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Riverside Police Department (City of Riverside, California)

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Riverside Police Department
ADULT ENTERTAINMENT
PERMIT APPLICATION
Application Instructions
Complete the application and all accompanying forms legibly in black or blue ink. Forms completed in pencil
will be returned. All authorized individuals must sign and date the forms, where applicable. Incomplete
applications will not be accepted.
Submit all completed paperwork to: Riverside Police Department - 4102 Orange Street, Riverside, CA 92501
Tuesday through Thursday by appointment only between the hours of 10:00 AM to 4:00 PM.
Questions or to schedule an appointment contact Special Investigations Bureau
Telephone: (951) 353-7206
E-mail: RPDVice@riversideca.gov
Permit
Application Fee (Total) Valid
New - Adult Entertainment $919 1 Year
Renewal - Adult Entertainment $584 1 Year
The application will be reviewed by Business Tax License, Planning Division, Building & Safety Division,
Fire Department, and Police Department.
For complete application process, visit www.riversideca.gov/RPD/Permits
Section A - Entertainment Type (check all that apply)
Adult-Oriented Bookstore Adult-Oriented Theater (Live Performances)
Adult-Oriented Cabaret Adult-Oriented Rental Establishment
Adult-Oriented Motion Picture Arcade Social Club
Adult-Oriented Motion Picture Theatre Other:
Section B - Business Information
Corporation Limited Liability Company (LLC) General Partnership
Limited Partnership
Limited Liability Partnership (LLP)
Sole Proprietorship
Applicant Name (Legal Ownership Structure):
Business Name (DBA): Place and Date of Filing of DBA:
Business Site Address:
Taxpayer Identification
Number:
Type:
Secretary of State of
Registration Entity ID:
(If Applicable)
SSN/ITIN EIN NIN
Applicant/Business Phone: Applicant/Business Email Address:
Mailing Address:
AEP_9.40_ RPD-Vice 10/2019
Page 1 of 12
Section C - Owner(s) Information
Last Name: First Name:
Home Address:
Phone: Email:
Business Title: Percentage Owned:
Date of Birth: Place of Birth:
Government Issued ID
Number: Issuing State:
Last Name:
First Name:
Home Address:
Phone: Email:
Business Title: Percentage Owned:
Date of Birth: Place of Birth:
Government Issued ID
Number: Issuing State:
Last Name:
First Name:
Home Address:
Phone: Email:
Business Title:
Percentage Owned:
Date of Birth: Place of Birth:
Government Issued ID
Number: Issuing State:
Last Name:
First Name:
Home Address:
Phone: Email:
Business Title:
Percentage Owned:
Date of Birth: Place of Birth:
Government Issued ID
Number: Issuing State:
*Attach additional pages if necessary
AEP_9.40_ RPD-Vice 10/2019
Page 2 of 12
Section D - Owner Disclosures
1.
Has any owner ever been convicted of a misdemeanor involving moral turpitude, or entered
into a plea of guilty or nolo contendere to, any felony in the United States or a
foreign country within the past 5 years?
2. Has any owner ever had a City of Riverside Permit suspended or revoked?
3. Has any owner ever been denied a business license by the City of Riverside?
If you answered “Yes” to any of the questions above, please provide a written statement detailing the date(s)
and circumstances of such convictions, pleas of guilty or nolo contendere, sanctions, fines, denials,
suspensions, or revocations, including, but not limited to, specific offenses and/or violations, agency
involved, name of any business names, and account numbers.
Yes No
Section E - Property Information
Is the business located in the Downtown Entertainment District (D.E.D)?
Yes No
Is the location: Owned? Rented/Leased?
Yes NoYes No
If rented/leased, provide the name and contact information of the property owner(s) below.
Property Owner Name:
Property Owner Phone:
Property Owner Email Address:
Page 3 of 12
Section F - General Operating Conditions
Note: Attach additional pages if necessary
Alcohol/Food/Additional Businesses
1. Will liquor be sold on the premises?
Yes No
License Type
Alcohol Beverage Control
License No.
