, in addition to these penalties, to impose a penalty of up to three times the cost of the registration or permit on a practitioner, owner of a body art facility, or sponsor of a temporary body art event who fails to obtain needed permits. This bill would authorize a city, county, or city and county to adopt regulations or ordinances that do not conflict with, or are more stringent than, the provisions of the bill as those provisions relate to body art. Because this bill would place the inspection and enforcement requirements on local governments and because it creates a new crime, it would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for specified reasons. The people of the State of Culiforniu c!o enact us hllotivs: SECTION 1. Chapter 7 (commencing with Section 119300) of Part 15 of Division 104 of the Health and Safety Code is repealed. SEC. 2. Chapter 7 (commencing with Section l 19300) is added to Part l5 of Division 104 of the Health and Safety Code, to read: 93 - 3 - Ch. 638 CHAPTER ~. BODY ART Article 1. General Provisions 119300. (a) This chapter shall be known, and may be cited, as the Safe Body Art Act. (b) The purpose ofthis chapter is to provide minimum statewide standards for the regulation of persons engaged in the business of tattooing, body piercing, and the application of permanent cosmetics in California. These requirements are intended to protect both the practitioner and the client from transmission of infectious diseases through the application of proper body art procedures and the control of cross-contamination of instruments and supplies. 119301. For purposes of this chapter, the following definitions shall apply: (a) "Antiseptic solution" means a liquid or semiliquid substance that is approved by the federal Food and Drug Administration to reduce the number of microorganisms present on the skin and on mucosal surfaces. (b) "Bloodborne pathogen" means adisease-causing microorganism that, when present in the blood, can be transmitted to humans, including, but not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). (c) "Body art" means body piercing, tattooing, branding, or application of permanent cosmetics. (d) "Body art facility" means the specified building, section of a building, or vehicle in which a practitioner performs body art, including reception areas, the procedure area, and the decontamination and sterilization area. "Body art facility" does not include a facility that only pierces the car with a disposable, single-use, presterilized clasp and stud or solid needle that is applied using a mechanical device to force the needle or stud through the car. (e) "Body piercing" means the creation of an opening in a human body for the purpose of inserting jewelry or other decoration. "Body piercing" includes, but is not limited to, the piercing of an car, including the tragus, lip, tongue, nose, or eyebrow. "Body piercing" does not include the piercing of an ear, except for the tragus, with a disposable, single-use, presterilized stud and clasp or solid needle that is applied using a mechanical device to force the needle or stud through the ear. (f) "Branding" means the process in which a mark or marks are burned into human skin tissue with a hot iron or other instrument, with the intention of leaving a permanent scar. (g) "Client" means an individual upon whom a practitioner performs body art. (h) "Decontamination and sterilization area" means a room, or specific section of a room, that is set apart and used only to decontaminate and sterilize instruments. 93 Ch. 638 - 4 - (i) "Department" means the State Department of Public Health. (j) "Decontamination" means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where the pathogens are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. (k) "Disinfectant" means a product that is registered by the federal Environmental Protection Agency and the Department of Pesticide Regulation, as indicated on the label, to reduce or eliminate the presence of disease-causing microorganisms, including human immunodeficiency virus (HIV) and hepatitis B virus (HBV) for use in decontaminating work surfaces. (~ "Enforcement officer" means all local health officers, directors of environmental health, and duly authorized registered environmental health specialists and environmental health specialist trainees. (m) "Hand hygiene" means either of the following: (1) Thoroughly washing all surfaces of the hands and under the fingernails with soap and warm water. (2) In the absence of contamination with blood or other bodily fluids, or obvious soiling, applying an antiseptic solution to all the surfaces of the hands and underneath the fingernails. (n) "Instrument" means a nonmedical application device used in performing body art, including, but not limited to, needles, needle bars, needle tubes, forceps, hemostats, tweezers, razors, or razor blades. (o) "Local enforcement agency" means the local health agency of the county, city, or city and county. In jurisdictions where the local health agency and the environmental health agency are separate departments, the jurisdiction shall specify which entity will be the local enforcement agency for purposes of this chapter. (p) "Mucosal surface" means the moisture-secreting membrane lining of all body cavities or passages that communicates with the exterior, including, but not limited to, the nose, mouth, vagina, and urethra. (q) "Owner" means either of the following: (l) The person or persons whose name or names appear on the health permit, business license, property deed, or rental agreement of the body art facility. (2) A person, acting as a principal of a corporation or partnership, who employs practitioners to perform body art or other activity regulated by this chapter. (r) "Permanent cosmetics" means the application of pigments in human skin tissue for the purpose of permanently changing the color or other appearance of the skin. This includes, but is not limited to, permanent eyeliner, eyebrow, or lip color. (s) "Potable water" means water that complies with the standards for transient noncommunity water systems pursuant to the California Safe Drinking Water Act (Chapter 4 (commencing with Section 116275) of Part 12). (t) "Practitioner" means a person who performs body art on a client. 93 - 5 - Ch. 638 (u) "Procedure area" means a room, or designated portion of a room, that is set apart and only used to perform body art. (v) "Procedure site" means the area or location on the human body selected for the placement of body art. (w) "Sharps waste" has the same meaning as that term is defined in Section 117755. (x) "Sponsor" means an individual or business entity, including an event coordinator or manager, responsible for the organization of a convention, trade show, or other temporary event that includes a body art demonstration booth. A sponsor may also be a body art practitioner. (y) "Sterilization" means the complete destruction of all microbial life forms, including spores. (z) "Tattooing" means the insertion of pigment in human skin tissue by piercing with a needle. (aa) "Vehicle" means a vehicle that has been fitted or designed to perform body art. (ab) "Workstation" means the area within a procedure area where a practitioner performs body art. The workstation includes, but is not limited to, the client chair or table, counter, mayo stand, instrument tray, storage drawer, and practitioner's chair. Article 2. Restrictions on the Performance of Body Art l 19302. (a) Pursuant to Section 653 of the Penal Code, a client shall be at least 18 years of age to be offered or to receive a tattoo or permanent cosmetics application, regardless of parental consent. (b) Pursuant to Section 652 of the Penal Code, persons under 18 years of age shall not be offered or receive a body piercing unless the piercing is performed in the presence of his or her parent or guardian. (c) A client shall be at least 18 years of age to be offered or to receive a branding, regardless of parental consent. (d) The piercing or application of permanent cosmetics to the nipples or genitals of a minor is prohibited. The application of permanent cosmetics to the nipples of a minor is authorized when applied by a registered permanent cosmetic technician with the consent of the minor's parent or guardian and as directed by a physician. (c) A body art facility may refuse to perform body piercing on a minor, regardless of parental or guardian consent. l 19303. (a) Prior to the performance of body art, the client shall read, complete, and sign an informed consent form that shall include, but not be limited to, all of the following information: (1) A description of the procedure. (2) A description of what the client should expect following the procedure, including suggested care and any medical complications that may occur as a result of the procedure. (3) A statement regarding the permanent nature of body art. 93 Ch. 638 - 6 - (4) Postprocedure instructions that include all of the following: (A) Information on the care of the procedure site. (B) Restrictions on physical activities such as bathing, recreational water activities, gardening, or contact with animals, and the duration of the restrictions. (C) Signs and symptoms of infection, including, but not limited to, redness, swelling, tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent drainage from the procedure site. (D) Signs and symptoms that indicate the need to seek medical care. (b) Prior to the performance of body art, the client shall receive, complete, and sign a questionnaire that includes all of the following information: (l) Whether the client may be pregnant. (2) Whether the client has a history of herpes infection at the proposed procedure site, diabetes, allergic reactions to latex or antibiotics, hemophilia or other bleeding disorder, or cardiac valve disease. (3) Whether the client has a history of medication use or is currently using medication, including being prescribed antibiotics prior to dental or surgical procedures. (4) Other risk factors for bloodborne pathogen exposure. (c) The questionnaire and all responses shall be considered confidential information. The body art facility shall maintain the privacy of the information and shall not sell, share, or transfer the information. A body art facility shall comply with all state and federal laws with respect to the protection of a client's personally identifiable information, including, but not limited to, medical information, and shall be subject to existing penalties for violation of applicable laws. The body art facility shall shred any confidential medical information after two years from performing the body art procedure on the client. l 19304. This chapter does not restrict the activities of a physician and surgeon licensed under Chapter 5 (commencing with Section ?000) of Division 2 of the Business and Professions Code or a physician assistant licensed under Chapter 7.7 (commencing with Section 3500) of Division 2 of the Business and Professions Code. Nothing in this chapter authorizes a practitioner to perform activities that are restricted under Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code. Article 3. Practitioner Registration 1 19306. (a) A person shall not perform body art if he or she is not registered with the local enforcement agency. (b) As a condition of registration, the applicant shall provide all of the following: (l) Evidence of current hepatitis B vaccination, including applicable boosters, unless the practitioner can demonstrate hepatitis B immunity or 93 - 7 - Ch. 638 has complied with current federal OSHA hepatitis B vaccination declination requirements. (2) Evidence of completion of OSHA Bloodborne Pathogen Training consistent with Section l 19307 and pursuant to paragraph (2) of subdivision (g) of Section 5193 of Title 8 of the California Code of Regulations or its successor. (3) Proof that he or she is l8 years of age or older. (4) Self-certification of, knowledge of, and commitment to meet state law and relevant local regulations pertaining to body art safety. (5) For first-time registrants, documentation evidencing a minimum of six months of related experience. The local enforcement agency may require documentation that includes, but is not limited to, dates, type, and location of work, and the name and contact information of the registrant's supervisor or supervisors. (6) His or her business address and the address at which he or she will perform any activity regulated by this chapter. (7) Payment of a registration fee directly to the local enforcement agency. The local enforcement agency shall set the fee at an amount not to exceed the amount necessary but that is sufficient to cover the actual costs of administering the program. (c) A practitioner shall display, in a place readily visible to the public at the body art facility where the practitioner is performing body art, the certificate confirming registration with the local enforcement agency in the jurisdiction in which that practice is conducted. (d) A valid and current registration issued by a local enforcement agency shall be valid in any other jurisdiction for no more than five consecutive days, or 15 days total, in any one calendar year. (e) Practitioner registration shall be renewed annually by a process to be determined by the local enforcement agency. (f) A practitioner shall obtain all necessary permits to conduct business, including, but not limited to, being registered with the local enforcement agency. In addition to the penalties available pursuant to Article 6 (commencing with Section 119320), a practitioner who violates this subdivision shall be subject to suspension and a penalty not to exceed three times the cost of registration. l 19307. (a) Prior to registering with the local enforcement agency, a practitioner shall complete a Bloodborne Pathogens Exposure Control Training program that is specific to his or her practice. (b) An owner shall provide Bloodborne Pathogens Exposure Control Training pursuant to the requirements of paragraph (2) of subdivision (g) of Section 5193 of Title 8 of the California Code of Regulations, or its successor, for all employees, contractors, and volunteers who perform duties within the decontamination and sterilization area or procedure area. (c) The Bloodborne Pathogens Exposure Control Training shall meet all of the following criteria: (1) Training shall be conducted by a person or persons who are knowledgeable in exposure control and infection prevention in the body art 93 Ch. 638 - 8 - setting and who are approved by the local enforcement agency in accordance with the provisions of this section. (2) Training and training materials shall be specific to performing body art. (3) Training shall consist of not