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1 APPLICATION FOR FIREWORKS BOOTH TEMPORARY USE PERMIT (TUP) Planning Division - (661) 267-5200 38250 Sierra Highway, Palmdale, CA 93550 [EMAIL REDACTED] Please complete all sections of this form and submit the following information to the Planning Division no later than April 1. Verify that the information (i.e. address of booth) on this paperwork is the same as on the Business License paperwork. All the paperwork should match! INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. TEMPORARY USE PERMIT CHECKLIST Fee of $299. A $500 deposit is required for all events on undeveloped land. 1 copy of the Owner’s Letter of Authorization. 1 copy of the Certificate of Liability Insurance. 1 copy of the State Fire Marshal Retail Fireworks License sticker. 1 original stamped copy of the Site Plan by the L.A. County Fire Department. 1 copy of the vicinity map demonstrating: subject parcel, major streets, adjoining businesses, railroads, etc. Please check all that apply: Will a tent or other structure be erected on site? Y e s N o Will a generator be used on site? Y e s N o Will a temporary power pole be used on site? Y e s N o Will food or drink be available to the public on site? Y e s N o Will amplified sound be on site? Y e s N o Will portable toilet facilities be on site? Y e s N o Is the site City-owned property? Y e s N o Is this site located within a developed shopping center? Y e s N o Is this site paved? Y e s N o Is the paving striped for parking? Y e s N o SITE PLAN CHECKLIST Completed non-profit organization, firework’s distributor, and property owner information. Site address or Assessor’s Parcel Number (APN) of booth’s actual location. Adjacent buildings and structures as well as adjacent streets. North arrow. Ingress (show width) and egress (show width) of traffic to and from booth location. Actual location of fireworks booth. NOTE: Building permit and electrical permit may be required. City Use Only TUP No.: ---PAGE BREAK--- 2 SITE LOCATION DEVELOPED LAND, provide exact address and APN (information must be the same as stated on the Fireworks Permit Application): -OR- VACANT land, the APN must be provided: N or S of (Street Name) E or W of (Street Name) NON-PROFIT ORGANIZATION INFORMATION: Name of Organization (do not abbreviate): Contact Person: Address: City: State: Zip: Email: Telephone No.: Fax No.: FIREWORKS DISTRIBUTOR INFORMATION: Business Name: Contact Person: Address: City: State: Zip: Email: Telephone No.: Fax No.: PROPERTY OWNER INFORMATION: Name: Point of Contact (if applicable): Address: City: State: Zip: Email: Telephone No.: Fax No.: ---PAGE BREAK--- 3 OWNER AUTHORIZATION LETTER FIREWORKS BOOTH TEMPORARY USE PERMIT ADDRESS OR APN: If the applicant is not the owner of record, then a letter authorizing the applicant to represent the owner(s) must be submitted. Note: All owners must sign as their names appear on the deed to the land. This letter shall serve to notify and verify that I/we am/are the legal owners of the property described and attached hereto and do hereby authorize the applicant to file and represent my/our interest in the above referenced applications(s). I/we have read this Letter of Authorization and know the contents thereof; and so hereby certify (or declare) under penalty of perjury under the laws of the State of California that the information contained in the above referenced application(s) is true and correct. OWNER(S) OF RECORD (Include extra sheets if necessary): Printed Name: Title: Address: Telephone: City: State: Zip: Signature: Date: Email: APPLICANT / APPLICANT’S REPRESENTATIVE: I certify under penalty of perjury that I am the applicant and that the foregoing statements and answers herein contained and the information herein submitted, are in all respects true and correct. Printed Name: Title: Address: Telephone: City: State: Zip: Signature: Date: Printed Name: Title: Address: Telephone: City: State: Zip: Signature: Date: ---PAGE BREAK--- 4 FIREWORKS TEMPORARY USE PERMIT APPROVAL PROCESS FIRE DEPT.: Applicant is required to contact the Fire Department and obtain an approval stamp on the proposed site plan prior to submittal of the TUP application. All booths must be inspected by the Fire Department prior to opening: For information, call (661) 537-2901. HEALTH DEPT.: Sale of food or drink will require a Health Department permit. If applicable, Planning will require 1 copy of a valid health permit. For information, call (661) 723-4533. PLANNING DIVISION: Applicant is required to obtain Temporary Use Permit application, instructions, and approval prior to opening. For information, call (661) 267-5200. BUSINESS LICENSE: All fireworks booths require a Business License. Documents must be displayed on site at all times during the event. For information, call (661) 267-5434. BUILDING & SAFETY DIVISION: Unless power is provided via a generator, Building and Safety will require a permit. Please contact the Building & Safety Division early in the application process to verify permit requirements. For information, call (661) 267-5353. CODE ENFORCEMENT: The Code Enforcement Officer verifies site clearance from all departments and confirms conformance of the use to the approved site plan. An inspection will be made after fireworks have been delivered to the booth and the Fire Department has completed their inspection. A field inspection is required by Code Enforcement BEFORE you can begin selling any products. For information, call (661) 267-5234. * * * * * * * * * * * * * * * * * * * * * * * * * * * FOR OFFICE USE ONLY * * * * * * * * * * * * * * * * * * * * * * * * * Permit No.: Organization: Distributor: L.A. COUNTY FIRE DEPARTMENT: A site inspection completed on at confirmed that the site is in compliance with the Los Angeles Fire Department. Comments: Name of Inspector: Signature: Date: CODE ENFORCEMENT: A site inspection completed on at confirmed that the site is in compliance with the Conditions of the Temporary Use Permit referenced above and City codes. All necessary permits and licenses have been posted or otherwise verified. Comments: Name of Officer: Signature: Date: ---PAGE BREAK--- 5 FIREWORKS TEMPORARY USE PERMIT STANDARDS Please read the following information carefully. The following standards shall be adhered to for all Fireworks Sales pursuant to Ordinance No. 892 of the City of Palmdale. 1. Dates of Operation: Occupancy and sales shall be limited to the period of time between noon on June 28 and noon on July 5, once all approvals have been obtained. No structures or fireworks shall be left on site after July 6. 2. Sanitary sewer facilities, either portable or permanent, shall be provided. 3. The parking area used for fireworks sales shall be located pursuant to the approved site plan, and clearly delineated for customers. 4. All unimproved parking areas and main walk areas shall be kept damp or shall be covered with a material to prevent the raising of dust. 5. Applicant shall provide safe and adequate roadway access including adequate vehicular sight distance at the driveway entrance/exit. 6. In no event shall any portion of the proposed use encroach onto any public rights-of-way, or be located in a way which might cause a hazard. 7. The temporary use shall not adversely affect the surrounding neighborhood by means of odor, noise, dust or other nuisances. 8. Written authorization from the property owner or their agent is required. 9. A $500 bond or cash deposit, or other amount deemed necessary by the City, will be required for undeveloped sites to assure clean-up. The deposit shall be returned upon written request of the applicant following verification of site clean-up, and removal of temporary structures. Any expense incurred by the City for clean-up of the subject property shall be deducted from the deposit and the remainder returned to the applicant. 10. Booths shall not be located closer than 300 feet to another fireworks booth.