Fillable Cannabis Special Event Application Fillable 031519 (City of Oakland)

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Cannabis Special Event Application Fillable 031519 (City of Oakland)

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INSTRUCTIONS FOR THE

SPECIAL EVENT PERMIT APPLICATION FOR

TEMPORARY CANNABIS EVENTS

Please be sure to submit your application a minimum of 45 days in advance of

your proposed event. Late submittals will not be accepted.

STEP 1: Your proposed site must be pre-approved by the Fire Prevention

Bureau (FPB). Complete the FPB Special Event form and bring it to

the FPB located on the 3

Floor of 250 Frank H. Ogawa Plaza for

pre-approval. If the location is pre-approved, the FPB will sign a

Pre-Approval Form for your event and you may move forward with

the application process. If the site is not pre-approved, you will

need to either make corrections to the facility to become compliant

or choose an alternative site.

STEP 2: All applicant board members, partners and managers must

undergo a Live Scan

background. The Live Scan must have been

done within the last 90 days. Your stamped form will be submitted

with your application. A $32 processing fee for each Live Scan

form included in your application will be required when your

application is submitted.

STEP 3: Complete/Attach the following Application forms:

 Special Event Questionnaire

 Special Event Application

 Supplemental Special Event Application for Temporary Cannabis

Events

 Signed FPB Pre-Approval Form

STEP 4: Schedule an appointment with the OPD Special Events Unit by

calling Officer Huy Nguyen or Sgt. Pedro Espinoza at (510)

777- 8525 to submit your application for review and pay any

required fees.

ApplicantsmustalsocompletetheFirePreventionBureauSpecialEventsApplication,whichisavailableonthe3



Floorof250FrankH.OgawaPlaza,andcomplywithallfirecoderequirements.

Thepurposeofthebackgroundcheckistodeterminewhetheranindividualhasbeenconvictedorpleadguiltyor

nolocontendertoviolentoffensesorthoseinvolvingfraudordeceitinthelastsevenyears.Applicantswithsucha

convictionorguiltypleawillbeofferedanopportunitytopresentevidenceofrehabilitation.

OAKLANDFI

REPREVENTIONBUREAU

PRE‐APPROVALFORMFORTEMPORARYCANNABISEVENTS

Theproposedtemporarycannabiseventsiteof_____________________________(address/location) is:

Approvedasapotentialeventspacesubjecttositeinspectionandfinalapproval.

NotapprovedasapotentialeventspaceduetothefollowingFireLifeSafetyconcerns:

____

_____________________________________________________________________________ ____

_____________________________________________________________________________ ________

_____________________________________________________________________________ _______

__________________________

FirePreventionBureauStaff

__________________________

Date

SPECIAL EVENTS

DANCES/CONCERTS/SHOWS

PERMIT PREREQUISITES

_____________________________________________________________________________________

1. NOTIFICATION REQUIRED: A minimum of 30 days notice must be given to the Police Department prior to the event.

Applications may be obtained in advance of the date of the event; however, the application process must commence no later

than thirty (30) days prior to the event.

NOTE: The permit process is NOT COMPLETE until all requirements have been met.

2. INSURANCE COVERAGE REQUIRED: The facility where the function is to be held must have a liability insurance policy in

effect at the time of the event or both. A copy of the Certificate of Insurance must be provided with the completed

application. Within the certificate, “THE CITY OF OAKLAND” shall be named as additionally insured.

3. TICKETS: If tickets are to be sold for the event, a City of Oakland business license is required. Business licenses for the City

of Oakland may be obtained at 250 Frank Ogawa Plaza, Suite 1320. Telephone: (510) 238-3704.

4. NONPROFIT ORGANIZATION: If the function is being sponsored by a nonprofit organization, the Internal Revenue Service or

State of California Nonprofit Exemption documentation must be provided with the completed application.

5. VENUES: A completed contract with the venue, where the event is to be held, must be submitted with the application,

although the contract may be tentative pending approval of the permit.