On sale beer
On sale beer and wine
On sale distilled spirits
2. Is food being sold on the premises?
Yes No
If yes, list types of food sold:
3. Is a bonafide-eating place provided on the premises?
NoYes
(Bonafide eating place means a place which is regularly used for serving meals for compensation, which has
suitable kitchen facilities containing conveniences for cooking an assortment of foods for ordinary meals
other than fast foods, sandwiches or salads. The kitchen must contain proper refrigeration for food and must
comply with all applicable regulations of the Health and Human Services Department.)
AEP_9.40_ RPD-Vice 10/2019
Page 4 of 12
4. Are non-alcoholic beverages sold?
Yes No
5. How many tables for seating?
6. Are other types of businesses conducted on the premises?
Yes No
If yes, list type(s):
7. Are pool tables provided?
NoYes
If yes, indicate how many:
If your business has more than two (2), provide copy of Pool Hall Permit with this application.
8. Is VIP/Bottle service provided?
Yes No
9. What is the occupancy for establishment set by Fire Marshall?
Hours of Operation
Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Open
(AM/PM)
Close
(AM/PM)
Admission and/or Membership Fees
10. Will minors be allowed on the premises?
Yes No
11. Will the premises be open to the general public?
Yes No
12. Will a "Cover Charge" be charged?
Yes No
If yes, describe the cover charge
schedule:
13. Is there a private area for exclusive use of members and their guests only?
NoYes
If yes, types of membership fees:
14. Will guests of members pay an admission fee or other charges?
NoYes
If yes, describe the fee schedule and other
charges:
Proximity of Businesses and Residences
15. Are there surrounding businesses?
Yes No
If yes, what type(s)?
AEP_9.40_ RPD-Vice 10/2019
Page 5 of 12
If yes, approximately how close:
(How many feet away?)
16. Are there surrounding residences?
NoYes
Parking Facilities and Arrangements
17. Is parking available?
NoYes
If yes, how many parking spaces?
If no, what is the street address of the off-premises parking facility?
18. Days and hours parking facility will be available:
Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Open
(AM/PM)
Close
(AM/PM)
Security
19. Will security guards be provided?
Yes No
If yes, number of security guards?
20. If applicable, provide Proprietary Security Employer License (PSE) number:
21. Provide list of Proprietary Security Officer (PSO) employees:
Employee Name PSO License #
*Attach additional pages if necessary
AEP_9.40_ RPD-Vice 10/2019
Page 6 of 12
22. Days and hours security guards or other security will be provided (fill out completely):
Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Open
(AM/PM)
Close
(AM/PM)
23. Will a private security firm be used?
NoYes
If yes, provide the following information of the contracted security firm:
Firm
Name:
City of Riverside
Business License No:
Address:
Phone: Email:
24. Provide a list of all members with access to the surveillance camera system to be used. Refer to RMC
Code 9.40
Employee Name(s) with access to surveillance camera system:
25. Provide a detailed description of the security plan for the proposed business during the scheduled hours
of entertainment (Attach additional pages if necessary):
AEP_9.40_ RPD-Vice 10/2019
Page 7 of 12
Section G - Proposed Entertainment Activities & Schedule
Proposed Entertainment Activity: Yes No
Outdoor Entertainment?
Dancing by patrons, guests, customers, participants, attendees?
Dancing by performers?
Live music by more than two (2) performers?
Amplified music (recorded)?
Disc Jockey?
Karaoke?
Adult Entertainment as defined by RMC Section 19.240?
Adult Entertainment as defined by RMC Section 9.40?
Full Nude?
Partial Nude?
Will the establishment serve as a family pool/billiard hall as provided in RMC Section 5.28?
Any other type of entertainment not listed above?
If yes, briefly describe the entertainment activity:
NoYes
If yes, provide dimensions of dance floor: L x W
= sq ft
Dance Floor?
NoYes
If yes, provide dimensions of stage: L x W
= sq ft
Stage?
Describe floor material and surface type:
Proposed Entertainment Schedule:
Please provide the days and times of the week that you would like to have entertainment at your
establishment. Please fill out completely. If you do not wish to have entertainment on a certain day, mark N/A.
Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Open
(AM/PM)
Close
(AM/PM)
Describe entertainment by performers:
AEP_9.40_ RPD-Vice 10/2019
Page 8 of 12
Section H - Declarations
Print
Name:
Signature:
___________________
Date:
R
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h
t
T
h
u
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b
Print
Name:
Signature:
___________________
Date:
R
i
g
h
t
T
h
u
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b
1.
I hereby declare that I am authorized to submit this application on behalf of the entity or individual listed
on the application because I am an owner of the entity, I have authority from the owner or am the owner.
2. I acknowledge that any false, misleading, or fraudulent statement of material fact in this application by
an
agent of an owner, or an owner, will be held against the owner and is grounds for denial of this
application,
or suspension or revocation of the permit associated with this application.
3. I hereby declare that I have read and understand all the laws, rules and regulations, and policies and
procedures associated with this application; and that I fully understand the nature, meaning, and
content of such laws, rules, and policies. I warrant and represent that I will adhere to all laws, rules,
and policies during the application process and after a permit is issued by the City.
4. I hereby declare that I have conducted my own research and investigation regarding the compliance of
the proposed location with state and local laws, including, but not limited to, location requirements,
zoning regulations, and address requirements. I further declare that the proposed location of the
Entertainment Permit fully complies with applicable state and local law.
5. I acknowledge that any promise, representation, or any other statement made to me by any agent or
employee of the City that is not contained within this application is null, void, and unenforceable and
that I am not relying on any such promise, representation, or statement.
6. I acknowledge the City will review this application for compliance with applicable laws, regulations, and
ordinances, and that this application may be denied as allowed by laws, rule, or policies of the City.
7. I acknowledge that this application does not confer an entitlement or a vested right to receive a permit,
and I acknowledge that I must follow all rules and procedures to obtain a permit prior to operating or
otherwise claiming that I have any such right to a permit or to operate.
8.
I hereby declare that I have read this acknowledgement and advisement, that I have had the opportunity
to consult with, and be represented by, legal counsel of my own choice prior to the execution and
submission of this application, and that I am knowingly and voluntarily submitting this application in
compliance with this acknowledgement and advisement and all applicable laws.
9.
I acknowledge that I am jointly and severally liable for any and all taxes, fees, and charges associated with
the permit.
10.
I consent for the City of Riverside, by and through its appropriate officers, agents, and employees to verify
and confirm the information contained in this application, and to conduct such other investigations as may
be reasonably required by the City of Riverside, its officers, agents, and employees for the purpose of
determining the capability, fitness, and capacity of the applicant to obtain the Entertainment Permit.
11. All changes to Operations requires Police Department notice within 10 business days.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
AEP_9.40_ RPD-Vice 10/2019
Page 9 of 12
Section I - Application Attachments
Staff
Only
All Applications
Copy of your Statement of Information
Copy of CA Seller's Permit
Copy of Alcoholic Beverage Control License with conditions
Copy of Fictitious Business Name Filing, if applicable
Property Owner Authorization of Entertainment Activities
If the applicant is the owner of the property, include a copy of the Title or Deed to the property
Copy of Property Owner's City of Riverside Business Tax License
Interior Floor Plan to include:
a. Dimensions of interior floor plan
b. Location inside the establishment where entertainment activities will be taking place
c. Indicate locations of all exit doors, include widths of doors, and panic hardware
d. All fixed seating throughout
e. Dance floor dimensions and type of flooring materials used
f. If a stage is to be added, give exact measurements including height, location, and
materials used
Parking Agreement/Parking Plan (if using a parking facility that is not part of the business
premises)
If you have any questions as to your occupant load, or if your business will change because of a change in
use a floor plan must be submitted to the 3rd floor Planning and Building Department, Plan Check
Engineer. Your business must meet the requirements under RMC Section 19.240.
For more information, please contact the Planning and Building Department at (951) 826-5371.
