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Oakland Cabaret License Application

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Oakland Cabaret License Application Powered By Docstoc
					                                                    CITY OF OAKLAND
                                           OFFICE OF THE CITY ADMINISTRATOR
                                                                      TH
                                          1 FRANK H. OGAWA PLAZA – 11 FLOOR
                                                   OAKLAND, CA 94612
                                                  PHONE: 510-238-3294


                                             CABARET APPLICATION
                                            General Cabaret Application


NAME OF BUSINESS: ___________________________________________________Permit # ____________

ADDRESS: _____________________________________________________________ ZIP: _____________

BUSINESS PHONE: ___________________________________BUSINESS FAX: ______________________

EMAIL CONTACT ADDRESS: ________________________________________________________________

CONTACT NAME: __________________________________________ PHONE: ________________________

OCCUPANCY: __________________________

Days and Hours of Proposed Operation:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

Will kitchen be open during the Extended Hours?        Yes            No

 Application is made by: _________________________________________________________________

                                     Individual            Partnership             Corporation

Please list all Partners, Officers and members of the Corporation: (should be same names listed on ABC application)


NAME: _____________________________________________________ DATE OF BIRTH: ___________________

TITLE: ______________________________________ CA DRIVER’S LICENSE No. _________________________

Residence: ____________________________________________________________________________________
            Address                                      City                      Zip

Business: _____________________________________________________________________________________
            Address                                       City                     Zip



NAME: _____________________________________________________ DATE OF BIRTH: ___________________

TITLE: ______________________________________ CA DRIVER’S LICENSE No. _________________________

Residence: ____________________________________________________________________________________
            Address                                      City                      Zip

Business: _____________________________________________________________________________________
            Address                                       City                     Zip


CABARET APPLICATION                                                                                               1
NAME: _____________________________________________________ DATE OF BIRTH: ___________________

TITLE: ______________________________________ CA DRIVER’S LICENSE No. _________________________

Residence: ____________________________________________________________________________________
            Address                                      City                      Zip

Business: _____________________________________________________________________________________
            Address                                       City                     Zip


   (Please use additional sheet if necessary)

   MANAGER INFORMATION:

   NAME                                                   WORK SCHEDULE




   The following items are attached:

 Copy of Business Tax Certificate                      Copy of Health Inspection
 Copy of Fire Inspection                               Copy of Public Group Assembly
 Live Scan completed for all                           Extended Hours Business/Security Plan
 Non-refundable Application Fee                        ABC Conditions


   I declare under penalty of perjury that all foregoing statements are true and correct. Any false
   statement shall be cause for revocation of any permitted issued under 5.12 to Title 5 of the Oakland
   Municipal Code.

   Signature of Applicant: ______________________________________________________

   Date: ____________________




Received by: ___________________________________________ Date: _____________________

Receipt No. _______________________

Copy sent to:
       Fire Department                          Chief of Police                  Office of the Mayor
       City Council District ___                City Council Rep. at Large       NSC ________
       ABAT                                     OPD Special Events




   CABARET APPLICATION                                                                             2

				
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