6. SECURITY: A contract with a licensed and bonded company is necessary. Depending on the size of the event, and the type

of event, security is required. One security officer per fifty (50) attendees, to one security officer per one hundred (100)

attendees.

7. IDENTIFICATION: A current and valid photo identification is required. It must be issued by a Municipal, State or Federal

agency and have a photo of the person making the application for the permit. A PHYSICAL ADDRESS is required. POST OFFICE

BOXES are not permitted.

8. BUILDING AND FIRE SERVICES’ PLAN REVIEW AND INSPECTION REQUIREMENTS: Non-conforming Buildings (warehouses,

factories, etc.) and other event locations used as public assemblies are subject to plan review by the Building Department

and/or Fire Department. Please submit plans (three copies) for review to the Fire Department at 250 Frank H. Ogawa Plaza,

Suite 3341.

9. ALCOHOL (ABC License): If you will be serving and/or selling alcoholic beverages, then you need to obtain an Alcoholic

Beverage Control license or provide documentation that the establishment hosting your event has a valid ABC license.

The California Department of Alcoholic Beverage Control’s website (http://www.abc.ca.gov/) has more information.

10. ALAMEDA COUNTY HEALTH DEPARTMENT: Any event where food or drink will be either sold or given away will need a

valid Alameda County Health Permit. Please contact @ (510) 567-6700.

11. SOUND: If you will be using any form of sound amplification outside (including but not limited to a microphone, amplifier

or bull horn), you will need to obtain a sound permit from the City Manager’s Office.

12. ADVERTISEMENTS: Copies of any and all promotional literature and announcement for an event must be provided with

the completed application. Originals or a photocopy of the advertisement may be submitted for approval.

13. STATE BOARD OF EQUALIZATION: If tangible personal property will be sold at the event, each vendor must get a

temporary Seller’s Permit from the State Board of Equalization. If the vendor already has a Seller’s Permit they must add the

special event location as a sub location on their existing Seller’s Permit. They vendor may visit boe.ca.gov, call (510) 622-4102,

or come to the nearest BOE office to obtain assistance with registration.

PLEASE BE SURE THAT YOU HAVE READ COMPLETELY ALL INFORMATION IN THIS PACKET AND THAT YOU

UNDERSTAND YOUR RESPONSIBILITIES FOR OBTAINING THIS PERMIT.

If you have any questions, contact our office @ (510) 777-8525.

SPECIAL EVENTS PERMIT

QUESTIONNAIRE

Instructions:

You are required by Oakland Municipal Code 9-52.030 to obtain a special event or dance permit

before holding or assisting in the conducting or carrying on of a special event or dance in any public

place in the City of Oakland.

Upon approval, your application will serve as your permit. Unless you can provide documentation

confirming that you are a charitable institution, you must have a business license to conduct a

special event and if you intend to sell or furnish alcoholic beverages, you must obtain a one-day

liquor license from the California Alcohol Beverage Control Board.

Please complete this form and return it with copies of any required documents for further processing.

NOTE:

UNTRUTHFULNESS IN COMPLETING THIS FORM WILL RESULT IN DENIAL OF THE

APPLICATION.

OAKLAND PARKS & RECREATION DEPARTMENT MAY REQUIRE SOME EVENTS TO HAVE

SECURITY AND/OR POLICE SERVICES.

DANCING IS NOT PERMITTED BETWEEN 1:00 AM and 9:00 AM.

