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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 2 Game Arcades/Coin Operated Games Business Permit Application REV. 10/11/22 GAME ARCADES AND COIN-OPERATED GAMES 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 phone number and email: If the business is advertised to the public and operates under a name other than the name of the applicant, 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. A full description of the intended business activity and, if a new business, the estimated starting date of such business activity: State the exact location within the business establishment where the game arcade or coin-operated machines will be located: The number of coin-operated machines for which a permit and license is being applied for: 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 2 Game Arcades/Coin Operated Games Business Permit Application REV. 10/11/22 OPERATING REQUIREMENTS: 1. Manager Required - A game arcade permittee shall employ a person on the premises to act as manager at all times during which the arcade is open. Such manager shall be permitted to Section 5.04.050. 2. Visibility of Interior - The permittee shall maintain the interior premises of the game arcade in a manner such that it is clearly visible from the entrance to the establishment in which the game arcade is located. Notwithstanding Subsection 2.a., if the game arcade is located in a physically segregated portion of the premises, the permittee shall maintain its interior in a manner such that it is clearly visible from the entrance into the game arcade. 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 SPECIAL CONDITIONS PLACED: Recommend ( ) Not Recommended ( ) Los Angeles County Sheriff’s Department: Signature Date Planning Manager: Signature Date