less than two hours of instruction that includes all of the following: (A) A copy and explanation of the California Occupational Safety and Health Administration Bloodborne Pathogens Standard contained in Section 5 l93 of Title 8 of the California Code of Regulations, or its successor. (B) A copy and explanation of applicable county, city, or city and county ordinances that pertain to bloodborne pathogen transmission control in body art. (C) Discussion of transmission, control, and symptoms of the diseases caused by bloodborne pathogens. (D) Discussion of tasks involved in performing body art and how those tasks may lead to exposure to bloodborne pathogens for the client or practitioner. (E) Discussion of the types and uses of personal protective equipment, such as disposable gloves, including an explanation of the limitations of the equipment. (F) Discussion of the types of tasks, proper task technique, and order of tasks before and after putting on and removing personal protective equipment, to avoid contamination. (G) Discussion of the importance of hand hygiene and a demonstration of proper hand hygiene techniques. (H) Discussion of choice, use, and storage of disinfectants and antiseptics. (I) Information on the signage required for biohazard materials and the importance of properly labeling chemicals and supplies. (J) Information on hepatitis B vaccine, including safety and accessibility. (K) Discussion of what constitutes a bloodborne pathogen exposure incident, including all of the following: (i) Examples of bloodborne pathogen exposure, how the exposure occurred, and what actions to take to prevent or minimize future exposures. (ii) Risk of infection following a bloodborne pathogen exposure incident. (iii) Procedures to be followed after an exposure incident, including medical followup. (L) Opportunities for interactive questions and answers with the instructor. (d) Each person required to complete a Bloodborne Pathogens Exposure Control Training program pursuant to this section shall annually complete a minimum of two hours of Bloodborne Pathogens Exposure Control Training update presented by a trainer eligible pursuant to paragraph (1) of subdivision (c). (c) Records of training required pursuant to this section shall be maintained for three years and shall be available for inspection upon request of the enforcement officer. 1 19308. (a) Before performing body art, the practitioner shall do all of the following: 93 - 9 - Ch. 638 (l) Wash and dry his or her hands consistent with sound hygenic practices. (2) Put on a clean apron, bib, or lap pad over clean, dry clothing. (3) Put on personal protective equipment that is appropriate for the task. (4) Don clean, previously unused, disposable examination gloves on both hands just prior to the procedure. Gloves shall be worn throughout the procedure. If gloves come into contact with an object or surface other than the client's prepared skin or material to be used for the procedure, or if a glove is torn or punctured, both gloves shall be removed, hand hygiene performed, and new, clean, previously unused, disposable examination gloves shall be donned. If gloves are removed for any reason during a procedure, hand hygiene shall be performed prior to donning new, clean, previously unused, disposable examination gloves. (5) If the skin at the procedure site is to be shaved, the skin shall be first washed with soap and water. Asingle-use, disposable razor shall be used to shave the procedure site and then discarded into a sharps container. (6) Immediately prior to performing the body art, the client's skin shall be prepared with an antiseptic solution, antimicrobial, or microbicide, according to manufacturer's instructions. The item used for application shall be discarded after use. (b) At the completion of the procedure, the practitioner shall do all of the following: (1) Answer questions regarding the procedure site. (2) Provide postprocedure instructions. (3) Place all used or discarded sharps waste in a sharps waste container. (4) Wash and disinfect reusable instruments as provided in subdivisions (d) and (e) of Section l 19309. (5) Package and sterilize reusable instruments that may have come in contact with nonintact skin or mucosal surfaces. (6) Decontaminate the workstation and procedure area. 119309. (a) The practitioner shall maintain a clean and sanitary environment. (b) All solid surfaces and objects in the procedure area and the decontamination and sterilization area that have come into contact with the client or the materials used in performing the body art, including, but not limited to, chairs, armrests, tables, countertops, and trays, shall be immediately decontaminated after each use and then disinfected by application of a disinfectant, used according to manufacturer's directions. (c) The surfaces and objects in the procedure area shall be disinfected again before use if the area has been used for any activity following its previous disinfection. (d) The practitioner shall wear disposable gloves on both hands when touching, decontaminating, or handling a surface, object, instrument, or jewelry that is soiled or that is potentially soiled with human blood. (e) An instrument or other reusable item that comes into contact with nonintact skin or mucosal surfaces shall either be single use or be washed, disinfected, packaged, and sterilized after each procedure. Sterilization shall 93 Ch. 638 -10 - be accomplished pursuant to the procedures established in Section l 19315 by steam autoclave. (f) An instrument or reusable item that does not come into contact with nonintact skin or mucosal surfaces shall be washed with a solution of soap and water, using a brush that is small enough to clean the interior surfaces, and decontaminated after each procedure. (g) A reusable item that cannot be immediately washed, disinfected, and sterilized following completion of the body art procedure shall be placed in a basin of water with or without detergent. (h) Sterile instrument packs shall be evaluated before use, and if the integrity of a pack is compromised in any way, including, but not limited to, being torn, punctured, wet, or having evidence of potential moisture contamination, the instrument pack shall be discarded or reprocessed before use. (i) No food, drink, tobacco product, or personal effects are permitted in the procedure area. The practitioner shall not eat, drink, or smoke while performing a procedure. If a client requests to cat, drink, or smoke, the procedure shall be stopped and the procedure site shall be protected from possible contamination while the client leaves the procedure area to cat, drink, or smoke. (j) Branding shall not be done with another client in the procedure area. During the procedure, the practitioner and the client shall wear appropriate protective face filter masks. 119310. (a) Jewelry placed in newly pierced skin shall be sterilized prior to piercing as specified in Section 119315 or shall be purchased presterilized. Sterile jewelry packs shall be evaluated before use and, if the integrity of a pack is compromised, including, but not limited to, being torn, wet, or punctured, the pack shall be discarded or reprocessed before use. (b) Only jewelry made of ASTM F138, ISO 5832-1, and AISI 316E or AIS1316LVM implant grade stainless steel, solid l4-karat through 18-karat yellow or white gold, niobium, ASTM F 136 6A4V titanium, platinum, or other materials found to be equally biocompatible shall be placed in newly pierced skin. (c) Ear piercing equipment with a disposable, single-use, presterilized stud and clasp may be used only for piercing the car pursuant to Section 1 19304. (d) If measuring the body piercing site is necessary, clean calipers shall be used and the skin marked using clean toothpicks and ink. 1193 l 1. (a) A product applied to the skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils and marking and transfer agents, including pens, shall be single use and discarded into a waste container at the end of the procedure unless the product can be disinfected for reuse. (b) Only commercially manufactured inks, dyes, and pigments shall be used. (c) Inks, pigments, soaps, and other products in multiple-use containers shall be dispensed in a manner to prevent contamination of the storage 93 - 1 l - Ch. 638 container and its remaining contents through the use of a single-use receptacle. (d) Inks and pigments shall be placed into a clean, single-use receptacle. The inks and pigments remaining in the receptacle shall be discarded immediately upon completion of the procedure. (e) If a tray is used for inks or pigments, it shall be decontaminated after each procedure. (f) Only single-use needles and needle bars shall be used in tattooing and the application of permanent cosmetics. Needles and needle bars that are purchased in a nonsterilized state, shall be sterilized, pursuant to the process required by Section 119315. (g) Needles, needle bars, grommets, and razors shall be discarded into a sharps waste container immediately upon completion of the procedure. (h) Any part of a tattooing machine that may be touched by the practitioner during the procedure shall be covered with a disposable plastic sheath that is discarded upon completion of the procedure, and the machine shall be decontaminated upon completion of the procedure. (i) A machine used to insert pigments shall be designed with removable tip parts between the tip and motor housing, and in a manner that will prevent backflow into enclosed parts of the motor housing. (j) A hand tool used to insert pigment shall be disposed of in a sharps container, with the sharps intact, unless the needle can be mechanically ejected from the hand tool. Article 4. Permanent Body Art Facilities l 19312. (a) A body art facility shall not conduct business without a valid health permit. (b) The application for a health permit for a body art facility shall include all of the following: (1) A copy of the facility's infection prevention control plan, as required by Section 119313. (2) A fee, as set by the local enforcement agency at an amount not to exceed the amount necessary but that is sufficient to cover the actual costs of administration of the program. Fees established by this section shall be used exclusively in support of activities pursuant to this chapter. (c) The local enforcement agency shall issue a health permit after an investigation has determined that the proposed body art facility and its method of operation meets the specifications of the approved plans or conforms to the requirements of this article. (d) A health permit is valid only for the location of the facility and the time period indicated on the permit and may not be transferred to another owner or facility. (e) The health permit shall be posted in a conspicuous place at the body art facility. Certificates of registration for all practitioners performing body art in that facility shall also be prominently displayed either near the health 93 Ch. 638 - 12 - permit or at the individual practitioner's procedure area if each practitioner has a designated area. (~ A person proposing to construct a practice site or mobile practice site, other than a temporary body art event booth, shall submit plans to the Plan Review Unit of the local enforcement agency. The plans shall be approved in advance of the issuance of a building, plumbing, or electrical permit. All required corrections must be made and the body art facility approved to open before body art can be performed in the facility. (g) Health permits shall be renewed annually through a process to be determined by the local enforcement agency. (h) An owner who operates a body art facility shall obtain all necessary permits to conduct business, including, but not limited to, a permit issued by a local enforcement agency. In addition to the penalties available pursuant to Article 6 (commencing with Section 119320), an owner who violates this subdivision shall be subject to the closure of the facility and a penalty not to exceed three times the cost of the permit. 119313. (a) A body art facility shall maintain and follow a written Infection Prevention and Control Plan, provided by the owner or established by the practitioners, specifying the procedures to achieve compliance with each applicable requirement of this chapter. (b) The Infection Prevention and Control Plan shall include all of the following: (1) Procedures for decontaminating and disinfecting environmental surfaces. (2) Procedures for decontaminating, packaging, sterilizing, and storing reusable instruments. (3) Procedures for protecting clean instruments and sterile instrument packs from exposure to dust and moisture during storage. (4) A set up and tear down procedure for any form of body art performed at the body art facility. (5) Techniques to prevent the contamination of instruments or the procedure site during the performance of body art. (6) Procedures for safe handling and disposal of sharps waste. (c) The Infection Prevention and Control Plan shall be revised when changes are made in infection prevention practices, procedures, or tasks. (d) Onsite training on the facility's Infection Prevention and Control Plan shall take place when tasks where occupational exposure may occur are initially assigned, any time there are changes in the procedures or tasks, and when new technology is adopted for use in the facility, but not less than once each year. (e) Records of training required pursuant to this section shall be maintained for three years and shall be available for inspection upon request of the enforcement officer. l 19314. (a) With the exception of a temporary demonstration booth and a mobile site, as specified in Sections 1 19317 and 1 19318, a body art facility shall comply with all of the following: 93 -13 - Ch. 638 (l) Have floors, walls, and ceilings that are smooth, free of open holes, and washable. (2) Be free of insect and rodent infestation. (3) Be separate from any residential areas used for sleeping, bathing, or meal preparation. A body art facility associated with a residential dwelling shall have a separate entrance and toilet facility, and shall not have a door allowing direct access between the body art facility and the residential dwelling. (b) Procedure areas in a body art facility shall meet all of the following standards: (1) Be equipped with a light source that provides adequate light at the procedure area. (2) Be separated, by a wall or ceiling-to-floor partition, from nail and hair activities. (3) Be equipped with a sink supplied with hot and cold running water, containerized liquid soap, and single-use paper towels that are dispensed from a wall-mounted, touchless dispenser that is accessible to the