PLEASE PRINT – ILLEGIBLE INFORMATION WILL DELAY APPROVAL

Applicant’s Name

Date of Birth

Address City  Oakland State/Zip

Home Phone ( )

Bus. Phone ( )

Person in Charge/Present and Available for Police Contact on the Date/Time of Event

Date of Birth

Business, Organization or Club Hosting/Sponsoring Event

Address City  Oakland State/Zip

Phone No. ( )

Date of Event

Day of Week

Starting Time

Ending Time

Name of Facility or Club

Address City  Oakland State/Zip

Maximum Occupancy of Facility

Does Facility Have Off-Street Parking?  No  Yes – How Many Spaces

Contract with the Owner/Manager/Agent of the Event Facility  Yes – Attach Copy

No – Explain

TF-1099 (07/18)

Page 1 of 2

Two (2) References from Previous Events Starting with the Most Recent

Date

Location

City  Oakland State/Zip

Contact Person

Phone No. ( )

Date

Location

City  Oakland State/Zip

Contact Person

Phone No. ( )

How Many Tickets will be Sold

Ticket Price

Ticket Sale

 Door  In Advance  None

How Many are Expected to Attend

Target Age Group

Under 18 Allowed

 Yes  No

General Public Allowed

 Yes  No

Advertisement  None  Flyers

 Radio/TV  Other (explain)

Music/Entertainment Live/Recorded?  No  Yes – Name of Group/Organization/Individual

Security Officers  No  Yes – Name of Company

Security Officer(s)

 Armed  Unarmed

In Addition to Security Officers, How Many Adult Chaperons for Events Under 18 Years of Age

ATTACH COPY OF SECURITY CONTRACT/AGREEMENT WITH SECURITY COMPANY SHOWING THE

NUMBER OF GUARDS WITH THEIR ARRIVAL AND DEPARTURE TIMES. It must be at least 30 minutes

before and after the event. A ratio of 1 security person per 50 anticipated attendee will be required. The

contract should provide a contingency plan for additional security in the event the expected attendance exceeds

the expectations.

NOTE:

THE SECURITY COMPANY MUST BE LICENSED TO DO BUSINESS IN OAKLAND.

Alcoholic Beverages Furnished or Sold

 Yes

 No

Have You Ever Applied /Received a Special Events Permit in the City of Oakland  Yes  No

Have You Ever Been Denied a Special Events Permit in the City of Oakland  No  Yes –

Explain ________________________________________________________________________________ .

I have read all requirements and information on this form and have completed the form as accurately as

possible. I understand that this is NOT a permit, but an application pending approval of the Oakland

Police Department. Incomplete, illegible or missing documentation may delay the permit process. I also

understand untruthfulness will result in denial of my permit.

_________________________________________________________ Date ____________________

Applicant’s Signature

Page 2 of 2

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signature

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OAKLAND POLICE DEPARTMENT

Special Events Permit Application

TF-807-3 (Jul 10)

APPLICANT INFORMATION

Applicant Name Date of Birth Contact No. Alternate Contact No.

Applicant’s Address City Oakland Zip Code

EVENT INFORMATION

Date of Application Type of Event

Select one

Other Event (Describe)

Location/ Address of Event Date of Event Time/ Start-End

No. Persons Expected Persons Allowed

Select one

Ticket Sales

Select One

No. of Monitors/ Security Security Company Telephone No.

Type of Music

Select one

Other Music (Describe) Will food/drink be sold

Yes No

PERMIT INFORMATION

HAVE YOU EVER BEEN DENIED A PERMIT? Yes No

Applicant agrees to abide by Oakland Municipal Code Dance Hall Regulations, Section 5-4.03

HOLD HARMLESS AGREEMENT

The Special Event applicant or president of designee of the sponsoring organization(s) (hereafter called “permittee”)

agrees to reimburse the City of Oakland (hereafter called “City”) for all losses incurred by it in repairing or replacing

damage to City Property proximately caused by the permittee, its officers, employees, agents, monitors, or any other

persons or forming the special event, who were, or should have been, under the permittee’s control. Persons who merely

attend or join in a special event are not considered by that reason alone to be “under the control” of the permittee.

