Fillable Form 534 Special Event Permit Application ( (City of Irwindale)

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Form 534 Special Event Permit Application ( (City of Irwindale)

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  • 12 check-boxes
  • 71 other fields

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Revised 11/07/2019 Page 1
Special Event Permit Application
City of Irwindale Community Development Department
5050 Irwindale Avenue • Irwindale, California 91706 • (626) 430-2208
By completing the information requested, this application will serve as a request for approval of a special event/temporary use
permit. Planning Division staff will assist you in completing this application and can be reached at (626) 430-2208. Planning
Division counter hours are 8:00 AM to 6:00 PM, Monday through Thursday.
The Planning Department requires that Special Event Permit Applications be completed and submitted for processing
and application fee paid at least thirty (30) calendar days prior to the date of the proposed event. PLEASE NOTE:
Applications submitted less than ten (10) calendar days prior to a proposed event WILL NOT
be accepted. Submission
of a Special Event Permit Application is not a guarantee that your event can be permitted. It is recommended that you
do not promote your event until you’ve received confirmation from the Community Development Department that your
event may proceed.
Event Information
Name of Proposed Event:
Location of Event:
Event Date(s) and Event Hours:
On-site Contact(s):
Please give a detailed description of the proposed event. (Attach separate sheets, if necessary.)
Please list all temporary equipment (e.g. tents, fencing, canopies, stages, seating equipment, carnival rides, ticket booths, food
booths, vendor booths, etc.) or temporary facilities (e.g. restrooms, etc.) that will be used in conjunction with this event. (Please
indicate the location of all temporary equipment and temporary facilities on the site plan.)
Will there be any type of entertainment (live or recorded)?
Y
N If yes, please provide specific details of the nature
of entertainment (e.g. names of entertainers, dates and hours of appearance, etc.) and attach a schedule of events.
Will this event consist of any vendors?
Y
(sales food or merchandise) that will be conducted during this event. In addition, provide a list of all vendor names, including
vendor business address, contact person’s name and telephone number. (Please indicate vendor locations on site plan.)
Will alcoholic beverages be sold or served during the event?
Y
N If yes, please indicate the date and hour that
alcoholic beverages will be available for consumption. (Please indicate the location of all alcoholic beverage booths on the site
plan.)
Is there an admission fee to this event?
Y
N If yes, what is the admission fee?
Are tickets being
sold in advance?
Y
N If yes, please indicate source of ticket sales.
Special Event Permit Application
Revised 11/07/2019 Page 2
Is there a parking fee for this event?
Y
N If yes, what is the parking fee?
(Please, attach a detailed plot plan of the parking site. Plan should include lane access and exits.)
Is this event being advertised?
Y
N If yes, please indicate the source of advertisement (e.g. radio, television,
newspaper, fliers, etc.)
Anticipated daily attendance:
The City of Irwindale requires private security at all special events. Please submit the company name and the proposed security
plan for this event. Plan must include security deployment for the event area, parking site, and traffic control.
Property Owner Certification
I certify that I am presently the legal owner of the above-described property. Further, I acknowledge the filing of this application
and certify that all of the above information is true and correct. (If the undersigned is different from the legal property owner, a
letter of authorization must accompany this form.)
Print Name and Title Signature
Address
Phone Number E-mail Address Date
Applicant Certification
Any false, misleading or fraudulent statement of material fact in the required application shall be grounds for denial of the
application for a special/temporary use permit.
I have used all reasonable diligence in completing this form. I have reviewed the form and to the best of my knowledge the
information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that
the foregoing is true and correct.
