Form DBPR COSMO6 "Application for Salon Licensure" - Florida

What Is Form DBPR COSMO6?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2015;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR COSMO6 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR COSMO6 "Application for Salon Licensure" - Florida

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1 of 5
State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Salon Licensure
Form # DBPR COSMO 6
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
Complete all sections of this application.
Application for
Pay $95 fee (make check payable to the Department of Business and
Salon Licensure
Professional Regulation).
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
Application Instructions (by section)
a. Section I
i.
Please select the salon type you are applying to license.
ii.
Please select the transaction type.
b. Section II
i.
Fill out each section completely.
ii.
Sole proprietorship/individual ownership may not be required to obtain a Federal
Employer ID Number.
iii.
Indicate the salon business type.
iv.
If the salon is a business type other than sole proprietorship, indicate the ownership
name.
v.
Business ownership: Provide the name, Social Security number, address, and the
percentage of ownership for all persons holding greater than or equal to a ten percent
ownership interest in the business.
Fla. Stat. § 559.79.
vi.
If the salon will be owned by a corporation, each Officer, Director, Chief Executive or
other person who is able to directly or indirectly control the operation of the salon must
provide their name, title, Social Security number, and an address.
Fla. Stat. § 559.79.
c. Section III
i.
Answer whether or not the proposed salon meets the applicable requirements
established by Rules 61G5-20.002 and 20.010, Florida Administrative Code.
ii.
Answer the question regarding any prior discipline.
iii.
For mobile salons, include a description of the motor vehicle and its identification number.
d. Section IV
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
DBPR COSMO 6 Application for Salon Licensure
Incorporated by Rule: 61-35.011
June, 2015
1 of 5
State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Salon Licensure
Form # DBPR COSMO 6
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
Complete all sections of this application.
Application for
Pay $95 fee (make check payable to the Department of Business and
Salon Licensure
Professional Regulation).
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
Application Instructions (by section)
a. Section I
i.
Please select the salon type you are applying to license.
ii.
Please select the transaction type.
b. Section II
i.
Fill out each section completely.
ii.
Sole proprietorship/individual ownership may not be required to obtain a Federal
Employer ID Number.
iii.
Indicate the salon business type.
iv.
If the salon is a business type other than sole proprietorship, indicate the ownership
name.
v.
Business ownership: Provide the name, Social Security number, address, and the
percentage of ownership for all persons holding greater than or equal to a ten percent
ownership interest in the business.
Fla. Stat. § 559.79.
vi.
If the salon will be owned by a corporation, each Officer, Director, Chief Executive or
other person who is able to directly or indirectly control the operation of the salon must
provide their name, title, Social Security number, and an address.
Fla. Stat. § 559.79.
c. Section III
i.
Answer whether or not the proposed salon meets the applicable requirements
established by Rules 61G5-20.002 and 20.010, Florida Administrative Code.
ii.
Answer the question regarding any prior discipline.
iii.
For mobile salons, include a description of the motor vehicle and its identification number.
d. Section IV
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
DBPR COSMO 6 Application for Salon Licensure
Incorporated by Rule: 61-35.011
June, 2015
2 of 5
General Information
Salon Operation
i.
A license must be issued and available for posting before the salon can open for
business.
ii.
A new salon application must be submitted for a change of location, name or ownership.
Any of these changes void the previous license.
iii.
All salons will be inspected, with the exception of flea market salons, after the license has
been issued. Flea market salons must be inspected before a license can be issued.
iv.
Fee: $95 (make check payable to the Department of Business and Professional
Regulation).
Salon Requirements – for a complete list of safety and sanitary requirements please refer to Rule
61G5-20.002, Florida Administrative Code.
GENERAL SALON SAFETY AND SANITARY REQUIREMENTS
All salons must have the following:
1. Adequate ventilation.
2. Closed container for depositing hair.
3.
a. Shampoo bowls with:
● Hot and cold running water.
b. Sink or lavatory with:
● Hot and cold running water.
4. A closed container or cabinet for clean/disinfected articles.
5. A closed dustproof linen cabinet.
6. A closed receptacle in the cosmetology services area for soiled linens OR an open receptacle in an
area separated from the public.
7. Containers for waving lotions and other types of such preparations.
8. Wet sanitizers.
9. Toilet and lavatory facilities:
a. On the premises, in the same building, and within 300 feet of the salon.
b. Facilities must have the following:
1. Toilet tissue.
2. Soap dispenser with soap or other hand cleaning material.
3. Sanitary towels or other hand-drying device.
4. Waste receptacle.
10. If nail services are provided on site, a separate well-ventilated area for extending and sculpting nail
services is required.