The permittee further agrees to defend without costs, indemnify, and hold harmless the City, its officers, agents, and

employees from any liability to any persons, damages, losses, or injuries arising out of or alleged to arise out of the

permitted special events, which was proximately caused by the actions of the permittee, its officers, employees, agents,

including monitors, or any other persons attending or joining in the special event who were, or reasonably should have

been under the control of the permittee. Persons who merely attend or join in a special event are not considered by that

reason alone to be “under the control” of the permittee.

I have read and I understand the Hold Harmless Agreement and I declare under penalty of perjury that the information

provided in this application is true and correct.

Permittee’s Signature ________________________________________ Date ________________

Police Overtime cost Attached: Yes No Application Fees Paid: Yes No

ABC Endorsement: Approved Denied

Verified By:

________________________________________ _____________

Special Events Personnel Serial No.

Pursuant to OMC §9.52.080, a Special Events Permit is conditionally approved in order for the applicant to obtain additional

required documentation.

_____________

__________________________________ ______________ ___________________

Signature of Special Events Coordinator Serial No. Date Signed

A Permit is Hereby Approved

Denied – Pursuant to OMC Section 9.52.090 Subsection (Select Appropriate Subsection)

_____________

__________________________________ ______________ ___________________

Signature of Chief of Police Designee Serial No. Date Signed

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

1

SUPPLEMENTALSPECIALEVENTPERMITAPPLICATIONFORCANNABISEVENTS

SUPPLEMENTALSPECIALEVENTPERMITAPPLICATIONFORTEMPORARYCANNABISEVENTS

A. ApplicantInformation

1. ApplicantName:_____________________________________________________________

2. DBAoftheApplicant(IfApplicable):_____________________________________________

3. MailingAddress:____________________________________________________________

City/Zip:___________________________________________________________________

4. Email:_____________________________________________________________________

5. Phone:____________________________________________________________________

6. (IfApplicable)WebsiteforApplicant:_______________________________________ ____

7. StateEventOrganizerLicenseNumber____________________________________________

StateEventOrganizerLicenseExpirationDate:_____________________________________

8. FederalEmployerIdentificationNumber:_________________________________________

9. StateEmployerIdentifi cationNumber:___________________________________________

10. Allapplicantboardmembers,partnersandmanagersmustundergoalivescanbackground.

Pleaseattachacopyofthestampedcompletedlivescanform.



11. PleaseattachacopyofApplicant’scurrentCityofOaklandbusinesstaxcertificate.



B. EventInformation

1. NameofTemporaryCannabisEvent:________________________________________________

2. Date(s)ofProposedEvent:________________________________________________________

3. HoursofProposedEvent:_________________________________________________________

4. AddressofProposedEvent

:___________________________________________ ____________

a. Iftheproposedeventwilltakeplaceonprivateproperty,pleaseattachauthorization

fromthepropertyownerforthiseventtobeheldattheidentifiedaddress.

5. EstimatedTotalofEventAttendees:_________________________________________________

6. PleaseattachacopyofacompletedFirePreventionBureau’sPre‐ApprovalForm

forTemporary

CannabisEvents.

7. Pleaseattachanitineraryoftheproposedeventthatincludessetup,eventactivities,andbreak

downofevent.

8. Pleaseattachadiagramofthephysicallayoutoftheevent.Thediagrammusti ndicatewhere

theeventwilltakeplaceonthelocationgrounds,

allentrancesandexitstobeusedby

participantsattheevent,allcannabisconsumptionareas,allretailareaswherecannabisgoods

willbesold,wherecannabisgoodsandwastewillbestored,andthespecificlocationofeach

cannabislicenseeparticipatingintheevent.

9. Istherealicensefor

thesaleofalcoholortobaccoattheproposedlocationoftheevent?

YesNoNotSure

10. ApplicantPrimaryPointofContactDuringtheEvent



Thepurposeofthelivescanistoidentifyifanoperatorhasbeenconvictedorpleadnolocontenderorguiltytoa

violentoffenseorcrimeoffraudinthelastsevenyears.Applicantswithrecentrelevantconvictionsmaystill

petitiontheCityAdministratorforreconsiderationiftheycan

demonstrateevidenceofrehabilitation.