These additional requirements may be applicable:
1. Handicapped requirements may apply.
2. All Fire Department approvals to be obtained.
3. Electrical plan check and permit may be required for exit path illumination.
AEP_9.40_ RPD-Vice 10/2019
Page 10 of 12
PROPERTY OWNER CONSENT AND AUTHORIZATION
OF ADULT ENTERTAINMENT ACTIVITIES
I, , declare under penalty of perjury that:
(Name of Property Owner/ Authorized Representative)
1. I am the Property Owner of record, or the duly authorized representative of the Property
Owner, for the real Property located at (“the
Property”)
2. The Property Owner acknowledges and consents to the business,
, conducting the
Tenant Applicant (Corporation/LLC/Partnership/Sole Owner)
proposed entertainment activities as indicated on Page 7 of the City of Riverside Annual
Adult Entertainment Permit Application at the Property.
3. No person shall engage in any entertainment activities on the proposed Property without all
licenses and permits required by the Riverside Municipal Code (RMC) while an entertainment
application is pending.
4. The City of Riverside may enter the property to conduct inspections of the Property during the
application process in order to thoroughly investigate whether an entertainment permit should
be granted.
5. I have read, understand,and will ensure compliance with the terms in RMC Section 9.40
("Adult Entertainment and Similar Activities"), as applicable. I further understand that as the
legal owner of the property, I am responsible for any violation and nuisance activity which
may occur at the above-mentioned property.
I certify
under penalty of perjury under the laws of the State of California that the foregoing is true
and correct.
(Signature of legal owner/owner representative) (Printed Name & Title)
(Date)
(Signature of legal owner/owner representative)
(Signature of legal owner/owner representative)
(Printed Name & Title)
(Printed Name & Title)
(Date)
(Date)
*This authorization form will not be valid without notarization. The authorization form
automatically expires upon sale or transfer of the property to a new legal owner. If sale or
transfer of the property occurs prior to the applicant obtaining an entertainment permit, the
applicant must resubmit this notarized form with approval of the new legal owner of the
property.
AEP_9.40_ RPD-Vice 10/2019
Page 11 of 12
Riverside Police Department
ADULT ENTERTAINMENT PERMIT
APPLICATION
NOTARY ACKNOWLEDGMENT
CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
)State of California
County of ______________________________
On _________________________ before me, _____________________________________________,
Date Here Insert Name and Title of the Officer
personally appeared __________________________________________________________________
Name(s) of Signer(s)
__________________________________________________________________________________,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/
her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature _________________________________
Place Notary Seal and/or Stamp Above
Signature of Notary Public
)
AEP_9.40_ RPD-Vice 10/2019
Each of the following must be initialed by the Business Owner*:
Page 12 of 12
1.
I have received and reviewed a copy of Chapter 9.40 (Adult-Oriented Businesses) of the Riverside
Municipal Code (RMC) and the information checklist relating to the Adult-Oriented Business.
2. I have submitted a site plan with this application designating the building and/or unit proposed for
the proposed Adult-Oriented business, and a dimensional interior floor plan depicting how the
business will comply with all applicable requirements of Chapter 9.40 of the Riverside Municipal
Code. (RMC 9.40.050(H) and RMC 9.40.050(I))
3. I have submitted this application describing the proposed business and explaining in detail how
the business will satisfy the applicable requirements of the Riverside Municipal Code Section
9.40.050(D).
4. I am familiar with and understand the provisions of Chapter 9.40 of the Riverside Municipal Code
applicable to the proposed Adult-Oriented Business, including the following:
it is a misdemeanor for any person under the age of eighteen to enter or remain on the
premises of an Adult-Oriented Business at any time. A sign giving notice of this provision
must be posted at each entrance of the business. Every person having responsibility for the
operation of the Adult-Oriented Business who, with knowledge that a person is a minor
(under the age of eighteen), who fails to exercise reasonable care in ascertaining the true
age of a minor, knowingly allows such minor to enter or remain on the premise of the
business is guilty of a misdemeanor. (RMC 9.40.130(F))
5. An Adult-Oriented Business permit is valid from the date of permit approval as long as the
application and Adult-Oriented Business remain in compliance with the conditions of the permit
and provisions of Chapter 9.40 of the Riverside Municipal Code. (RMC 9.40.070)
6. Any changes in the nature of composition of the Adult-Oriented Business from one type of Adult-
Oriented Business use to another type of Adult-Oriented Business use will render the Permit null
and void. (RMC 9.40)