practitioner. (c) Decontamination and sanitation areas within a body art facility shall meet all of the following requirements: (l) Be separated from procedure areas by a space of at least five feet or by a cleanable barrier. (2) Be equipped with a sink, hot and cold running water, liquid soap in awall-mounted dispenser, and single-use paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to the practitioner. (d) Each procedure area and decontamination and sterilization area shall have lined waste containers. (e) Each procedure area and decontamination and sterilization area shall have a container for the disposal of sharps waste that meets the following requirements: (l) The sharps waste container shall be portable, if portability is necessary to ensure that the sharps waste container is within arm's reach of the practitioner. (2) The sharps waste container shall be labeled with the words "sharps waste" or with the international biohazard symbol and the word "BIOHAZARD." (3) All sharps waste produced during the process of tattooing, body piercing, or the application of permanent cosmetics shall be disposed by either of the following methods: (A) Removal and disposal by a company, or removal and transportation through amail-back system approved by the department pursuant to subdivision (b) of Section l 18245. (B) As solid waste, after being disinfected by a method approved by the department pursuant to paragraph (3) of subdivision (a) of Section 118215. (f) No animals shall be allowed in the procedure area or the decontamination and sterilization area. 93 Ch. 638 - 14 - l 19315. A body art facility shall conform to the following sterilization procedures: (a) Clean instruments to be sterilized shall first be scaled in peel-packs that contain either a sterilizer indicator or internal temperature indicator. The outside of the pack shall be labeled with the name of the instrument, the date sterilized, and the initials of the person operating the sterilizing equipment. (b) Sterilizers shall be loaded, operated, decontaminted, and maintained according to manufacturer's directions, and shall meet all of the following standards: (1) Only equipment manufactured for the sterilization of medical instruments shall be used. (2) Sterilization equipment shall be tested using a commercial biological indicator monitoring system after the initial installation, after any major repair, and at least once per month. The expiration date of the monitor shall be checked prior to each use. (3) Each sterilization load shall be monitored with mechanical indicators for time, temperature, pressure, and, at a minimum, Class V integrators. Each individual sterilization pack shall have an indicator. (4) Biological indicator monitoring test results shall be recorded in a log that shall be kept on site for two years after the date of the results. (5) A written log of each sterilization cycle shall be retained on site for two years and shall include all of the following information: (A) The date of the load. (B) A list of the contents of the load. (C) The exposure time and temperature. (D) The results of the Class V integrator. (E) For cycles where the results of the biological indicator monitoring test are positive, how the items were cleaned, and proof of a negative test before reuse. (c) Clean instruments and sterilized instrument packs shall be placed in clean, dry, labeled containers, or stored in a labeled cabinet that is protected from dust and moisture. (d) Sterilized instruments shall be stored in the intact peel-packs or in the sterilization equipment cartridge until time of use. (e) Sterile instrument packs shall be evaluated at the time of storage and before use. If the integrity of a pack is compromised, including, but not limited to, cases where the pack is tom, punctured, wet, or displaying any evidence of moisture contamination, the pack shall be discarded or reprocessed before use. (f) A body art facility that does not afford access to a decontamination and sterilization area that meets the standards of subdivision (c) of Section 1193 l4 or that does not have sterilization equipment shall use only purchased disposable, single-use, presterilized instruments. In place of the requirements for maintaining sterilization records, the following records shall be kept and maintained for a minimum of 90 days following the use of the instruments 93 -15 - Ch. 638 at the site of practice for the purpose of verifying the use of disposable, single-use, presterilized instruments: (1) A record of purchase and use of all single-use instruments. (2) A log of all procedures, including the names of the practitioner and client and the date of the procedure. 1 19316. (a) If a practitioner performs body art in a vehicle, a health permit is required if the practitioner will practice in the vehicle in the jurisdiction for more than seven days in a 90-day period. To obtain a health permit, the vehicle shall meet the requirements set forth in subdivisions (b) to (g), inclusive, of Section 1 19317. (b) If the vehicle will be operating in the jurisdiction for less than seven days in a consecutive 90-day period, the vehicle shall be treated as a temporary booth and will be subject to Section 1 19317. Article 5. Temporary Body Art Facilities l 19317. A practitioner may, in the local jurisdiction of registration, practice in a temporary demonstration booth for no more than seven days in a 90-day period. The demonstration booth shall meet all of the following requirements: (a) Be located within a building that has hand washing facilities with hot and cold running water, soap, and single-use paper towels to which practitioners have direct access. (b) Constructed with a partition of at least three feet in height separating the procedure area from the public. (c) Be free of insect or rodent infestation. (d) Used exclusively for performing body art. (e) Equipped with adequate light available at the level where the practitioner is performing body art. (f) Equipped with hand washing equipment that, at a minimum, consists of containerized liquid soap, single-use paper towels, afive-gallon or larger container of potable water accessible via spigot, and a wastewater collection and holding tank of corresponding size. Potable water shall be refilled and the holding tank evacuated at least every four procedures or every four hours, whichever occurs first. (g) Not allow animals within the confines of the demonstration booth. (h) Be operating with all necessary permits to conduct business, including, but not limited to, valid permits issued by a local enforcement agency. In addition to the penalties available pursuant to Article 6 (commencing with Section t 19320), a sponsor or practitioner who violates this subdivision shall be subject to closure of the temporary body art event and a penalty not to exceed three times the cost of the permit. 1 193 l 7.5. A local enforcement agency may establish a fee not to exceed the amount necessary, but that is sufficient to cover, the actual costs of the administration of Section 1 19317. 93 Ch. 638 - 16 - 119318. (a) The sponsor shall obtain all necessary permits to conduct business in the jurisdiction where the event will be held, including, but not limited to, valid permits issued by a local enforcement agency. A local enforcement agency may establish a tee not to exceed the amount necessary, but that is sufficient to cover, the actual costs of the administration of this section. In addition to the penalties available pursuant to Article 6 (commencing with Section 119320), a sponsor who violates this subdivision shall be subject to closure of the temporary body art event and a penalty not to exceed three times the cost of the permit. (b) The sponsor of a temporary body art event shall be responsible for ensuring the availability of support facilities and supplies for practitioners and vendors, including, but not limited to: (1) Access to a potable water supply. (2) Restrooms that have flush toilets supplied with toilet paper, and hand wash sinks supplied with hot and cold potable running water, soap, and single-use paper towels to which practitioners have direct access. (3) Sharps waste containers for each demonstration booth. (4) The use of a licensed medical waste disposal company for removal of all sharps waste containers used during the body art event. (5) Frequent trash pickup from demonstration booths. (6) An eye wash station. (7) A decontamination and sterilization area that is separated from a procedure area by at least five feet or by a cleanable barrier. (8) Adequate backup supplies that have been stored in compliance with subdivision (d) of Section l 19315 and that can be purchased by practitioners, including, but not limited to: (A) Presterilized tattoo needles. (B) Presterilized needle tubes. (C) Presterilized piercing instruments, including, but not limited to, needles, receiving tubes, corks, marking tools, and forceps. (D) Plastic bags, barrier film, clip cord covers, and plastic wrap. (E) Ink cups. (F) Nitrile and latex gloves. (G) Single-use tubes of water-based and petroleum-based lubricants. (H) Absorbent dressing materials. (c) The name, telephone number, and directions to an emergency room near the temporary body art event shall be posted in a conspicuous location. (d) Each practitioner working in a booth at a temporary body art event shall display his or her certificate of registration, or keep the certificate in a folder that is available for inspection upon request of the enforcement officer or a client. 93 - 17 - Ch. 638 Article 6. Enforcement l 19319. (a) An enforcement officer may enter a body art facility during the facility's hours of operation and other reasonable times to do any of the following: (1) Conduct inspections, issue citations, and secure samples, photographs, or other evidence from a body art facility, or any facility suspected of being a body art facility. (2) Check the Infection Prevention and Control Plan, required pursuant to Section 119313, to determine if persons working in the facility are following the plan, and to determine if the plan is in compliance with this chapter. (3) Secure as evidence documents, or copies of documents, including the Infection Prevention and Control Plan, or any record, file, paper, process, invoice, or receipt for the purpose of determining compliance with this chapter. (b) A written report shall be made and a copy shall be supplied or mailed to the owner or practitioner at the completion of an inspection or investigation. (c) Based upon inspection findings or other evidence, an enforcement officer may impound instruments that are found to be unsafe to use. Within 30 days, the local enforcement agency that has impounded the equipment shall commence proceedings to release the instrument or to seek administrative or legal remedy for its disposal. (d) It is a violation of this chapter for the owner or a person working in a body art facility to do any of the following: (1) Conceal records or evidence, or to withhold evidence. (2) Interfere with the performance of the duties of an enforcement officer. (3) Make a false statement, representation, certification, record, report, or otherwise falsify information required to be submitted or maintained pursuant to this chapter. 119320. (a) A certificate of registration or a health permit may be suspended by a local enforcement agency for a violation of this chapter. (b) A body art facility or practitioner whose certificate of registration or health permit has been suspended shall cease doing business until the certificate or permit has been reinstated. Suspension of the registration of one practitioner in a body art facility does not affect the status of other practitioners in the facility unless the violation or violations are for conditions or equipment that affects the ability of all the practitioners in the facility to comply with the provisions of this chapter. (c) A body art facility for which the health permit has been revoked shall close and remain closed until a new health permit has been issued. (d) Whenever an enforcement officer finds that a practitioner or body art facility is not in compliance with the requirements of this chapter, the enforcement officer shall issue a notice to comply or a notice of violation to the registrant or permitholder setting forth the acts or omissions with which the registrant or permitholder is charged, and informing him or her 93 Ch. 638 - 18 - of a right to a hearing, if requested, to show cause why the registration or permit should not be suspended or revoked. (e) (1) A written request for a hearing shall be made by the registrant or permitholder within 15 calendar days after receipt of the notice. (2) The hearing shall be held within l5 calendar days of the receipt of a request for a hearing. Upon written request of the registrant or permitholder, the hearing officer may postpone a hearing date, if circumstances warrant the action. (f) A failure to request a hearing within 15 calendar days after receipt of the notice shall be deemed a waiver of the right to a hearing. (g) The hearing officer shall issue a written notice of decision to the registrant or permitholder within five working days following the hearing. In the event of a suspension or revocation, the notice shall specify the acts or omissions with which the registrant or permitholder is charged, and shall state the terms of the suspension or that the registration or health permit has been revoked. (h) A certificate of registration or health permit may be reinstated or a new certificate of registration or health permit issued if the local enforcement agency determines that the conditions that prompted the suspension or revocation no longer exist. 119321. !fan imminent health hazard is found, the enforcement officer may suspend a registration temporarily and order the practitioner to cease operation if the hazard is not corrected. If the hazard affects the entire body art facility, then the entire facility may be closed immediately. Whenever a registration or health permit is suspended as the result of an imminent health hazard, the enforcement officer shall issue to the registrant or permitholder a notice setting forth the acts or omissions being charged, specifying the pertinent code section, and informing the registrant or pcrmitholder of the right to a hearing. 1 19322. The local enforcement agency may, after providing opportunity for a hearing, modify, suspend, or revoke a certificate of registration or a health permit for serious or repeated violations of any requirement of this chapter or for interference in the performance of the duty of the enforcement otTcer. 