Print Name and Title Signature
Address
Phone Number E-mail Address Date
INDEMINIFICATION CLAUSE FOR SPECIAL EVENT PERMIT
The Applicant here after “Indemnitor” agrees to the following indemnification clause:
Indemnitor
shall indemnify, protect, defend and hold harmless the
City of Irwindale (City), its officers, officials, employees, agents and volunteers (“Indemnified Parties”) from and against any
and all damages to property or injuries to or death of any person or persons, and shall defend, indemnify, save and hold
harmless the City, its officers, officials, employees, agents and volunteers from any and all claims, demands, suits, actions or
proceedings of any kind or nature, including, but not by way of limitation, all civil claims, workers’ compensation claims, and all
other claims resulting from or arising out of the acts, errors or omissions of Indemnitor, its officers, agents and/or employees,
whether intentional or negligent, (collectively, “Claims”) in the performance of this Agreement. In addition to bearing the full cost
and expenses of defending the City, the Indemnitor shall indemnify, protect, defend and hold harmless the Indemnified Parties
from and against any and all losses, liabilities, damages, costs and expenses, including legal counsel’s fees and costs resulting
or related to any such Claims.
I HAVE READ AND UNDERSTAND THE ABOVE
DATE
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Special Event Permit Application
Revised 11/07/2019 Page 3
Minimum Requirement Checklist For SEP Filing
1. Completed Special Event Permit Application – Signed by applicant and property owner.
2. Completed and signed by applicant – “Indemnification Clause for Special Event Permit.” (SEP Application Page 2).
3. Attach a detailed site plan of the event; plan should include the following information (if applicable):
• Location of all temporary equipment
• Vendor Locations
• Parking site (Including lane access and exists)
4. Special Event Permit Application fee paid. Application cannot be accepted and processed until required fee is paid.
5. The applicant shall require all vendors that are expected to make any taxable sales transactions at this Irwindale
event to complete form BOR-530-B REV. 4 (10-98) LOCAL TAX ALLOCATION FOR TEMPORARY SALES
LOCATIONS AND CERTAIN AUCTIONEERS, and to submit the completed form to the California State Board of
Equalization.
6. The event organizer and all event vendors are required to obtain a City of Irwindale business license. Business
license applications must be filed online and have all fees paid prior to the event. Contact (626)430-2252 for additional
information. Apply online at http://www.irwindaleca.gov/index.aspx?NID=186.
7. The County of Los Angeles Public Health Department requires that the event organizer and all food vendors
(including restaurants) participating in the event must obtain a Temporary Food Facility (TFF) permit.
LA County Department of Public Health, Environmental Health Division: http://www.publichealth.lacounty.gov/eh/
Additional Requirements For Irwindale Speedway & Event Center (aka Irwindale Speedway) Filing
8. All Special Events shall be pre-approved by the City and shall take place in City-approved areas within the Irwindale
Speedway & Event Center site.
9. Attach a detailed site plan of the event; plan should include the following information (if applicable) :
• The base for this required site plan shall be the Irwindale Speedway & Event Center Site Plan of Record that was
approved by the City or a clear aerial image of the entire site.
• Description of the parking layout, vehicle circulation details, on-site traffic signage details, and drag strip layout for
review and approval by the Planning Department, Public Works/Engineering Department and
by the Police
Department.
10. Please Note: If the SEP application for proposed IEC event is submitted less than twenty (20) calendar days before
the event, Applicant shall pay an additional fee of $250.00 for each day the application is late. No SEP applications will
be processed if submitted less than ten (10) days in advance.
City Required Accounting For All Admissions And Parking Fees Collected
11. In accordance with Irwindale Municipal Code Section 3.04 the City charges an admissions tax upon every person
who pays an admission charge to any place located in the City limits. All Special Events that are charging an admissions
fee are required to pay, along with other required application
fees, an Admissions Tax deposit equal to 3% of the
projected gross income for the proposed event.
12. On or before the 15th day of the month following the special event, the applicant will give an accounting to the City of
all taxable admissions and parking fees collected for the special event by submittal of the completed “Admisisons Tax
Monthly Report” form
. The Admissions Tax deposit received will be credited towards any additional taxes owed. The
form can be found online on the City’s website under “Planning” at http://www.irwindaleca.gov/.
Cancellation Policy
1. Should Event Organizer, for any reason, need to cancel their event; they must provide a written notice of cancellation and
must be received in our office no later than ten (10) days prior to the event start date. Cancellations must be in written form;
verbal cancellations will not be accepted.
