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APPLICATION FOR TEMPORARY USE PERMIT (TUP) Planning Division - (661) 267-5200 Case No.: 38250 Sierra Highway Palmdale, CA 93550 Date: (661) 267-5200 [EMAIL REDACTED] Received by: Fee: Please complete all sections of this form and submit the following information to the Planning Division. Information about how to get a permit and permit standards are on the last page of this application. All information must be received and the fees paid before the application can be processed. The application is to be filed with the Planning Division at least 30 days in advance of the event. ALL MAPS MUST BE FOLDED BY APPLICANT TO A MAXIMUM 8½” x 11” SIZE PLANS MAY ALSO BE PROVIDED ON 11” X 17” PAPER TEMPORARY USE PERMIT CHECKLIST Completed application The original Owner Authorization Letter One copy of a current Health Department permit (if applicable) One copy of the Certificate of Liability Insurance naming the City as additionally insured (if applicable) One copy of the Fire Department permit and a copy of the Certificate of Flame Resistance if a tent larger than 10’ x 10’ is being used One copy of the license issued by the State of California Department of Alcoholic Beverage Control (if applicable) One copy of ‘Responsible Beverage Service’ training for each person handling alcohol (if applicable) Two copies of a detailed site plan prepared in compliance with the Event Site Plan Checklist (attached) A vicinity map showing the existing major street patterns, railroads, and other significant landmarks within a minimum of one mile of the exterior boundaries of the site on 8½” by 11” paper. ---PAGE BREAK--- EVENT SITE PLAN CHECKLIST Applicant’s name, address, and telephone number Address of the event (if applicable) or Assessor’s parcel number North arrow Adjacent streets Site dimensions Delineation of the areas where alcohol is to be sold, dispensed and consumed Locations of planned security measures Indication of areas utilized for live entertainment/amplified music Proposed fencing (if required, identify type and height) Access to and from the site (show width) Parking (existing and proposed Dust control method (if use is located on undeveloped property) Any proposed structures or existing structures to be used for the temporary event (show dimensions and use). NOTE: A building permit will be required for tents and other temporary structures. An electrical permit is required for installation of electricity. Sanitary facilities - Type: Fire Department approval stamp ---PAGE BREAK--- APPLICATION FOR TEMPORARY USE PERMIT (TUP) Permit No.: Location of Event (Address if Available): Approximately Feet N or S of (Circle) (Street Name) Approximately Feet E or W of (Circle) (Street Name) Dates of event: to Set-up date: Strike-down date: Proposed hours of operation from: to Describe proposed activity; please specify all planned activities, and structures to be used. Will a tent or other structure be erected on site? Yes / No Will electricity be needed on site? Yes / No Will a fence be constructed? Yes / No Will food or drink be available on site? Yes / No Will alcoholic beverages be available on site? Yes / No Will a band or amplified sound be on site? Yes / No Will portable toilet facilities be on site? Yes / No Is this site located at an existing shopping center or other developed parking lot? Yes / No Is this site paved? Yes / No Is the paving striped for parking? Yes / No Does this site have a curb and gutter? Yes / No Does this site have an access driveway? Yes / No Is the site owned by the City? Yes / No APPLICANT: Name and Email: Contact Person: Address: City: State: Zip: Telephone No.: ( ) ORGANIZATION/REPRESENTATION: Name and Email: Address: City: State: Zip: Telephone No.: ( ) PROPERTY OWNER: Name and Email: Address: City: State: Zip: Telephone No.: ( ) (Revised 1/20) ---PAGE BREAK--- OWNER AUTHORIZATION LETTER TEMPORARY USE PERMIT NO.: ASSESSOR’S PARCEL NUMBER(S): 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 Signature Date Printed Name Signature Date 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. APPLICANT / APPLICANT’S REPRESENTATIVE: Printed Name Signature Date Address Telephone Printed Name Signature Date Address Telephone SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF NOTARY PUBLIC (Revised 1/20) ---PAGE BREAK--- TEMPORARY USE PERMIT STANDARDS AND APPROVAL PROCESS The following standards shall be adhered to for all Temporary Uses. All Temporary Use Permits must be reviewed by the following as applicable. The Planning Division will identify which department approvals are necessary based on the type of use proposed. PLANNING DIVISION: Obtain the temporary use and business license application forms and instructions regarding the requirements. Allow a minimum of two months for processing this application. Submittal shall include a completed Temporary Use Permit application form, 1 copy of required exhibits and permits, and payment of applicable fees as listed in the application check list. For information call (661) 267-5200. STATE OF CALIFORNIA ALCOHOLIC BEVERAGE CONTROL: All uses involving sale of alcoholic beverages will require a license from the State of California Department of Alcoholic Beverage Control. For