Fillable Riverside Police Department ENTERTAINMENT PERMIT APPLICATION (City of Riverside, California)

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Riverside Police Department ENTERTAINMENT PERMIT APPLICATION (City of Riverside, California)

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Riverside Police Department
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 - Entertainment $1,224.50 2 Years
Renewal - Entertainment $649.00 2 Years
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)
Entertainment with Dancing (Bar) Entertainment without Dancing (Bar)
Entertainment with Dancing (Restaurant) Entertainment without Dancing (Restaurant)
Karaoke/Open Mike Social Club
Pool/Billiard Hall 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:
Page 1 of 11
EPA 5.80_RPD-Vice 11/2019
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:
Page 2 of 11
*Attach additional pages if necessary
EPA 5.80_RPD-Vice 11/2019
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 11
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.
Premises Type
(Club, Restaurant, or Commercial Store)
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.)
EPA 5.80_RPD-Vice 11/2019
Page 4 of 11
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)?
EPA 5.80_RPD-Vice 11/2019
Page 5 of 11
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
EPA 5.80_RPD-Vice 11/2019
Page 6 of 11
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 5.80
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):
EPA 5.80_RPD-Vice 11/2019
Page 7 of 11
Section G - Proposed Entertainment Activities & Schedule
Entertainment - Restaurant Entertainment - Tavern (Bar) Entertainment - Other
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?
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:
Describe entertainment by performers:
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)
EPA 5.80_RPD-Vice 11/2019
Page 8 of 11
Section H - Declarations
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, to 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. I understand, acknowledge, consent and agree that with the issuance of the Entertainment Permit any
Conditional Use Permit for the premises is and will be deemed voided as for the entertainment only.
12. 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.
Print
Name:
Signature:
___________________
Date:
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Print
Name:
Signature:
___________________
Date:
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Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
Initials:
EPA 5.80_RPD-Vice 11/2019
Page 9 of 11
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 from a B occupancy with an occupant load less than fifty (50) persons to an A occupancy, (usually an
A-3) fifty (50) persons or more but less than 300, a floor plan with the above requirements must be
submitted to the 3rd floor Planning and Building Department, Plan Check Engineer. 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.
EPA 5.80_RPD-Vice 11/2019
Page 10 of 11
PROPERTY OWNER CONSENT AND AUTHORIZATION
OF 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
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 5.80
("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.
EPA 5.80_RPD-Vice 11/2019
Page 11 of 11
Riverside Police Department
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
)
EPA 5.80_RPD-Vice 11/2019
Riverside Municipal Code, Section 5.80, states you must have a valid 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 Entertainment. Copies of the application for the 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 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
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, the following
are required: Zoning Approval, Fire Marshall Approval, and Building & Safety Approval.
Riverside Police Department
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
FEES: (Credit/Debit Card or Cash/Check/Money Order Payable to City of Riverside)
$1,224.50 Entertainment Permit Fee (New Business/Change of Ownership)
$649.00 Entertainment Permit Renewal Fee every two (2) years
Entertainment Permits must be renewed every two years. 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 $1,224.50.
*All original Application documents; including original notarized acknowledgement must be
turned in with the completed application.
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) 826-5737
Building & Safety Approval Building & Safety - Telephone: (951) 826-5697
EPA 5.80_RPD-Vice 11/2019
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Riverside Police Department ENTERTAINMENT PERMIT APPLICATION (City of Riverside, California)

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Completed 25 February 2021

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