1 19323. Performing body art without being registered, operating a body art facility without a health permit, or operating a temporary body art event without a permit shall be a misdemeanor. The local enforcement agency may also assess an administrative penalty in an amount not less than twenty-five dollars ($25) and not more than one thousand dollars ($1,000) for violation of a provision of this chapter. All fines are to be retained by the local enforcement agency for enforcement of the provisions of this chapter. 1 19324. A city, county, or city and county may adopt regulations or ordinances that do not conflict with, or arc more stringent than, the provisions of this chapter as they relate to body art. 119324.5. The local fees imposed pursuant to this chapter shall not exceed the reasonable costs to a local government for issuing licenses and 93 - 19 - Ch. 638 permits, performing investigations, inspections, and audits, enforcing orders, and the administrative enforcement and adjudication thereof. Article 7. Mechanical Stud and Clasp Ear Piercing 119325. (a) The piercing of the ear with a mechanical stud and clasp device does not constitute body art as defined in this chapter. It is the intent of the Legislature, in enacting this article, to provide uniform and statewide requirements for the performance of ear piercing with a mechanical stud and clasp device. The piercing of an ear with a mechanical stud and clasp device shall only be subject to the requirements in this article. (b) The area within a facility where mechanical stud and clasp car piercing is conducted shall be safe and sanitary and shall not constitute a threat to the public health and safety, as reasonably determined by the local enforcement agency. (c) The mechanical stud and clasp device that is used to pierce an car pursuant to this article shall be single-use, presterilized, stud and clasp only. (d) The single-use mechanical stud and clasp device used to pierce an car pursuant to this article shall meet all of the jewelry requirements in subdivisions (a) and (b) of Section 119310. l 19326. (a) The local enforcement agency may require a facility that provides mechanical stud and clasp ear piercing services to submit a notification form, which shall be provided by the local enforcement agency in the jurisdiction in which the facility is located. If the local enforcement agency requires this notification form, the form shall include all of the following information: (1) The address of all facilities within the jurisdiction where mechanical stud and clasp car piercing will be performed. (2) A statement that the mechanical stud and clasp car piercing will be conducted in compliance with the requirements of this article. (3) The contact information for the person responsible for compliance with this article and who the local enforcement agency should contact regarding complaints from the public regarding mechanical stud and clasp ear piercing at a facility listed in paragraph (l ). (b) Information for more than one location within a single jurisdiction with the same owner or operator may be included on a single notification form. If the local enforcement agency requires notification, it shall provide a notification form that allows the owner or operator of more than one facility in the jurisdiction to provide the required notification for all of its facilities in a single form designed for that purpose. (c) No person shall be required to provide notification until and unless the local enforcement agency makes a form for this purpose available. Facilities performing mechanical stud and clasp car piercing on the date the local enforcement agency makes the form available shall have five months from that date in which to complete and submit the form. Facilities that 93 Ch. 638 - 20 - begin performing mechanical stud and clasp ear piercing after the form is made available shall be required to submit the form prior to offering services. 119327. (a) A person piercing an car with a mechanical stud and clasp piercing device shall meet the following requirements before providing mechanical stud and clasp ear piercing services: (1) Is at least l 8 years of age. (2) Received one hour of training that covers all of the following topics: (A) Proper use of the mechanical stud and clasp ear piercing device. (B) Types of bloodbome pathogens and the prevention of the transmission of bloodborne communicable diseases. (C) Proper hand hygiene. (D) The safe and sanitary use of single-use equipment, including, but not limited to, gloves, towels, and disinfectant wipes. (3) If the person will also be piercing the cartilage of the upper car, that person shall also receive training on proper techniques for this type of piercing. (b) The training requirements of subdivision (a) shall not apply to an individual who was employed to perform mechanical stud and clasp ear piercing prior to the effective date of this article. 119328. (a) A local enforcement agency may charge aone-time facility notification fee in an amount between twenty-five dollars ($25) and forty-five dollars ($45) for each facility operating pursuant to this article. The fee charged shall not exceed the amount reasonably necessary to cover the actual costs of administering and enforcing the provisions of this article. (b) After December 31, 2015, a county may charge a different fee, set by local ordinance, provided that the increased fee is necessary to cover the actual costs of administering and enforcing the provisions of this article. (c) The local enforcement agency may not charge a different fee for facilities based on what part of the ear is being pierced. SEC. 3. This act shall become operative on July 1, 2012. SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article Xlll B of the California Constitution for certain costs that may be incurred under this act because a local agency or school district has the authority to levy service charges, fees, or assessments sufficient to pay for the program or level of service mandated by this act, within the meaning of Section 17556 of the Government Code. No reimbursement is required by this act pursuant to Section 6 of Article X1I1 B of the California Constitution for those costs that may be incurred by a local agency or school district because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section l 7556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution. O 93 ATTACHMENT D CORRESPONDENCE Reekstin, Scott From: John Johnson [jahlove2000@hotmail.com] Sent: Monday, October 10, 2011 7:39 PM To: Reekstin, Scott; fleshskingrafix@gmail.com Subject: RE: Revised Draft Body Art Ordinance Hello Mr Reekstin, Below are my suggestions regarding the proposed regulations for body art in Tustin. In my personal notes I highlighted a tremendous amount of material I feel is outstanding. What's below are just some ideas I have that I hope can be useful. As vice president of the Association of Professional Piercers I'd like to say we completely support regulations that make our industry as safe as possible for everyone. It's important that regulations are clear, practical, and realistic. 4140.010 Definitions (e) The earlobe and ear rim are excluded from the definition of body piercing. I'd like to suggest that ear lobe and rim piercings are equally important as any other part of the ear and body and deserve the same amount of attention to safety. (r) I'd like to suggest a clear definition of "appropriate and approved method of testing to ensure sterilization." Leaving this definition open to interpretation may be risky. 4140.020 Exposure Control Training (d) (8) The word "sterile" is misused here. The environment of tattooing and piercing is not sterile, but aseptic. Also, the word "disinfected" is misused to describe prepared skin. Disinfection is exclusive to hard surfaces. "clean" or "prepared" skin would be more technically accurate. 4140.040 Body Art Facilities (I) "All solid surfaces and and objects in the procedure area and preparation area shall be immediately cleaned..." seems either vague or extreme. If this is to be interpreted literally, it takes us way beyond protocol for any general medical or dentist's office. In my personal studio I would be disinfecting objects and surfaces that are not potentially contaminated. My procedure area is large with 2 counter tops, 8 sets of cabinets, and 11 drawers, not including mirrors, doors, floors, knobs, and handles. Section 4140.010 Definitions (n) allows for a procedure area to be either a room or portion of a room. Practitioners and health officers may interpret this differently. I'd like to suggest a more practical standard might be "any surface where hand washing is done, counters and portable stands used during the procedure, lamps, chairs, and tables used by practitioners and clients must be immediately cleaned..." 4140.060 Cleaning, Sterilization, and Housekeeping (a) This section does not allow for practitioners using Statim sterilizers. This is a type of autoclave developed years ago for the dental industry that became very popular in the piercing industry. The manufacturer now makes a model specifically for the tattoo industry. It's intended for fast sterilization just prior to any procedure, eliminating the need for sterilizer pouches. This is becoming a standard machine in piercing studios and should be allowed in your regulations. Reusable instruments need to be contaminated and pre-sterilized so they can be handled and stored safely, then sterilized a second time just minutes before a new procedure. This is a very important advancement in sterilization for the piercing industry and many piercers won't even work in studios without them. http://statim.us/ (b) I'm not sure why water is preferred for soaking instruments. I would only expect that to increase the bacterial load. There are plenty of disinfectant and enrymatic soaking products intended for decontamination. (c) I can't speak for every ultrasonic manufacturer, but I've never known of an ultrasonic intended for removal of gross debris. I suggest that tools be scrubbed manually prior to any cycle in an ultrasonic. 4140.080 (d)(5) Be aware that a client's health and medical history is confidential information and client's have the right no to answer any related questions. 4140.110 Tattoo and Permanent Cosmetics (g) Piercing needles have been excluded from this section and not addressed in the next section "Body Piercing." 4140.120 Body Piercing (b) There is a lot of confusion in the piercing industry of what exactly "implant grade" jewelry is. For example, many piercers refer to 316LVM as implant grade stainless steel. The 316 series of steel in and of itself is not the implant standard. Implant stainless steel is actually designated as ASTM-F-138. I suggest clearly defining the materials allowed in initial piercings. You can find the requirements for APP members here, http://www.safepiercing.org/piercing/jewelry- for-initial-piercings/. Also, you can find California regulations here, http://www.dtsc.ca.gov/HazardousWaste/Jewelry/upload/jewelry-fart-sheet-052710.pdf While our state actually has regulations for implant standard materials for initial piercings, they are completely unenforced, as far as I know. I imagine less than 10% of piercing studios state wide are using qualified materials. Thanks for your time and effort. I look forward to the November 1st hearing. Sincerely, John Johnson Nlr Johnson, ~^~~~ received suggestions at the last Planning Commission meeting, which were incorporated into the draft ordinance_ I rF~~_~~~nrnend that you forward your suggestions to me now rather than wait until the November 1 public hearing, so that City staff can review your suggestions and discuss them with you in advance of the meeting. Ideally, it would be best to Hive any suggested changes to me prior to the Planning Commission meeting tomorrow. SCOTT REEKSTIN ~ SENIOR PLANNER http://www.tu.stinca.org ATTACHMENT E PLANNING COMMISSION RESOLUTION NO. 4181 RESOLUTION NO. 4181 A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF TUSTIN, CALIFORNIA, RECOMMENDING THAT THE TUSTIN CITY COUNCIL APPROVE CODE AMENDMENT 2011-06 (ORDINANCE 1407) AMENDING PART 4 OF CHAPTER 1 OF ARTICLE 4 OF THE TUSTIN CITY CODE REGULATING THE INSPECTION OF BODY ART FACILITIES BY THE ORANGE COUNTY HEALTH CARE AGENCY; AMENDING PART 4 OF CHAPTER 1 OF ARTICLE 3 ADDING DEFINITIONS PERTAINING TO BODY ART; AMENDING PART 5 OF CHAPTER 6 OF ARTICLE 3 PERTAINING TO A BODY ART PERMIT; AND AMENDING SECTION 9232b OF PART 3 OF CHAPTER 2 OF ARTICLE 9 TO PERMIT BODY ART FACILITIES. The Planning Commission of the City of Tustin hereby finds and determines as follows: A. That the proposed amendment to the Tustin City Code is necessary to: 1) enable the inspection and regulation of body art facilities within the City of Tustin by the Orange County Health Care Agency and the City of Tustin; 2) establish a body art permit for body art practitioners; and 3) permit body art facilities subject to operational requirements necessary and appropriate to protect the health and safety of body art facilities. B. That permanent cosmetics facilities are currently the only type of body art facility permitted and regulated within the City of Tustin. Other types of body art facilities include tattoo establishments and body piercing facilities. C. That tattoo establishments and body piercing facilities are not listed as permitted uses in the Tustin Zoning Code, and the Tustin City Code contains no specific provisions regulating the location, development, or operational characteristics of establishments where tattoos or body piercings are placed on individuals. D. That in a recent case, Anderson v. City of Hermosa Beach, the Ninth Circuit Court of Appeals ruled that the City of Hermosa Beach's total prohibition on the establishment and operation of tattoo parlors within the city was unconstitutional, and that cities may only impose reasonable "time, place, and manner" regulations on such activities. The Ninth Circuit held that a tattoo, the process of tattooing, and the business of tattooing are pure forms of expression fully protected by the First Amendment to the United States Constitution, and that the City of Hermosa Beach's total ban on tattoo parlors was not a reasonable "time, place, or manner" restriction. Resolution No. 4181 CA 2011-06 Page 2 The Ninth Circuit's decision calls into question the effectiveness of the Tustin City Code in regulating the act and/or business of tattooing and addressing land uses related to tattooing. E. That tattooing is an activity that, if undertaken in unsanitary conditions, can lead to the transmission of infectious diseases, including hepatitis, syphilis, tuberculosis, and HIV. Based upon the experience of other cities, it is reasonable to conclude that similar negative effects could occur in the City of Tustin