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Business License 38250 Sierra Highway Palmdale, CA 93550 661/247-8384 661/267-5434 [EMAIL REDACTED] [EMAIL REDACTED] Page 1 of 3 Carnival/Concession Business Permit Application REV. 10/11/22 CARNIVAL OR CONCESSION PERMIT APPLICATION This Application is for (check one) New Permit Annual Renewal Business Name: (If a Corporation, the name shall be as set forth in its Articles of Incorporation) Business Address: Business Telephone number and Email: If the business is advertised to the public and operates under a name other than the name of the applicant, please list such other name or designation: If a corporation, the names and addresses of all directors, any stockholder holding 10% or more of the shares, and the name and address of an officer who is duly authorized to accept service of legal process. If a corporation, the applicant shall provide a copy of its articles of incorporation. Please list the exact location of the intended carnival or circus: Please list the proposed dates and hours of operation: Please list the names of all agents and employees involved in the operation and management of the carnival and a similar list of agents and employees involved in the conduct of the concession if the permit application is for a concession. The names, addresses and telephone numbers of at least two individuals who may be contacted by the City in case of an emergency: ---PAGE BREAK--- Business License 38250 Sierra Highway Palmdale, CA 93550 661/247-8384 661/267-5434 [EMAIL REDACTED] [EMAIL REDACTED] Page 2 of 3 Carnival/Concession Business Permit Application REV. 10/11/22 OTHER REQUIREMENTS TO BE SUBMITTED WITH APPLICATION: 1. A detailed schedule of the concessions to be presented by the applicant at the carnival, including the various fees to be charged, the names of the persons in charge of each concession, and the rules for the operation of each such concession. 2. Copies of all contracts, agreements or other written memoranda between the applicant and any other person with respect to the operation of each concession at the carnival, including a statement as to disbursement, “split” or other apportionment of the proceeds between the applicant and any other person. 3. A detailed description of the mechanical devices or equipment owned by or under the control of the applicant to be used in the operation of the carnival or concession. 4. Copies of all policies and binders of liability insurance, including, but not limited to, vehicle, public, product and professional, and workers’ compensation insurance held by the applicant. 5. Copies of the applicant’s rules and regulations governing the operation of the carnival or concession. 6. Proposed date, time and location for on-site inspection by interested City or County departments prior to the commencement of the carnival or concession. 7. A statement that the applicant agrees to operate the carnival or concession in strict accordance with the provisions of this Section and all other applicable laws and assumes full responsibility for the lawful and safe operation of the carnival or concession. 8. Where the applicant for a carnival or concession permit is not the sponsor of the carnival or concession, the name, address and telephone number of each sponsor and a detailed description of the functions, responsibilities, and obligations of any such sponsor in the operation of the carnival or concession. THE APPLICATION FOR PERMIT SHALL BE FILED AT LEAST 60 DAYS PRIOR TO THE COMMENCEMENT OF ANY CARNIVAL. A CARNIVAL OR CONCESSION MAY ONLY OPERATE BETWEEN THE HOURS OF 10:00 a.m. AND 10:00 p.m. ---PAGE BREAK--- Business License 38250 Sierra Highway Palmdale, CA 93550 661/247-8384 661/267-5434 [EMAIL REDACTED] [EMAIL REDACTED] Page 3 of 3 Carnival/Concession Business Permit Application REV. 10/11/22 INSURANCE REQUIREMENTS: Every applicant for a carnival permit shall obtain and maintain in full force and effect public liability insurance in conformance with Section 5.04.240 of this Chapter. The liability coverage shall be in the amount of 5,000,000. PLEASE SUBMIT A COPY WITH THIS APPLICATION CONDITIONS OF APPROVAL: 1. The zone in which the carnival is proposed to be conducted has been approved by the Planning Division and will not be detrimental to the public health, safety and welfare. 2. The carnival is not located within 500 feet of a residential neighborhood, or the carnival operator has received the written consent of more than 50% of the owners and tenants of any residences located within 500 feet of the carnival site. 3. The applicant will adequately provide for the maintenance and cleanliness of the carnival site prior to, during, and upon closing of the carnival. I declare under penalties of perjury that this application is true and correct to the best of my knowledge and belief. Signature Title Date OFFICE USE ONLY Recommend ( ) Not Recommended ( ) Los Angeles County Sheriff’s Department: Signature Date Planning Manager: Signature Date