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CITY OF SANTA BARBARA (City of Santa Barbara)

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U.S.A. forms for City of Santa Barbara

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RENEWAL APP
LICATION
FOR TAXICAB DRIVER PERMIT
(Pursuant to Santa Barbara Municipal Code, Chapter 5.29)
Refund Policy/Authorization to Release
Arrest History signed
Applicant Acknowledgment signed
Applicant must submit the following documents, completed & signed where applicable:
RENEWAL APPLICATION FACE SHEET: F ADDITIONAL ITEMS:
Drug test (NIDA, or
10-panel)*
Alcohol test
(BAT)*
2
Passport-sized Photos
*Test results must be in a SEALED envelope, or faxed/emailed by testing agency.
All items must be submitted to the Police Technician at 215 E. Figueroa
St, Santa Barbara, CA 93101. Call (805) 897-2333 to make an appointment and
drop off any applications in person with the Police Technician.
Renewal Fee: $100 if paid before expiration date of permit, or
Late Renewal Fee: $200 if paid after the expiration date of permit.
Please complete the following:
Applicant’s Full Name:
Name As Listed On CA Driver’s License (if different):
Current Permit Number : Current Permit Exp:
Residence Address (include street, city, and zip code):
Mailing Address, if different (include street, city, and zip code):
Email
Phone Number: Date of Birth:
Current Taxicab Employer or Business Name: Cab #
CA Driver’s License #: Exp: Social Security #:
Applicant’s signature indicates that he/she understands that if any information
herein is misrepresented, incomplete, or omitted it may be grounds for denial.
Applicant’s signature Date
CITY OF SANTA BARBARA
Police Technician’s recommendations:
Initials/ Body #:
Date:
CHIEF OF POLICE or DESIGNEE:
Upon review, this application is: DENIED
APPROVED–1 YR APPROVED–2 YRS
Signature: _________________________________ Title:_____________________________ Date:________
City Stamp/Paid
And register receipt
$100 Renewal Fee
OR
$200 LATE Renewal
Date Stamp - Received
Applicant Photo
Temp Issd. Thru:
VDX GUS
Permit #
New Exp:
CLU Permit Log
Date sent to Billing/ Finance:
Applicant Notified of Status:
Date:
Phone/Voicemail Mail
Date Permit Issued/Mailed:
Last Updated 6/7/22
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REFUND POLICY & GROUNDS FOR DENIAL
TAXICAB DRIVER PERMIT RENEWAL
NOTICE TO APPLICANT: The application fee for this renewal is NON-REFUNDABLE.
Once paid, the application fee
is not refundable. The following circumstances are no exception:
If you are denied a renewed taxicab driver permit;
If you withdraw your application; or
If you fail to complete the permit process.
Please read the Grounds for Denial and sign this acknowledgement before you complete the application.
Complete language of Grounds for Denial can be found in Santa Barbara Municipal Code, §5.29.190.
GROUNDS FOR DENIAL (condensed):
1. Less than 6 months of driving experience in the United States.
2. No valid California driver’s license.
3. Under 21 years of age (except with proof of a valid Class B California driver’s license).
4. Required registration as a sex offender pursuant to Section 290 of the California Penal Code, or required
registration in another state or country as a sex offender comparable to §290 PC.
5. A conviction of, or release from confinement for a conviction of, a crime involving moral turpitude, narcotics or
dangerous drugs within the past 3 years.
6. A conviction of reckless driving within 2 years preceding application for permit or renewal.
7. A conviction of operating a vehicle while under the influence of alcohol or drugs 2 or more times within 7 years
immediately preceding an application for a permit or renewal.
8. 3 or more public intoxication convictions in the 2 years immediately preceding an application for a permit or renewal.
9. For a new permit: 2 or more moving violation convictions within 1 year preceding an application; or
For a renewal: 3 moving violation convictions within 1 year, OR 4 moving violation convictions in 2 years. “Moving
violation” is defined by State Vehicle Code §12810.
10. 1 or more citations or warrants outstanding which, in the opinion of Police Department staff, may result in a
conviction of an offense that would normally result in denial or permit revocation.
11. Any conviction of a felony or misdemeanor hit and run.
12. A positive result on a state or federally-recognized controlled substances and/or alcohol tests.
13. Failure to complete the application process.
14. False statements, or incomplete or inaccurate information on the application.
Signature below confirms that the applicant has read the above information, understands the Grounds for
Denial of a permit, and understands that the application fee is NON-REFUNDABLE.
Applicant Signature: Date:
As an applicant for a City permit within the City of Santa Barbara, I hereby authorize the release of any and all
information that you may have concerning my work records, education records, medical records, and information of a
confidential or privileged nature to the City of Santa Barbara Police Department and its agents.