as a result of the establishment or operation of tattoo establishments that do not meet minimum sterilization, sanitation, and safety standards. F. That the City has received inquiries regarding the permitting and establishment of tattoo establishments within the City. The issuance or approval of any business license, permit or other entitlement for the establishment or operation of tattoo establishments is a threat to the public health, safety, and welfare in that there currently are no specific standards or regulations in the Tustin City Code that comprehensively address the potential negative effects associated with the location and operation of such facilities. Absent reasonable time, place, and manner regulations governing tattoo establishments, such uses could be established in areas of the City where they are inconsistent and/or incompatible with the surrounding land uses and/or operated under unsanitary conditions, thereby increasing the risk of transmission of infectious diseases. G. That the proposed amendment will establish body art facilities, including body piercing, tattooing, or the application of permanent cosmetics, as a permitted use within the City of Tustin Retail Commercial (C-1), Central Commercial (C-2), Heavy Commercial (C-3), and Commercial General (CG) Zoning Districts, subject to operational requirements, and establish that all body art practitioners practicing at such facilities shall be licensed as further described herein. H. That on March 20, 2007, the Tustin City Council adopted Ordinance No. 1324 to enable the inspection and regulation of permanent cosmetics facilities within the City of Tustin by the Orange County Health Department. That on February 1, 2011, the Tustin City Council adopted Interim Urgency Ordinance No. 1392 relating to the establishment or operation of tattoo establishments. J. That on March 1, 2011, the Tustin City Council adopted Interim Urgency Ordinance No. 1396, which extended Interim Urgency Ordinance No. 1393 for an additional period of ten (10) months and fifteen (15) days. Resolution No. 4181 CA 2011-06 Page 3 K. That the proposed amendment is not subject to the California Environmental Quality Act ("CEQA") pursuant to CEQA Guidelines Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) (Title 14, of the California Code of Regulations) because it has no potential for resulting in physical change to the environment, directly or indirectly; it prevents changes in the environment by requiring the approval of body art permits for body art practitioners and imposing operational conditions on body art facilities. L. That on September 13, 2011, a public hearing was duly noticed and called by the Tustin Planning Commission on Code Amendment 2011-06 (Ordinance No. 1407). M. That the Tustin Planning Commission continued the public hearing to September 27, 2011. N. That on September 27, 2011, a public hearing was duly noticed, called and held by the Tustin Planning Commission on Code Amendment 2011-06 (Ordinance No. 1407). O. That the proposed amendments are consistent with the City of Tustin General Plan and comply with Goal 4 of the Public Safety Element to reduce the risk to the community's inhabitants from exposure to hazardous materials and wastes. The Planning Commission hereby recommends that the City Council adopt Ordinance No. 1407 approving Code Amendment 2011-06 attached hereto as Exhibit A, regarding body art facilities. PASSED AND ADOPTED at a regular meeting of the Tustin Planning Commission held on the 11th day of October, 2011. 1 J . T' MPS N Chairperson ~~ ELIZABETH A. BINSACK Planning Commission Secretary Resolution No. 4181 CA 2011-06 Page 4 STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS CITY OF TUSTIN ) I, ELIZABETH A. BINSACK, the undersigned, hereby certify that I am the Planning Commission Secretary of the Planning Commission of the City of Tustin, California; that Resolution No. 4181 was duly passed and adopted at a regular meeting of the Tustin Planning Commission, held on the 11~h day of October, 2011. ,~ ELIZABETH A. BINSACK Planning Commission Secretary J ii ORDINANCE NO. 1407 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TUSTIN, AMENDING PART 4 OF CHAPTER 1 OF ARTICLE 4 OF THE TUSTIN CITY CODE REGULATING THE INSPECTION OF BODY ART FACILITIES BY THE ORANGE COUNTY HEALTH CARE AGENCY; AMENDING PART 4 OF CHAPTER 1 OF ARTICLE 3 ADDING DEFINITIONS PERTAINING TO BODY ART; AMENDING PART 5 OF CHAPTER 6 OF ARTICLE 3 PERTAINING TO A BODY ART PERMIT; AND AMENDING SECTION 9232b OF PART 3 OF CHAPTER 2 OF ARTICLE 9 TO PERMIT BODY ART FACILITIES. The City Council of the City of Tustin hereby ordains as follows: Section 1. The City Council finds and determines as follows: A. That the proposed amendment to the Tustin City Code is necessary to: 1) enable the inspection and regulation of body art facilities within the City of Tustin by the Orange County Health Care Agency and the City of Tustin; 2) establish a body art permit for body art practitioners; and 3) permit body art facilities subject to operational requirements necessary and appropriate to protect the health and safety of body art facilities. B. That permanent cosmetics facilities are currently the only type of body art facility permitted and regulated within the City of Tustin. Other types of body art facilities include tattoo establishments and body piercing facilities. C. Tattoo establishments and body piercing facilities are not listed as permitted uses in the Tustin Zoning Code, and the Tustin City Code contains no specific provisions regulating the location, development, or operational characteristics of establishments where tattoos or body piercings are placed on individuals. D. In a recent case, Anderson v. City of Hermosa Beach, the Ninth Circuit Court of Appeals ruled that the City of Hermosa Beach's total prohibition on the establishment and operation of tattoo parlors within the city was unconstitutional, and that cities may only impose reasonable "time, place, and manner" regulations on such activities. The Ninth Circuit held that a tattoo, the process of tattooing, and the business of tattooing are pure forms of expression fully protected by the First Amendment to the United States Constitution, and that the City of Hermosa Beach's total ban on tattoo parlors was not a reasonable "time, place, or manner" restriction. The Ninth Circuit's decision calls into question the effectiveness of the Tustin City Code in regulating the act and/or business of tattooing and addressing land uses related to tattooing. 777346.3 Ordinance No. 1407 Page 2 E. Tattooing is an activity that, if undertaken in unsanitary conditions, can lead to the transmission of infectious diseases, including hepatitis, syphilis, tuberculosis, and HIV. Based upon the experience of other cities, it is reasonable to conclude that similar negative effects could occur in the City of Tustin as a result of the establishment or operation of tattoo establishments that do not meet minimum sterilization, sanitation, and safety standards. F. The City has received inquiries regarding the permitting and establishment of tattoo establishments within the City. The issuance or approval of any business license, permit or other entitlement for the establishment or operation of tattoo establishments is a threat to the public health, safety, and welfare in that there currently are no specific standards or regulations in the Tustin City Code that comprehensively address the potential negative effects associated with the location and operation of such facilities. Absent reasonable time, place, and manner regulations governing tattoo establishments, such uses could be established in areas of the City where they are inconsistent and/or incompatible with the surrounding land uses and/or operated under unsanitary conditions, thereby increasing the risk of transmission of infectious diseases. G. The City has completed a study, which is incorporated in the City Council Report dated October 4, 2011, regarding appropriate operational requirements necessary to protect the public health, safety, and welfare of the community and employees of body art facilities from impacts associated with the operation of body art establishments. H. That the proposed amendment will establish body art facilities, including body piercing, tattooing, or the application of permanent cosmetics, as a permitted use within the City of Tustin Retail Commercial (C-1), Central Commercial (C-2), Heavy Commercial (C- 3), and Commercial General (CG) Zoning Districts, subject to operational requirements established below, and establish that all body art practitioners practicing at such facilities shall be licensed as required herein-~y-t#e~it~y. That on March 20, 2007, the Tustin City Council adopted Ordinance No. 1324 to enable the inspection and regulation of permanent cosmetics facilities within the City of Tustin by the Orange County Health Department. That on February 1, 2011, the Tustin City Council adopted Interim Urgency Ordinance No. 1392 relating to the establishment or operation of tattoo establishments. K. That on March 1, 2011, the Tustin City Council adopted Interim Urgency Ordinance No. 1396, which extended Interim Urgency Ordinance No. 1393 for an additional period of ten (10) months and fifteen (15) days. 777346.3 Ordinance No. 1407 Page 3 L. That the proposed amendment is not subject to the California Environmental Quality Act ("CEQA") pursuant to CEQA Guidelines Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) (Title 14, of the California Code of Regulations) because it has no potential for resulting in physical change to the environment, directly or indirectly; it prevents changes in the environment by requiring the approval of body art permits for body art practitioners and imposing operational conditions on body art facilities. M. That on September 27, 2011, the Tustin Planning Commission held a public hearing on proposed Code Amendment 2011-006 and adopted Resolution No. 4181 recommending that the Tustin City Council approve Code Amendment 2011-006, subject to confirmation by the Planning Commission as part of the Consent Calendar on October 11, 2011 . N. That on November9stebe~18, 2011, a public hearing was duly noticed, called, and held before the City Council concerning Code Amendment 2011-006. O. That the proposed amendments are consistent with the City of Tustin General Plan and comply with Goal 4 of the Public Safety Element to reduce the risk to the community's inhabitants from exposure to hazardous materials and wastes. Section II PART 4 D Part 4 of Chapter 1 of Article 4 is hereby amended to read as follows: BODY ART FACILITIES 4140.010 DEFINITIONS 4140.020 EXPOSURE CONTROL TRAINING 4140.030 INFECTION PREVENTION AND CONTROL PLAN 4140.040 BODY ART FACILITIES 4140.050 PREEMPTION 4140.060 CLEANING, STERILIZATION, AND HOUSEKEEPING 4140.070 EQUIPMENT PURCHASED PRE-STERILIZED 4140.080 CLIENTS 4140.090 PRACTITIONER 4140.100 SKIN PREPARATION 4140.110 TATTOO AND PERMANENT COSMETIC APPLICATION 4140.120 BODY PIERCING 4140.130 SHARPS DISPOSAL 4140.140 TEMPORARY BODY ART FACILITIES 4140.150 MOBILE BODY ART FACILITIES 4140.160 ENFORCEMENT AUTHORITY 4140.170 REGISTRATION 4140.180 PERMIT AND FEE REQUIREMENTS 4140.190 PENALTIES 4140.200 PERMIT SUSPENSION OR REVOCATION 4140.210 HOURS OF OPERATION 777346.3 Ordinance No. 1407 Page 4 4140.220 4140.230 4140.010 DEFINITIONS MANAGEMENT OF OPERATIONS NUISANCE [] As used in this Chapter, unless the context otherwise requires, the following terms shall have the meanings ascribed to them respectively: (a) "Antiseptic" means a liquid or semi-liquid substance that is approved by the U.S. Food and Drug Administration, as indicated on the label, to reduce the number of microorganisms present on the skin and on mucosal surfaces. (b) "Bloodborne pathogen(s)" means disease causing microorganisms that, when present in the blood, can be transmitted to humans. These microorganisms include, but are not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). (c) "Body art" means the practice of physical body adornment including, but not limited to, the following techniques: body piercing, tattooing or application of permanent cosmetics. (d) "Body art facility" means the area within a building or other location in which a practitioner performs body piercing, tattooing or application of permanent cosmetics, including the preparation and procedure area, as defined in this Chapter. (e) "Body piercing" means the creation of an opening in the human body for the purpose of inserting jewelry or decorative objects. This includes, but is not limited to, piercing of an ear, lip, tongue, nose, belly button, cheek, forehead or eyebrow. Body piercing does not, for the purpose of this Chapter, include piercing the leading edge or earlobe of the ear with a sterile, disposable, single-use stud or solid needle that is applied using a mechanical device to force the needle or stud through the ear. (f) "Client" means any individual who receives a body piercing, tattoo or application of permanent cosmetics from a practitioner as defined in this Chapter. (g) "Disinfectant" means a product that is approved by the U.S. Environmental Protection Agency, as indicated on the label, to reduce or eliminate the presence of disease causing microorganisms. (h) "Health Officer" means the Orange County Health Officer or designee. (i) "Instrument" means any tattooing, body piercing or permanent cosmetics equipment or device that comes into contact with intact skin, non-intact skin, or mucosal surfaces. Such equipment includes, but is not limited to, needles, needle bars, needle tubes, forceps, hemostats, tweezers, razors, razor blades, or other tools and devices used to insert pigment or pierce the skin or mucosal surfaces of the human body. Such equipment also includes studs, hoops, rings or other decorative jewelry, materials or apparatuses inserted into any part of the body for the intended purpose of placement in a hole resulting from the piercing. _l n 777346.3 Ordinance No. 1407 Page 5 (j) "Permanent cosmetics" means the application of pigments inserted into or under the surface of human skin for the purpose of permanently changing the color or appearance of the skin. This includes, but is not limited to, permanent eyeliner, eye shadow, or lip color. (k) "Permanent cosmetics facility" means the area within a building in which a practitioner performs the application of permanent cosmetics, including the preparation and procedure area, as defined in this Chapter. (I) "Practitioner" means an individual who performs tattooing, body piercing, or who applies permanent cosmetics as defined in this Chapter. (m) "Preparation Area" means a room or a designated portion of a room that is used to clean and sterilize reusable instruments that are used for tattooing, body piercing, or permanent cosmetics. (n) "Procedure area" means a room or a designated portion of a room where tattooing, body piercing or the application of permanent cosmetics is performed. (o) "Proprietor' means the person having general control and management over the conduct of business at a body art facility, or the person operating such establishment, whether or not such person is the legal owner of the premises or the business. (p) "Purchased pre-sterilized equipment" means any individually packaged, single-use instruments, devices and/or needles that are obtained after processing to render them free of all microbial life forms. Each package shall have the manufacturer's processing identification number and date of expiration. (q) "Sharps waste" means any instrument or object, including but not limited to needles or razor blades, that has been used to penetrate the skin or mucosa to perform tattooing, body piercing or the application of permanent cosmetics, or otherwise contaminated by coming into contact with blood or surfaces that have not been disinfected or sterilized. (r) "Sterilization" means the complete destruction of all microbial life forms including spores. Sterilization includes the use of an appropriate and approved method of testing so as to ensure sterilization. (s) "Tattooing" means to pierce or puncture the human skin with a needle or other instrument for the purpose of the application of pigments or the inserting of pigment under the surface of the skin; the application of pigments or inks inserted into or under the skin for the purpose of producing a mark or by production of scars. 