PleasenotepursuanttoOMC5.80.030nomorethantwelvepermitsforaspecialeventinvolvingthesaleof

cannabismaybeissuedforthesamelocationorthesameindividualorentitypercalendaryear.



2

SUPPLEMENTALSPECIALEVENTPERMITAPPLICATIONFORCANNABISEVENTS

SameContactInformationasApplicant

Name:___________________________ __________________________________________

Email:_____________________________________________________________________

Phone:____________________________________________________________________

MailingAddress:____________________________________________________________

City/Zip:___________________________________________________________________



C. CannabisLicenseeInformation

1. Pleaselistbelowallcannabislicenseesthatwillbesellingcannabisproductsattheevent.

Attachadditionalpagesas

necessary.PerBureauofCannabisControlRegulationsSection

5602(c),pleasenoteonlystatelicensedretailersandmicrobusinessesauthorizedtoconduct

retailcansellcannabisproductsattemporarycannabisevents.



 LICENSEENAME LICENSETYPE STATELICENSE

NUMBER

LICENSE

EXPIRATIONDATE

1   

2   

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20   



2. Foreachlicensee,pleaseattachacopyoftheircurrentCityofOaklandbusinesstaxcertificate.

3. Foreachlicensee,pleaseattachalistofallemployeesthatwillbeprovidingcannabisproducts

attheevent.

4. Anychangestothelistoflicenseesore mployees aftersubmissionof

theSupplementalSpecial

EventPermitApplicationmustbemadeviaanupdatedSupplementalApplicationandEvent

DiagramsubmittedtotheOaklandPoliceDepartmentSpecialEventsUnitatleastoneweekin

advanceoftheevent.



3

SUPPLEMENTALSPECIALEVENTPERMITAPPLICATIONFORCANNABISEVENTS

D. OnsiteConsumptionInformation

1. Willcannabisbeconsume dattheevent?

YesNo

IfyouansweredNo,pleaseskiptoSectionE.Ifyouansweredyes,pleaseattachanOnsite

ConsumptionPlanthatoutlines:

 Thedifferentformsof

onsiteconsumptionthatwillbeallowed;

 Wheretheconsumptionwilltakeplace; 

 HowtheApplicantwilldeterdruggeddriving;

 HowApplicantwillensureanyconsumptionisnotvisiblefromapublicplaceorby

peopleunderageof21.

 HowApplicantwillensurenoconsumption/saleof

alcoholandtobaccowilltakeplace.

 Whetheranyconsumptionwilltakeplacewithin1,000feetofaschool,daycareor

youthcenterwhilechildrenarepresent.

2. Willcannabisbesmokedattheevent?

Yes

No

IfyouansweredNo,pleaseskiptoSectionE.IfyouansweredYes,pleaseclarifywherethe

smokingwilltakeplace:

InanenclosedareaInanunenclosedarea



E. SecurityInformation

PleaseattachaSecurityPlanalongwithalistofallSecurityGuardsand

theirGuardCardlicense

numbers.AllsecuritypersonnelshallbelicensedperBusinessandProfessionsCode7582.

F. OathofApplication

Ideclareunderpenaltyofperjurythattothebestofmyknowledge,theinformationcontainedin

thisapplicationanditssupportingdocumentationistruthful,correctandcomplete; and, the



informationcontainedinthisapplicatio n anditssupportingdocumentationdisclosesallfacts

regardingtheapplicantandassociatedi ndividualsnecessarytoallowtheCityofOaklandtoproperly

evaluatetheapplicant’squalificationsforaCannabisSpecialEventApplication.

IagreeandrecognizethatIamresponsibleforobeyingallFederal,State,

Countyandlocallaws.I

furtheragreeandunderstandthatanymisrepresentations,omissionsorfalsificationsinthe

applicationoranydocumentsattachedtheretooramendmentstheretowillbeimmediategrounds

fortheCityofOaklandtodenythispermitapplication.