11. Residential Salons –
a. Salon is separated from the living quarters by permanent wall construction.
b. Entrance to the salon is separate from the entrance to the living quarters of the residence.
c. Toilet and lavatory facilities’ entrance for the salon are separate from that of the living
quarters.
12. Mobile Salons –
a. Self-contained, flush chemical toilet with holding tank.
a. Clean water storage capacity of at least 35 gallons.
b. Waste water storage capacity equal to or greater than clean water storage capacity.
DBPR COSMO 6 Application for Salon Licensure
Incorporated by Rule: 61-35.011
June, 2015
3 of 5
State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Salon Licensure
Form # DBPR COSMO 6
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I – Salon Type and Transaction Type
CHECK ONE OF THE SALON TYPES
 Commercial/Residence
Flea Market Salon
Mobile Salon
Salon [0502/1030]
[0502/1031]
[0503/1030]
CHECK ONE OF THE TRANSACTION TYPES
Initial Salon
Location Change
Ownership Change
Section II – Salon/Owner Information
SALON INFORMATION
Name of Salon:
Federal Employer ID Number:
MAILING ADDRESS (License will be mailed to this address.)
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Contact Name:
Primary Phone Number
Primary E-Mail Address
BUSINESS LOCATION ADDRESS (Actual address of salon.)
Street Address
City
State
Zip Code
County (if Florida address)
Country
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
DBPR COSMO 6 Application for Salon Licensure
Incorporated by Rule: 61-35.011
June, 2015
4 of 5
Section II – Salon/Owner Information – continued
SALON BUSINESS TYPE
Business Type:(Select ONE only)
 Sole Proprietor
 Corporation or LLC  Partnership
If other than a Sole Proprietor, provide the Corporation, LLC or Partnership Name(s) below:
BUSINESS OWNERSHIP
Please list all persons with ownership greater than or equal to 10%.
Social Security
Name
Address
%
Number*
Ownership
1.
2.
3.
4.
5.
CORPORATIONS OR LLCs ONLY
Please provide the following information for each Officer, Director, Chief Executive or other
person who is able to directly or indirectly control the operation of the salon.
Officer’s Name
Title
Social Security
Address
Number*
1.
2.
3.
4.
5.
6.
7.
8.
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional
Regulation pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of
applicants and licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required
by § 559.79(1), Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. §
405(c)(2)(C)(i), to be used by the Department of Business and Professional Regulation to identify licensees for tax administration
purposes.
DBPR COSMO 6 Application for Salon Licensure
Incorporated by Rule: 61-35.011
June, 2015
5 of 5
Section III – Salon Information
SALON REQUIREMENTS
Cosmetology and Specialty Salons:
 YES
Does the salon meet all of the safety and sanitary requirements established in Rule
 NO
61G5-20.002 of the Florida Administrative Code?
Mobile Salon:
Does the mobile salon meet all of the applicable safety and sanitary requirements in
 YES
Rule 61G5-20.002 of the Florida Administrative Code, and meet all of the operational
 NO
requirements for mobile salons established in Rule 61G5-20.010 of the Florida
Administrative Code?
**BARBERS MAY NOT WORK IN A SALON UNLESS A COSMETOLOGIST IS ALSO EMPLOYED BY THE
SALON.
Has the owner of the proposed salon ever held a salon license in Florida that has been
 YES
revoked, suspended, fined, placed on probation, or otherwise been acted against?
 NO
If yes, please provide the following information:
Previous Salon License Number:
Date Salon Closed:
Previous Salon Name:
Previous Salon Address:
MOBILE SALONS ONLY
Vehicle Type:
 Motor Vehicle
 Other Mobile Type (e.g. travel trailer)
Description of Mobile Salon:
Vehicle Identification Number:
Section IV– Affirmation By Written Declaration
AFFIRMATION BY WRITTEN DECLARATION
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I
understand that my signature on this written declaration has the same legal effect as an oath or
affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts
stated in it are true. I understand that falsification of any material information on this application
may result in criminal penalty or administrative action, including a fine, suspension or revocation
of the license.
Signature:
Date:
Print Name:
DBPR COSMO 6 Application for Salon Licensure
Incorporated by Rule: 61-35.011
June, 2015
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