4140.020 EXPOSURE CONTROL TRAINING (a) Prior to registration as a body art practitioner with the Orange County Health Care Agency, all body art practitioners shall complete and submit proof of completion to the Health Officer se~-fy, of an Exposure Control Training Program that meets or exceeds the requirements of this Chapter. 777346.3 Ordinance No. 1407 Page 6 (b) The person conducting the training shall be knowledgeable in the subject matter covered by the elements defined in section 4140.020(d). (c) The organization providing the Exposure Control Training shall provide appropriate written training materials to each trainee. (d) The content of the Exposure Control Training Program shall include: (1) California Occupational Safety and Health Administration Bloodbome Pathogens Standard and other applicable standards and regulations with pertinent explanations. (2) The causes, control, and symptoms of the diseases caused by bloodborne pathogens. (3) The modes of transmission of bloodborne pathogens. (4) A discussion of risks involved in the application of body art and how they may lead to exposure to bloodborne pathogens for the client or body art practitioner. (5) The use of personal protective equipment such as disposable gloves and an explanation of the limitations of the equipment. (6) The importance of hand washing and a demonstration of the hand washing process as described in Section 4140.090. (7) The types, proper technique and order of tasks before and after putting on and removing gloves to avoid cross-contamination. (8) Activities that compromise a disinfected work area, a sterile procedure site, inks and pigments, sterile instruments and disinfected skin area. (9) Choosing, using and storing disinfectants and antiseptics. (10) Signs required for contaminated materials and the importance of labeling chemicals and supplies. (11) Information on Hepatitis B vaccine, including its efficacy, safety and method of administration. (12) What constitutes a bloodborne pathogen exposure incident, including: a. How the exposure occurred and what actions are to be taken to prevent or minimize future exposures. b. Risk of infection following a bloodborne pathogen exposure incident. c. Procedures to be followed after an exposure incident, including medical follow-up. d. Opportunity for interactive questions and answers with the instructor. 777346.3 Ordinance No. 1407 Page 7 4140.030 INFECTION PREVENTION AND CONTROL PLAN (a) Each proprietor shall establish, maintain and follow, at each body art facility, a written Infection Prevention and Control Plan. (b) The Infection Prevention and Control Plan shall include, at a minimum, the following: (1) Procedures for cleaning and disinfection of surfaces in the preparation and procedure areas. (2) Procedures for maintaining the sterility or integrity of instruments, equipment and other material used during tattooing, body piercing, or permanent cosmetics. (3) Procedures for cleaning, packaging, sterilizing, and storing reusable instruments, and equipment. (4) Procedures for safe handling and disposal of sharps waste. (5) Inventory (names, manufacturers, container size) of all chemicals and disinfectants and their intended use. (c) The Infection Prevention and Control Plan shall be revised by the proprietor whenever changes in practices or procedures are made, within thirty (30) days of a c_h_ange in practices or procedures. (d) The proprietor shall be responsible for ensuring that the Infection Prevention and Control Plan is followed. 4140.040 BODY ART FACILITIES (a) The health permit shall be posted in a conspicuous place in the lobby of the body art facility. (b) Body art facilities shall not be used as a food establishment, for human habitation or any other use which may cause contamination of instruments or equipment used for body art activities. (c) The floors, furnishings and equipment of body art facilities shall be kept clean and sanitary at all times during business hours. (d) Adequate lighting and ventilation shall be provided in the preparation and procedure areas. (e) Adequate toilet facilities, as required by the Tustin City Code, shall be available. Toilet rooms and bathrooms shall not be used for the storage of instruments, or other supplies used for body art activities, and shall be kept clean and sanitary at all times. (f) Rooms used for tattooing, body piercing or permanent cosmetic procedures shall be separated by a wall or partition from those areas used for nail, hair and other activities. 777346.3 Ordinance No. 1407 Page 8 (g) All sinks shall be supplied with hot (110°F minimum) and cold running water. (h) A sink that is readily accessible to the body art practitioner shalt be provided and equipped with liquid soap and single use paper towels dispensed from wall-mounted dispensers that protect the supply from contamination. (i) Pets or other animals shall not be allowed in the body art facility, except for trained guide or assistance animals for the disabled. No trained guide or assistance animal shall be allowed in the procedure or preparation area. Q) No person shall utilize or maintain in a body art facility equipment that does not comply with the requirements of this Chapter. (k) The proprietor shall maintain the body art facility and the general premises under the control of the proprietor in a clean and sanitary manner. (I) All solid surfaces and objects in the procedure area and preparation area shall be immediately cleaned and disinfected after each use with an appropriate bleach solution or other isinfectant-tk-a4 . Manufacturer's instructions for concentration, contact time, and disposal requirements for all disinfectants must be observed. (m)The practitioner shall wear disposable gloves on both hands when touching, cleaning or handling a surface or object soiled or potentially soiled with blood. Disposable gloves worn by the body art practitioner shall be promptly removed, and hands immediately washed whenever the practitioner leaves a procedure or preparation area. (n) Each procedure and preparation area shall have waste receptacles, which are lined with plastic bags manufactured for use in waste containers that fold over the top margin of the waste container. 4140.050 PREEMPTION The provisions of this Chapter are intended to supplement applicable state law and to be in addition to, and not in conflict with such laws. Each provision shall remain in effect until the enactment of state laws or the promulgation of state regulations that conflict with or otherwise preempt the authority of the County of Orange or the City of Tustin to control the conduct described in this Chapter. 4140.060 CLEANING, STERILIZATION, AND HOUSEKEEPING (a) Instruments that pierce the skin or touch non-intact skin that will be reused shall be cleaned, packaged in appropriately labeled sterilizer pouches and sterilized prior to reuse. (b) Used instruments that will be sterilized and reused shall be transported dry and then placed in a container of sleafl--water until cleaned and sterilized. Used instruments must be kept physically separated from sterilized or unused disposable instruments. Disposable instruments must be disposed of directly into a sharps container or into 777346.3 Ordinance No. 1407 Page 9 the appropriate trash receptacle after use and shall be disposed of as required herein. (c) Ultrasonic cleaners~sed; shall be available, maintained and operated according to manufacturer's instructions. mo(d) Clean instruments to be sterilized shall be first placed in sterilizer pouches that contain either a sterilizer indicator or internal temperature indicator. Each pack shall contain instruments for not more than one client. The outside of the pack shall be labeled with the name of the instrument, date sterilized and initials of the person operating the equipment. (-€3(e) Instruments must be repackaged and re-sterilized if the pouch is tom or otherwise compromised, if the indicator shows that adequate temperature was not reached or if the item is not used within 6 months of the date of sterilization. (~ f -Sterilized instruments must be maintained and stored in sterilized pouches until use. ~ (#)(g) Sterilizers shall be operated according to manufacturer's instructions. If manufacturer's instructions cannot be obtained, steam sterilization shall be accomplished in an autoclave with at least 15 pounds of pressure per square inch at a temperature of 250 degrees Fahrenheit for at least 30 minutes or as instructed by the local Health Officer should the standards for sterilization change from time to time. (+)(h) Liquid sterilants shall not be used to sterilize instruments. Vi(i) Sterilized instruments shall be placed in clean, dry, labeled containers or stored in a labeled cabinet that is protected from dust and water contamination. (~-}!i) Sterilization equipment shall meet the following requirements: (1) Only sterilizers intended for medical instruments shall be used. Sterilization equipment shall be cleaned, and maintained according to manufacturer's instructions. (2) Sterilization equipment shall be tested after the initial installation, after any major repair, and at the frequency recommended by the manufacturer. If no manufacturer's recommendation can be found, then the unit shall be tested at least weekly utilizing a biological monitoring system appropriate for the sterilizer type. (3) Biological indicator test results shall be maintained on site and available for review for a period of two years subsequent to the date of the results. (I) A written log of each sterilization cycle shall be maintained on-site and available for review for a period of two years, and shall include the following information: 777346.3 Ordinance No. 1407 Page 10 (1) Date of load. (2) The contents of the load. (3) The exposure time and temperature. (4) The results of the chemical indicator. 4140.070 EQUIPMENT PURCHASED PRE-STERILIZED (a) A practitioner using only purchased, disposable, single use and pre-sterilized instruments shall not be required to have sterilization equipment. (b) Invoices for the purchase of all pre-sterilized instruments must be maintained onsite and available for review for a period of two years after purchase. Required invoices include but are not limited to combo couplers, needle chambers, barrels, casings, tips and needles. 4140.080 CLIENTS (a) No body art procedure shall be performed on skin surface areas containing any rash, pimples, boils, or infection or otherwise manifesting any evidence of unhealthy conditions including but not limited to any evidence of inflammation, such as redness, swelling, infection, or open or draining lesions. (b) Prior to receiving a tattoo, body piercing or permanent cosmetics, the client shall read, sign and receive a copy of an informed consent form and post-procedure instructions appropriate to the procedure. (c) A copy of the signed informed consent form and post procedure instructions for all body art procedures must be maintained onsite and available for review for a period of two years after the procedure is performed. (d) The consent form and post-procedure instructions shall include at a minimum, the following: (1) Record of information from the client's picture identification showing the name, date of birth, gender, address of client, and driver's license or identification card number. (2) A summary, including the date, location and description of the procedure. (3) What to expect following the procedure, including any medical complications that may occur as a result of the procedure. (4) A statement regarding the permanent nature of body piercing, tattooing or permanent cosmetics. (5) A questionnaire regarding a client history of herpes, diabetes, allergic reactions to latex or antibiotics, hemophilia or any other bleeding disorder or the use of 777346.3 Ordinance No. 1407 Page 11 anticoagulants, which may prevent the healing of the site where the tattoo or permanent cosmetics were applied, and of cardiac valve disease or of being prescribed antibiotics prior to dental or surgical procedures. (6) Post-procedure instructions on the care of the site of the tattoo, body piercing, or permanent cosmetics. (7) Post-procedure restrictions on activities such as bathing, swimming, gardening or contact with animals. (8) Information regarding signs and symptoms of infection and to immediately consult a physician if any of the listed signs and symptoms of infection occur. 4140.090 PRACTITIONER (a) No body art operation shall be performed unless the practitioner is free of pustular skin lesions and any communicable diseases that could be transmitted in the normal practice of body art. (b) No practitioner shall eat, drink or smoke while performing a body art procedure. (c) No practitioner shall perform a body art procedure with unclean hands. For purposes of this section, hands shall not be considered clean unless they have been thoroughly washed with soap from a single service dispenser and warm water vigorously rubbing all surfaces of lathered hands for at least ten (10) seconds, followed by thorough rinsing under a stream of water. Hands shall be dried using single service towels from a sanitary dispenser or hot air blower. Practitioners shall wear new, disposable exam gloves for every client during the procedure. Gloves shall be discarded between each client, and hands shall be washed each time gloves are changed. If a glove is pierced, torn, or contaminated by coming into contact with any other person, or contaminated surface, both gloves shall be removed and discarded. A single pair of gloves shall not be used on more than one person. 