information call (818) 901-5017. HEALTH DEPT.: All uses involving sale of food or drink will require a Health Dept. permit. Planning will require 1 copy of a valid health permit prior to issuing preliminary approval. For information call (661) 723-4533. No City inspection necessary. FIRE DEPT.: For any uses requiring Fire Dept. approval, applicant is required to contact the Fire Dept. and obtain an approval stamp on the proposed site plan prior to submittal of the TUP application. Planning will require 1 copy of the stamped site plan prior to issuing preliminary approval. For information call (661) 949-6319. Fire Dept. inspection may be necessary. DIVISION OF OCCUPATIONAL SAFETY AND HEALTH: For any uses involving mechanical rides, applicant is required to contact the Northern California amusement ride office and obtain an approval and inspection prior to the event. For information call (916) 263-3511. BUSINESS LICENSE DIVISION: All temporary uses will require a Business License and some uses will require a Business Permit. These documents must be displayed on site at all times during the event. BUILDING & SAFETY DIVISON: All uses involving electricity will require an electrical permit obtainable from the Building and Safety Division. Tents and amusement rides require building permits. All permits require a field inspection. For information call (661) 267-5353. PLANNING DIVISION: All temporary uses require a field inspection by Planning BEFORE being initiated. The planner will verify site clearance from (Revised 1/20) ---PAGE BREAK--- all departments and confirm conformance of the use to the approved site plan. For information call (661) 267-5200. NOTE: FOR ANY DEPARTMENT/DIVISION REQUIRING A FIELD INSPECTION, YOU MUST CALL FOR AND REQUEST AN INSPECTION NO LATER THAN 24 HOURS PRIOR TO INITIATING OPERATION OF THE TEMPORARY USE. PLEASE REMEMBER THAT CITY OFFICES ARE CLOSED EVERY FRIDAY. 2. Seasonal sales shall conform to the following schedules: a. Christmas Tree Sales: Shall be limited to the period of time between the Friday after Thanksgiving and December 25, both dates inclusive. No structures, including but not limited to poles, fences, lights, spray booths, and sheds shall be erected or maintained on the site, and no Christmas trees shall be delivered to the site, sooner than the Monday before Thanksgiving or later than December 30th. b. Pumpkin Sales: Shall be limited to the period of time between October 1st and October 31st, both dates inclusive. No structure, including but not limited to poles, fences, lights, and sheds, shall be erected or maintained on the site, and no pumpkins shall be delivered to or left on the site, sooner than September 20th or later than November 1st, unless a Temporary Use Permit has been requested for Christmas tree sales, subject to Palmdale Municipal Code Section 17.27.030.B.1.b 3. The site plan shall show all items on the application checklist and be located in a zone permitting the requested activity. 4. All signs shall conform to the PMC. A separate permit is required for all signage and approval will be required from the Planning and Building and Safety Divisions. 5. Sanitary sewer facilities, either portable or permanent, shall be provided. 6. The parking area used for the temporary event shall be located pursuant to the approved site plan, and clearly delineated for customers. 7. All unimproved parking areas and walkways shall be kept damp or shall be covered with a material to prevent the raising of dust. 8. The applicant shall provide safe and adequate roadway access including adequate vehicular sight distance at the driveway entrance/exit. 10. 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. ---PAGE BREAK--- 11. The temporary use shall not adversely affect the surrounding neighborhood by means of odor, noise, dust or other nuisances. 12. Written authorization from the property owner or their agent is required. 13. The lots used for temporary activities shall be completely cleared of all temporary structures and debris which resulted from such operation within five days after the termination of the activity. 14. A $500 bond or cash deposit, or other amount deemed necessary by the City, may be required for temporary uses 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. 15. If this use will involve animals (circus, carnivals, animal exhibits, etc.), please contact the Department of Animal Care and Control in Lancaster ([PHONE REDACTED]) at least two weeks before the event so that they can arrange for an inspection upon the animals’ arrival. Fair, rodeo, horse, or school events are exempt from the recently enacted state law (AB 1635). 16. If the use involves mechanical rides, all mechanical rides shall have the state approved sticker indicating that each amusement ride has been inspected and approved by the State of California. ---PAGE BREAK--- TEMPORARY USE PERMIT REVIEW FORM Permit No.: * * * * * * * * * * * * * * * * * * * * * * FOR OFFICE USE ONLY * * * * * * * * * * * * * * * * * * * PLANNING DIVISION REVIEW: Use Permitted? Yes / No Deposit Required: Yes / No Amount Required: $ Receipt No.: USE APPROVED? Yes / No Credit Account No.: 01-2616-0097 Reason for Denial/Comments/Special Conditions: NAME (PRINT) SIGNATURE DATE (Revised 1/20)