7. An Adult-Oriented Business Permit is valid only for the exact location specified in the permit.
(RMC 9.40)
8. The Adult-Oriented Business Owner must allow officers of the City of Riverside and their
authorized representatives to conduct reasonable unscheduled inspections of the premises of
the Adult-Oriented Business for the the purpose of ensuring compliance with the law at any time
the Adult-Oriented Business is open for business or is occupied; provided the identification of the
City representative may be required. (RMC 9.40.160)
I understand that providing incorrect, false or misleading information is grounds for denial of this application
and revocation for the Adult-Oriented business permit. I understand that the operation of the aforementioned
business must comply with the provisions of Chapter 9.40 of the Riverside Municipal Code. (RMC 9.40.100(D)(1))
I declare under penalty of perjury that I am the owner* of the proposed Adult-Oriented business, that all of
the information upon this application, including the information submitted with this application, is true and
correct to the best of my knowledge and belief.
Business Owner Signature
Title
(Date)
Print Name
*the "Owner" (i) is the sole proprietor of the Adult-Oriented Business; or (ii) any general partner of a partnership which
owns and operates the Adult-Oriented Business; or (iii) the owner of a controlling interest in a corporation which owns
and operates the Adult-Oriented Business; or (iv) the person designated by the officers of a corporation to be the
Permit holder for the Adult-Oriented Business owned and operated by the corporation.
AEP_9.40_ RPD-Vice 10/2019
Riverside Municipal Code, Section 9.40, states you must have a valid Adult Entertainment permit to
operate a business designated as police regulated. You are responsible for being familiar with and
complying with the rules and regulations related to Adult Entertainment. Copies of the application for
the Adult Entertainment Permit may be obtained from the City of Riverside Police Department located at
4102 Orange Street Riverside, CA 92501 (951) 353-7614 or online at www.riversideca.gov/RPD/Permits.
Note: Regulation and enforcement will continue to be performed by the Riverside Police Department.
The granting of an Adult Entertainment Permit does not relieve the applicant from obtaining all
appropriate approvals required by the City of Riverside, State, or Federal law. The granting of a permit
does not relieve a permittee's obligation to comply with all applicable Local, State, and Federal laws,
including those related to building, zoning, fire, and other public safety regulations. The granting of an
Adult Entertainment Permit does not vest any development rights in the property or business (RMC). In
order to legally operate your business and to establish that your business location is suitable, it is
strongly recommended that you first obtain the following:
Riverside Police Department
ADULT ENTERTAINMENT PERMIT
APPLICATION INFORMATION SHEET
YOU MUST PROVIDE ALL OF THE REQUESTED INFORMATION WHEN APPLYING
INCOMPLETE APPLICATION PACKETS WILL NOT BE ACCEPTED
Submit all completed paperwork to the:
Riverside Police Department - 4102 Orange Street, Riverside, CA 92501
Tuesday through Thursday by appointment only between the hours of 10:00 AM to 4:00 PM.
Questions or to schedule an appointment contact Special Investigations Bureau
Telephone: (951) 353-7206
Email: RPDVice@riversideca.gov
The following approvals can be obtained at Riverside City Hall - One Stop Shop located:
3rd Floor 3900 Main Street, Riverside, CA 92501
Zoning Approval Planning Department - Telephone: (951) 826-5371
Fire Marshall Approval Riverside Fire Marshall - Telephone: (951) 826-5697
Building & Safety Approval Building & Safety - Telephone: (951) 826-5737
FEES: (Credit/Debit Card or Cash/Check/Money Order Payable to City of Riverside)
$919 Adult Entertainment Permit Fee (New Business/Change of Ownership)
$584 Adult Entertainment Permit Yearly Renewal Fee
$32 Department of Justice Live Scan Fee
Adult Entertainment Permits must be renewed every year. There is no grace period for permit
renewals. Permit renewal applications must be received prior to expiration of your existing permit or
you will have to re-apply and the full permit fee of $919.
*All original Application documents; including original notarized acknowledgement must be turned in
with the completed application.
AEP_9.40_ RPD-Vice 10/2019
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Completed 25 February 2021

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