4140.100 SKIN PREPARATION No body art operation shall be performed unless the skin is adequately prepared prior to the operation. For purposes of this section, skin shall be considered properly prepared if it is thoroughly cleaned with an antiseptic according to manufacturer's instructions. If necessary, the skin shall be shaved with a new, single use disposable razor. 4140.110 TATTOO AND PERMANENT COSMETICS APPLICATION (a) All inks, pigments, petroleum jellies, soaps, and other reusable products used in a procedure shall be dispensed from containers in a manner to prevent contamination of the original container and its contents. (b) Pigments shall be placed into clean single use cups or caps that shall be disposed of immediately in an appropriate waste receptacle upon completion of the procedure. (c) Only single-use rinse cups shall be used with procedures, and they shall be disposed of immediately upon completion of the procedure. 777346.3 Ordinance No. 1407 Page 12 presed~e- (a)jd) All inks, dyes or pigments used shall be commercially manufactured for the procedure and shall be used according to manufacturer's instructions. (~fe) All products applied to the skin including stencils shall be single use and disposed into a waste receptacle after the procedure. (~ f~_Needles and needle bars shall be sterilized prior to tattooing or application of permanent cosmetics or shall be purchased pre-sterilized. Needles shall be used only once and then disposed of. in a sharps container. (#}(4) If a rotary pen, or traditional coil machine that reuses components is used, then the use of sterilization equipment shall be required for sterilization of the reusable parts that make contact with the client or blood. {+}(h) All rotary pens and other devices used to apply pigments must be designed and used to prevent backflow of pigments into the machine. 4140.120 BODY PIERCING (a) All jewelry or other objects to be placed in newly pierced skin shall be sterilized, or purchased pre-sterilized, be in good condition, and be designed and manufactured for insertion into the intended body part. (b) Only jewelry or other objects made of implant grade stainless steel, solid 14K through 24K gold, niobium, titanium, platinum or other materials determined to be equally bio- compatible shall be placed in newly pierced skin. 4140.130 SHARPS DISPOSAL (a) Each procedure area shall have a container for the disposal of sharps (needles, razor blades, etc.) waste that is rigid, puncture resistant, leak proof and that is closeable and sealable so that when sealed, the container cannot be reopened without great difficulty. The container must be labeled with the words "sharps waste" or with the international biohazard symbol and the word "BIOHAZARD." (b) All sharps waste produced during the process of tattooing, body piercing and permanent cosmetics shall be disposed of by one of the following methods: (1) Steam sterilized on-site and disposed of as solid waste. If this method is utilized, a chemical indicator strip or tape that indicates that the container has been treated must be affixed prior to sterilization, and shall stay affixed to the container when it is disposed. 777346.3 Ordinance No. 1407 Page 13 (2) Treated on-site by a method approved by the Health Officer, and disposed of as solid waste. (3) Removal and disposal through use of a Registered Medical Waste Hauler in accordance with the provisions of the California Medical Waste Management Act. Tracking documents must be maintained on-site and be available for review for a period of two years from the date of removal from the body art facility. 4140.140 TEMPORARY BODY ART FACILITIES Temporary body art facilities shall be prohibited in the City of Tustin. 4140.150 MOBILE BODY ART FACILITIES Mobile body art facilities shall be prohibited in the City of Tustin. 4140.160 ENFORCEMENT AUTHORITY The Health Officer or his or her designee is charged with the enforcement of this Chapter, except for Sections 4140.210, 4140.220 and 4140.230. The City of Tustin Police Department and the City of Tustin Code Enforcement Officer are also authorized to enforce this ordinance. The Health Officer may, during the establishment's hours of operation and other reasonable times, enter, inspect, search and secure samples, photographs, or other evidence from any body art facility, or any location suspected of being a body art facility, for the purpose of enforcing this Chapter. It is a violation of this Chapter for any person to refuse to permit entry or inspection, the taking of samples or other evidence, or access to the facility in order to copy any record as authorized by this Chapter, or to conceal any samples or evidence, or withhold evidence concerning them. A written report of the inspection shall be made and a copy shall be supplied or mailed to the proprietor or practitioner of the body art facility. 4140.170 REGISTRATION (a) Every practitioner as defined in this Chapter shall register with the Health Officer See-Agens~r-and shall have on display so as to be readily visible to the public proof that shows that the practitioner has registered, as specified in Health and Safety Code Section 119303. (b) Registration of all practitioners is required every three years. 4140.180 PERMIT AND FEE REQUIREMENTS A body art facility shalt not be open for business without: (1) at least one valid body art permit issued by the Director of Community Development to a practitioner practicing body art at that location during operating hours, (2) a valid City business license, and (3) a valid County health permit. The Health Officer shall issue a health permit when inspection has determined that the proposed body art facility and its method of operation will conform to the requirements of this Chapter. A health permit, once issued, is nontransferable. Ahealth permit shall be valid only for the proprietor and location approved. The Orange County Board of Supervisors shall adopt fees for the health permit, practitioner registration, and related 777346.3 Ordinance No. 1407 Page 14 services. Fees shall be sufficient to cover the actual expenses of administering and enforcing this program. 4140.190 PENALTIES Violation of any section of this Chapter by the proprietor or practitioner shall constitute a misdemeanor and upon conviction thereof shall be punishable by a fine not to exceed one thousand dollars ($1,000.00) per day per violation or by imprisonment in the county jail for a term not exceeding six (6) months, or both such fine and imprisonment. Each day the violation continues and is not corrected shall be a treated as a separate and distinct violation. 4140.200 PERMIT SUSPENSION OR REVOCATION (a) Whenever the Health Officer finds that a body art facility is not in compliance with the requirements of this Chapter, a written inspection notice shall be issued to the proprietor. If the proprietor fails to comply within the noted timeframe, the Health Officer shall issue to the proprietor, a notice of violation setting forth the acts or omissions with which the proprietor is charged. Failure to comply with the Notice of Violation within the noted timeframe may result in health permit suspension. (b) If any immediate danger to the public health or safety is found, unless the danger is immediately corrected, the Health Officer may temporarily suspend the permit and order the body art facility immediately closed. Immediate danger means any condition, based upon inspection findings or other evidence that may cause disease transmission, including, but not limited to: (1) Unclean or unsanitary floors furnishings toilet facilities, and equipment of the body art facility; (2) Inadequate sterilization of equipment; (3) Lack of appropriate disposal receptacles and methods; (4) Sewage contamination; (5) Lack of potable water supply; (6) Or any other condition, which in the opinion of the Health Officer, causes immediate danger to public health and safety and requires temporary suspension as noted above. (c) Whenever a health permit is suspended as the result of an immediate danger to the public health or safety, the Health Officer shall issue to the proprietor a notice setting forth the acts or omissions with which the proprietor is charged. (d) Any body art facility for which the health permit has been suspended shall close and remain closed until the health permit has been reinstated. 1 777346.3 Ordinance No. 1407 Page 15 (e) Where grounds for denial, suspension, non-renewal or revocation of a health permit exist, the Orange County Sheriff, Health Officer or Code Enforcement Officer shall serve the applicant or permit holder with a notice which shall state the reasons for the proposed action, the effective date of the action, and of the right to appeal the action. (f) Appeal shall be made by filing a written notice of appeal setting out the action appealed from, the grounds of the appeal and the facts upon which the appeal is based. The notice of appeal shall be filed with the Clerk of the Board of Supervisors not more than thirty (30) days after service of the notice of proposed action. A copy of the notice appealed shall be attached to the notice of appeal. Notice of the date, time, and place of the hearing on the appeal shall be mailed at least ten (10) days prior to the date of the hearing by certified mail, return receipt requested, with proof of service attached, addressed to the address on the permit. (g) Hearing on the appeal shall be conducted by a Hearing Officer who shall preside over the hearing, take evidence on the appeal and determine whether, on the basis of a preponderance of the evidence, the appealed action shall be upheld. The Hearing Officer shall render a written decision not less than forty-five (45) days after the date of the appeal hearing. The decision of the Hearing Officer shall be final. 4140.210 HOURS OF OPERATION (a) No body art facility shall operate except between the hours of 8 a.m. and 10 p.m. Sunday through Thursday and between 8 a.m. and 12 a.m. on Friday and Saturday. (b) The hours of operation shall be posted in a conspicuous place in the lobby of the establishment and in a window or other location visible from the outside. 4140.220 MANAGEMENT OF OPERATIONS (a) Each body art facility shall have a manager on the premises during all hours of operation who shall be responsible for the operations and maintenance of the facility, for compliance with all licensing requirements and to observe and supervise the actions of all persons on the premises. (b) Each body art facility shall provide a lobby or other seating area where customers and other invitees of the business may be seated while waiting or otherwise not having body art applied. (c) No body art facility shall knowingly permit loud, boisterous, lewd, violent or threatening behavior by clients or staff while in the facility or in any parking lot or other adjacent area under the control of the body art facility. 4140.230 NUISANCE (a) No body art facility shall be operated in a manner which constitutes a nuisance. (b) Operation of a body art facility in violation of this Chapter or applicable penal or health statute of the State of California shall constitute a public nuisance. 777346.3 Ordinance No. 1407 Page 16 (c) A body art facility may be found to be a nuisance on the basis of multiple violations of this Chapter, or any penal or health statute of the State of California or of multiple complaints which have not been resolved against the proprietor. (d) Nuisance determinations and abatement shall be made and performed in the manner set forth in Sections 3-14-2 and following of the Codified Ordinances of the County of Orange. Section III. Section 3141 of Part 4 of Chapter 1 of Article 3 is hereby amended to add the following definitions: Body art. The practice of physical body adornment including, but not limited to, the following techniques: body piercing, tattooing or application of permanent cosmetics. Body art facility. The area within a building or other location in which a practitioner performs body piercing, tattooing or application of permanent cosmetics, as defined in this Chapter, including the preparation and procedure area. Body piercing. The creation of an opening in the human body for the purpose of inserting jewelry or decorative objects. This includes, but is not limited to, piercing of an ear, lip, tongue, nose, belly button, cheek, forehead or eyebrow. Body piercing does not, for the purpose of this Chapter, include piercing the leading edge or earlobe of the ear with a sterile, disposable, single-use stud or solid needle that is applied using a mechanical device to force the needle or stud through the ear. Tattooing. To pierce or puncture the human skin with a needle or other instrument for the purpose of the application of pigments or the inserting of pigment under the surface of the skin; the application of pigments or inks inserted into or under the skin for the purpose of producing a mark or by production of scars. Section IV. Part 5 of Chapter 6 of Article 3 is hereby amended to read as follows: Part 5 BODY ART 3651 PERMIT REQUIRED No person shall engage in the business of applying body art without obtaining a body art permit issued by the Director of Finance. No person shall engage in the business of applying body art except at aduly-licensed body art facility specified in the County health permit registration form and in the City body art permit as required herein. This Part does not restrict the activities of any physician or surgeon licensed under Chapter 5 (commencing with Section 2000) of Division 2 of the Health and Safety Code. 3652 PREREQUISITES TO OBTAINING PERMIT No person shall be eligible to receive a body art permit until such person has obtained a valid County health permit for a body art facility or until such person is employed by a body art facility with a valid County health permit. 777346.3 Ordinance No. 1407 Page 17 Any person who wishes to obtain a body art permit to engage in the business of applying body art shall provide proof of: (1) registration with the 6e~#y-Health Officer 9epartr~er~t, (2) payment of an annual County inspection fee, and (3) address(es) where the business is to be conducted pursuant to Health and Safety Code Section 119303. 