2. Please keep in mind that Permit Fees are non-refundable. It is also possible that fees related to Police, Security, and/or
Crossing Guard Services will still be incurred.
Additional Information
The City of Irwindale requires a Certificate of Insurance (COI) which must reflect the following.
• General liability insurance. Permitee shall maintain commercial general liability insurance with coverage at least as
broad as Insurance Services Office form CG 00 01, in an amount not less than $1,000,000 per occurrence, $2,000,000
general aggregate, for bodily injury, personal injury, and property damage. The policy must include contractual liability
that has not been amended. Any endorsement restricting standard ISO “insured contract” language will not be
Special Event Permit Application
Revised 11/07/2019 Page 4
accepted. The City of Irwindale, its officers, officials, agents, and employees shall be included as additional insureds
on the policy.
• Workers’ Compensation with limits of $1 million (Required if the insured has paid employees)
• Liquor Liability required if alcohol will be consumed at the event
• The Description of Operations/Locations, etc. section must include the name of, the location of and the date(s) of the
proposed special event.
• The Certificate Holder section must reflect:
City of Irwindale
5050 N. Irwindale Avenue
Irwindale, CA 91706
• Endorsements: In addition to the certificate of insurance, the City of Irwindale requires an Additional Insured
Endorsement page naming “The City of Irwindale, its elected officials, representatives, employees and agents”
as additional insured and “The policy is endorsed with the Waiver of Subrogation in favor of the City of Irwindale,
its elected officials, representatives, employees and agents.” You must provide a copy of the actual endorsement.
Listing the City as an additional insured on the COI is not sufficient.
• Policy must be issued by an admitted insurer licensed to transact business in the State of California and by an insurer
assigned an A.M. Best Rating “Excellent” or better.
This event may be subject to permits, conditions and requirements imposed by other agencies. The City of Irwindale will not
issue a special/temporary permit until all applicable permits from the following agencies have been applied for:
City of Irwindale Building & Safety Department (626) 430-2205
City of Irwindale Police Department (626) 430-2244, ext. 241
Los Angeles County Fire Department (626) 574-0949
Los Angeles County Health Department (626) 813-3380
Upon review of Applicant’s application, the City Manager will impose such fees, terms, conditions and restrictions upon the
operation and conduct of the special event or temporary use.
Required Fee With Application Submittal
$150 Irwindale resident SEP application fee.
$500 SEP application fee if application is submitted 20 days or more in advance of the event.
Late Fee: If the SEP application is submitted less than twenty (20) calendar days before the event, applicant shall pay
an additional fee of $250.00 for each day the application is late. No SEP applications will be processed if submitted
less than ten (10) days in advance.
This section is for City of Irwindale’s Use Only.
File No(s): Permit No.:
Received By: Receipt No.:
Date: Filing Fee:
Departmental Approvals Date Date
Human Resources/Risk Management Business License
Building & Public Safety
Police Department
Public Works/Engineering Fire Department
Special Event and Temporary Use Permit
Building and Safety Department checklist
Please provide the following on your site plan.
Answer the questionnaire at the column to the right. Where “YES” is checked, please
contact Building & Safety at (626)430-2205. Items below may be subject to City permit
approvals and inspections by the local building inspector.
PARKING LAYOUT
Is parking provided? YES NO
Requires accessible parking stall(s)
RESTROOM
Permanent restroom facility available for the public? YES NO
Requires accessible restroom
Portable restrooms provided? YES NO
Requires accessible portable restroom
GRANDSTAND, STAGE, PLATFORM
Elevated more than 30 inches above finished floor or ground? YES NO
TENT/CANOPY
Larger than 120 square feet? YES NO
Larger than 4,500 square feet? YES NO
STRUCTURES (I.E. SPEAKERS, CANOPIES, ETC.)
Greater than 12 feet in height? YES NO
PLUMBING, ELECTRICAL, MECHANICAL
Any proposed work related to plumbing, mechanical, and/or electrical? YES NO
Revised 11/07/2019
Page 5
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Completed 14 July 2020

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