Signed:_________________________________________________________

Date:__________________________________________________________



PleasenoteOMC8.30restrictswheresmokingcantakeplaceintheCityofOakland,suchasenclosedareasthat

areplacesofemploymentandunenclosedareasthatarerecreationalareas.Formoreinformation,pleasevisit:

https://library.municode.com/ca/oakland/codes/code_of_ordinances?nodeId=TIT8HESA_CH8.30SM



4

SUPPLEMENTALSPECIALEVE

NTPERMITAPPLICATIONFORCANNABISEVENTS

ATTACHMENTS

Besureyourapplicationhasthefollowingitemsenclosed:

A. ApplicantInformation

CopyofStateEventOrganizerLicense

CopyofStampedLiveScanForm

CopyofApplicant’sCityofOaklandBusinessTaxCertificate

B. EventInformation

AuthorizationfromPrivatePropertyOwnerifApplicable

EventDiagram

ItineraryoftheEvent

CopyofFirePreventionBureauPre‐ApprovalFormforTemporaryCannabisEvents

C. CannabisLicenseeInformation

CopyofRetailer,Delivery‐Non‐StorefrontorMicrobusinesslicenseforeachvendor

CopyofCityofOaklandBusinessTaxCertificateforeachRetailer,Delivery‐Non‐Storefrontor

Microbusinesslicense

ListofLicenseeEmployees

D. OnsiteConsumptionInformation

OnsiteConsumptionPlan

E. SecurityInformation

SecurityPlan

SecurityGuardlistwithGuardCardNumbers

REQUEST FOR LIVE SCAN

Applicant Submission

CII 8016 (REV 4/01) ORIGINAL – Live Scan Operator; SECOND COPY – Requesting Agen

ORI: CA0010900 TYPE OF APPLICATION: PERMIT

Code assigned by DOJ

Job Title or Type of License, Certificate or Permit: __________________________________________________

Agency Address Set Contributing Agency:

OAKLAND POLICE DEPARTMENT 04764

Agency authorized to receive criminal history information Mail Code (five digit code assigned by DOJ)

455 7

Street

Address or P.O. Box

Officer John Romero

Contact Name (Mandatory for all submissions

OAKLAND, CA 94607

City, State, Zip

(510) 777-8578

Contact Number

NAME OF APPLICANT: _____________________________________________________________

(Please Print ) Last Name First Name Middle Initial

ALIAS: ____________________________________ DRIVER’S LICENSE # ____________________

Last Name First Name

DATE OF BIRTH: _______________________ SEX:  Male  Female Misc. No. BIL – 120181

HEIGHT: __________ WEIGHT: ______________ Misc. No: N/A

YE COLOR: __________ HAIR COLOR: _________ HOME ADDRESS: _______________________________

Street Address or P.O. Box

PLACE OF BIRTH: _______________________ ________________________________ _______

ity, State, Zip

SOCIAL SECURITY NUMBER: ______________________________________________________

YOUR NUMBER: ______________________________________ LEVEL OF SERVICE  DOJ  FBI

OCA No. (Agency Identifying No.)

f resubmission, list Original ATI Number; ______________________________________________________________________________

EMPLOYER:

(Additional responses for agencies specified by statute)

_________________________________________________________________

Employer Name

___

______________________________________________________________ Mail Code (five digit code assigned by DOJ: N/A

Street Address or P.O. Box

_________________________________________________________________ Agency Phone: _________________________________

City, State, Zip (optional)

LIVE SCAN TRANSMISSION COMPLETED BY: ____________________________________ Date: ______________

Name of Operator

___________________________________ ___________________________ __________________________

Transmitting Agency ATI No. Amount Collected/Billed

Cannabis Special Event Permit

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Cannabis Special Event Application Fillable 031519 (City of Oakland)

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Completed 21 July 2020

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