3653 APPLICATION REQUIREMENT In addition to providing the information required on the City's application form, the applicant shall provide evidence that a complete set of fingerprints of the applicant was taken through the Livescan service. 3654 OPERATIONAL REGULATIONS Every body art facility shall be open for inspection by any officer of the City of Tustin at all times during which body art services are being provided. A permittee shall not: (1) Do business at any location not specified in the County's registration form or City permit; or (2) Violate the sterilization, sanitation, and safety standards adopted by the State Department of Health Services. Section V. Section 9232a.2. of Part 3 of Chapter 2 of Article 9 is hereby amended to sequentially reletter item numbers (d) through (s) and include body art facilities as item (d) as follows: (d) Body art facilities (as defined in section 3141, and subject to the requirements of Part 4 of Chapter 1 of Article 4) Section VI. If any section, subsection, sentence, clause, phrase, or portion of this ordinance is for any reason determined to be invalid or unconstitutional by the decision of any court of competent jurisdiction, such decision shall not affect the validity of the remaining portions of this ordinance. The City Council of the City of Tustin hereby declares that it would have adopted this ordinance and each section, subsection, sentence, clause, phrase, or portion thereof irrespective of the fact that any one or more sections, subsections, sentences, clauses, phrases, or portions be declared invalid or unconstitutional. J 777346.3 Ordinance No. 1407 Page 18 PASSED AND ADOPTED by the City Council of the City of Tustin, at a regular meeting on the 1~"'~ day of November-9stebef, 2011. JERRY AMANTE Mayor ATTEST: PAMELA STOKER City Clerk STATE OF CALIFORNIA ) COUNTY OF ORANGE ) SS CITY OF TUSTIN ) CERTIFICATION FOR ORDINANCE NO. 1407 PAMELA STOKER, City Clerk and ex-officio Clerk of the City Council of the City of Tustin, California, does hereby certify that the whole number of the members of the City Council of the City of Tustin is 5; that the above and foregoing Ordinance No. 1407 was duly and regularly introduced at a regular meeting of the Tustin City Council, held on the 1S`~~ day of November8stebe~, 2011 and was given its second reading, passed, and adopted at a regular meeting of the City Council held on the 156`L day of November, 2011 by the following vote: COUNCILMEMBER AYES: COUNCILMEMBER NOES: COUNCILMEMBER ABSTAINED: COUNCILMEMBER ABSENT: PAMELA STOKER City Clerk L 777346.3 ATTACHMENT EXCERPTS FROM PLANNING COMMISSION MINUTES: 9/13/11, 9/27/11, AND 10/11 /11 l~.{ The Public Hearing opened at 8:18 p.m. The applicant, Chris Kim stepped forward. Mr. Kim spoke in favor of the Baden Baden restaurant operating past midnight. He stated he needs more hours of operation to make a profit on the restaurant, and that many customers leave his business when they realize it closes at midnight. Lieutenant John Strain stepped forward representing the Tustin Police Department. Lt. Strain stated the police department has had multiple calls for service to the restaurant, and that it would exacerbate an existing negative condition to extend the hours of operation. The Public Hearing closed at 8:26 p.m. The Planning Commission discussed their position regarding Resolution No. 4180 and expressed their concerns regarding extending the operating hours of Baden Baden restaurant. ~` ,~ L,4~ Moore Requested a modification to Resolution No. 4180 under finding "D" number 1 which currently reads, "...would change the nature of the use to a bar or night club." Would like the modification to read, "... is more similar to a bar or night club." Motion: It was moved by Puckett, seconded by Eckman to adopt Resolution No. 4180 as amended. Motion carried 5-0. Continued to the 5. CODE AMENDMENT 2011-06, DRAFT ORDINANCE NO. regular Planning 1407 -BODY ART ORDINANCE Commission meeting on September 27, The proposed code amendment would establish body art 2011 facilities, including body piercing, tattooing, or the application of permanent cosmetics, as a permitted use within the City of Tustin Retail Commercial (C-1 ), Central Commercial (C-2), Heavy Commercial (C-3), and Commercial General (CG) Zoning Districts, subject to operational requirements, and establish that all body art practitioners practicing at such facilities shall be licensed by the City. In addition, under existing Code provisions body art facilities could be permitted in other zoning districts if the Community Development Director and/or Planning Commission were to determine that a body art facility is similar to another permitted use. RECOMMENDATION: That the Planning Commission adopt Resolution No. 4181, recommending that the Tustin City Council adopt Draft E- Minutes -Planning Commission September 13, 2011 -Page 5 Ordinance No. 1407, amending Tustin City Code Section 4140 to regulate the inspection of body art facilities by the Orange County Health Care Agency; amending Section 3141 to add definitions pertaining to body art; amending Sections 3651- 3654 pertaining to a body art permit; and amending Section 9232b to permit body art facilities in certain commercial zones. ENVIRONMENTAL DETERMINATION: Proposed Code Amendment 2011-006 is not subject to the California Environmental Quality Act ("CEQA") pursuant to CEQA Guidelines Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) (Title 14, of the California Code of Regulations) because it has no potential for resulting in physical change to the environment, directly or indirectly; it prevents changes in the environment by requiring the approval of body art permits for body art practitioners and imposing operational conditions on body art facilities. At the opening of the Planning Commission meeting, Chair Thompson proposed that the item be continued to the next regularly scheduled Planning Commission meeting on September 27, 2011. None dissented. None REGULAR BUSINESS STAFF CONCERNS: 6. REPORT OF ACTIONS TAKEN AT THE SEPTEMBER 6, 2011, CITY COUNCIL MEETING. The Director noted she was available to answer any questions the Planning Commission had regarding the September 6, 2011, City Council meeting. COMMISSION CONCERNS: Eckman Thanked staff for their work on this evening's presentations, Moore Attended the 9-11 Remembrance Ceremony. Stated it was a great event. Kozak Thanked staff for their work, particularly on the Nonconforming Structures, Uses, and Lots document; • Attended the CPF Mills Act Workshop with Commissioner Puckett; Minutes -Planning Commission September 13, 2011 -Page 6 one portion of work which will be done at night; however, it should not negatively impact the surrounding neighborhoods. Ensured the Commission that the site will be monitored by security, and that any night-lighting utilized at the site will be turned downward as to not reflect into nearby homes. Alfredo de Valle stepped forward representing the Tustin Homeowners Association. He stated the homeowners' primary concems are noise, and the hours of construction at the site. Stated the noise in the past has occurred as early as 5:00 a.m., and would like it to be regulated by the noise ordinance. Added that dust in the area is already an issue due to the train, and was concerned that the amount of dust blowing into their homes will increase due to the location of the site. The Public Hearing closed at 7:27 p.m. The Planning Commission renewed their concerns generally regarding screening the site, controlling the loose dirt from the stockpile, and compliance with the BMPs. Kozak Recommended an addition to Condition of Approval 2.2 clarifying that graffiti be removed within 24 hours of observation. Also recommended that Flatiron, or a representative thereof, notify surrounding homeowners when night-work will be taking place. Thompson Requested that staff reduce ambiguity in Resolution No. 4182 regarding loose dirt and dirt from the stockpile. Requested that in Condition of Approval 2.4, the hours of operation be specifically listed due to public concern expressed regarding the matter. Additionally add language to ensure compliance with AQMD and dust control, adequate screening on all sides of the site, lighting, and approval of time extensions on astaff-level. Motion: It was moved by Thompson, seconded by Puckett, to adopt Resolution No. 4182 with the discussed amendments. Motion carried 5-0. Approved Resolution 4. CODE AMENDMENT 2011-06, DRAFT ORDINANCE NO. ..... No. 4181 as amended 1407 -BODY ART ORDINANCE. The proposed code amendment would establish body art facilities, including body piercing, tattooing, or the application of permanent cosmetics, as a permitted use within the City of Tustin Retail Commercial (C-1), Central Commercial (C- 2), Heavy Commercial (C-3), and Commercial General (CG) Zoning Districts, subject to operational requirements, and Minutes -Planning Commission September 27, 2011 -Page 3 establish that all body art practitioners practicing at such facilities shall be licensed by the City. In addition, under existing Code provisions body art facilities could be permitted in other zoning districts if the Community Development Director and/or Planning Commission were to determine that a body art facility is similar to another permitted use. ENVIRONMENTAL DETERMINATION: Proposed Code Amendment 2011-006 is not subject to the California Environmental Quality Act ("CEQA") pursuant to CEQA Guidelines Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) (Title 14, of the California Code of Regulations) because it has no potential for resulting in physical change to the environment, directly or indirectly; it prevents changes in the environment by requiring the approval of body art permits for body art practitioners and imposing operational conditions on body art facilities. RECOMMENDATION: That the Planning Commission adopt Resolution No. 4181, recommending that the Tustin City Council adopt Draft Ordinance No. 1407, amending Tustin City Code Section 4140 to regulate the inspection of body art facilities by the Orange County Health Care Agency; amending Section 3141 to add definitions pertaining to body art; amending Sections 3651-3654 pertaining to a body art permit; and amending Section 9232b to permit body art facilities in certain commercial zones. Reekstin Presented the staff report for Code Amendment 2011-06. Staff addressed Planning Commission questions and concems. Commission questions/concerns generally included zoning for the use and similar uses, model for Draft Ordinance No. 1407, potential for conflict/overlap between state law and the city ordinance, compliance with AMA medical standards, and the definition of "sharps." Minutes -Planning Commission September 27, 2011 -Page 4 The Public Hearing opened at 7:55 p.m. Bree Dewey stepped forward representing the Orange County Health Care Agency to assist in addressing Commission questions. Stated "sharps" would be defined in Draft Ordinance No. 1407 as needles. Addressed issues regarding proper disposal of sharps. Stated the AMA has no regulation over body art facilities. Michael Marsh stepped forward in favor of Code Amendment 2011-06. Mr. Marsh has been a practicing tattoo artist for 13 years, and he addressed Commission questions and provided suggestions to improve Draft Ordinance No. 1407. Mr. Marsh's recommendations generally included transportation of contaminated instruments in a moist towel as opposed to being submerged in water, mandatory use of an ultrasonic cleaner, use of disposable cups rather than reusable, and removing the option to use break-away needles to reduce the risk of contamination and needle-sticks. The Public Hearing closed at 8:04 p.m. The Planning Commission took consideration of Mr. Marsh's recommendations. Further Commission recommendations generally included technical clarification/definition for increased consistency in Draft Ordinance No. 1407. Motion: It was moved by Puckett, seconded by Kozak, to approve Resolution No. 4181 as amended, and requested that the amended Resolution be brought back at the next regular meeting for formal adoption by Consent Calendar. Motion carried 5-0. Continued to the 5. DRAFT ORDINANCE NO. 1397 CLARIFYING THE regular Planning MEANING OF LEGAL NONCONFORMING USES AND Commission meeting STRUCTURES IN THE CITY OF TUSTIN. on October 11, 2011 At the request of the City Council, staff prepared draft Ordinance No. 1397 to provide clarity, provide consistency and reduce any ambiguity related to any nonconforming structures, uses and lots in the City. The Tustin City Council has requested that the Planning Commission consider verbatim City Council minutes of March 15, 2011 and draft Ordinance No. 1397, and provide a recommendation on the proposed ordinance to the Tustin City Council. Resolution No. 4183 has been prepared for Planning Commission consideration and action in this regard. Minutes -Planning Commission September 27, 2011 -Page 5 Approved 2. APPROVAL OF CODE AMENDMENT 2011-06, DRAFT ~~ ORDINANCE NO. 1407 -BODY ART ORDINANCE. On September 13, 2011, a public hearing was duly noticed and called by the Planning Commission on Code Amendment 2011- 06. The public hearing was continued to September 27, 2011, at which time the Commission adopted Resolution No. 4181 recommending that the Tustin City Council approve Code Amendment 2011-06, subject to confirmation by the Planning Commission as part of the Consent Calendar on October 11, 2011. RECOMMENDATION: That the Planning Commission confirm that the revisions to Draft Ordinance No. 1407 correctly reflect the direction provided by the Commission on September 27, 2011. Motion Adopted Resolution No. 4183 as amended It was moved by Puckett, seconded by Eckman, to move the Consent Calendar. Motion carried 5-0. PUBLIC HEARINGS: 3. DRAFT ORDINANCE NO. 1397 CLARIFYING THE MEANING OF LEGAL NONCONFORMING USES AND STRUCTURES IN THE CITY OF TUSTIN. On September 27, 2011, the Planning Commission considered the proposed Ordinance 1397 and continued the public hearing to October 11, 2011, to allow staff to address concerns brought up by the Planning Commission and the general public. The concerns are as follows: 1) The issue of value (i.e. fair market, appraised, assessed, replacement, reasonable, etc.) for the purpose of repair, maintenance, and/or replacement; 2) Impact to existing historic resources; 3) The time period in which the owner would need to provide Statement of Evidence; 4) Incorporation of suggested evidence listed in the Investigative Procedures dated August 30, 2011, onto the proposed Ordinance; 5) Zoning Code versus Building Code; 6) General Plan Consistency. Minutes -Planning Commission October 11, 2011 -Page 2