I hereby release you, your organization, or others, from any liability or damage, which may result from furnishing the
information requested.
Printed (Permit Applicant’s Name) Signature (Permit Applicant) Date
CITY OF SANTA BARBARA
AUTHORIZATION TO RELEASE INFORMATION
TO THE CITY OF SANTA BARBARA, POLICE DEPARTMENT
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ARREST HISTORY – RENEWAL APPLICATION
(Pursuant to Santa Barbara Municipal Code, Chapter 5.29)
CITY OF SANTA BARBARA
T HISTORY(Pursuant to Santa
List ALL arrests and citations for the past 7 years. Include all infractions,
misdemeanors, and felonies. Failure to do so may result in DENIAL of this application.
Attach a separate sheet if necessary. If you don’t recall your arrest history, visit all law
enforcement agencies that may have arrested or cited you and request your arrest history.
If you were cited for any violations while in a taxicab, they must be listed below.
If you have not been arrested or cited in the past 7 years, write “NONE”.
The space below cannot be left blank.
Date Place (City/State) Reason for Cite or Arrest Final Conviction or Adjudication
Are you currently:
On probation? No Yes Charges:
On parole? No Yes Charges:
Required to register pursuant to Penal Code section 290 (sex registrant)? No Yes
Signature below indicates the applicant understands that if any information requested on this
form is misrepresented, it may be grounds for denial of this permit application.
____________________________________
Signature (Permit Applicant)
_________
Date
The Police Technician’s Verbal Verification
I, the Police Technician, verbally verified with applicant that:
applicant’s answer is “none” OR applicant listed complete & citation/arrest history
Police Technician Initials__________ Date: _________
Applicant Acknowledgement of Police Technician’s Verbal Verification:
(APPLICANT: DO NOT SIGN BELOW UNTIL ASKED TO DO SO)
By initialing here, I, the named applicant, confirm that the Police Technician verbally
verified my arrest history on this date:
Applicant Initials: ___________ Date: _________
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APPLICANT ACKNOWLEDGEMENT:
APPLICATION COMPLETION & PROCESS
CITY OF SANTA BARBARA
Read each section below, then initial where indicated to confirm your
acknowledgement and understanding of each section:
I understand that I should not submit my application to the Police Department if I am uncertain
about ANY information listed herein, or if any information is incomplete. I understand that it is my
responsibility to do all research necessary to ensure that my answers are complete and accurate.
Initials:_________
I understand that my application may be processed immediately upon submission to the Police
Department, and that once it is submitted, if any information is found by Police Department staff
to be missing, incomplete, misrepresented, or falsified, the application may be denied.
Initials: ________
I understand that the Police Department, at the discretion of Police Department staff, may accept
this application without the immediate submission of the following supplemental items: drug test
results; alcohol test results; and/or photographs. I understand that if an incomplete application is
accepted, I must submit any missing items within seven (7) days of submission of the incomplete
application. I understand that I will be ineligible for a temporary permit or any form of extension of
driving privileges until such time as all missing items have been submitted, and will only then be
eligible for a temporary permit if all items are received within 7 days of original submission.
Although the initial application process and background check may begin immediately after
submission
of the application without these items, the application will not be reviewed by the
Chief’s Designee until all required supplemental items are submitted to the Police Department. If
the supporting items are not submitted within 12 months of the date of submission of the
application, the application will become void and a new application must be submitted.
Initials:_________
By submitting this application to the Police Department, I confirm that I have included all
information requested in all sections of the application, that I have done all research necessary to
support the information listed, and that I am confident that the information I have provided is
complete and accurate.
Initials:_________
I confirm that I have familiarized myself with Santa Barbara Municipal Code Chapter 5.29,
particularly as it pertains to the rules, regulations, and requirements of being a taxicab driver.
Initials:_________
By signing below I confirm that I have thoroughly read, I understand, and I agree to
abide by all sections I have initialed on this page.
Signature Date
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CITY OF SANTA BARBARA (City of Santa Barbara)

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Completed 28 June 2022

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