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818-937-8300 APPLICATION FOR ARCADE DEVICES AND/OR ARCADE ESTABLISHMENT TITLE 5.20.070 Application Fee: $100.00 Annual License Fee: (Establishment) $175.00 Annual License Fee: (Per Device) $50.00 Personal Affidavit Required BUSINESS: NAME OF BUSINESS PHONE ADDRESS CITY ST./ZIP OWNERSHIP: INDIVIDUAL PARTNERSHIP CORPORATION NAME TITLE PHONE ADDRESS CITY ST./ZIP NAME TITLE PHONE ADDRESS CITY ST./ZIP NAME TITLE PHONE ADDRESS CITY ST./ZIP STATEMENT SETTING FORTH THE MANNER AND METHOD OF PROVIDING ADULT SUPERVISION AT THE BUSINESS LOCATION (MANAGER/PERSON IN CHARGE /MUST BE AT LEAST 21 YEARS OF AGE): NAME TITLE PHONE ADDRESS CITY ST./ZIP NUMBER OF ARCADE DEVICES TO BE PLACED AT ABOVE BUSINESS LOCATION:__________ FIVE OR MORE DEVICES – CONDITIONAL USE PERMIT NO. _______________________________ DISTRIBUTOR OR SUPPLIER OF ARCADE DEVICES: NAME PHONE ADDRESS CITY ST./ZIP STATEMENT SETTING FORTH THE NUMBER OF OFF-STREET PARKING SPACES AND STORAGE FACILITIES FOR AUTOMOBILES, BICYCLES, SKATEBOARDS AND OTHER MODES OF TRANSPORTATION: 818-937-8300 STATEMENT SETTING FORTH ANY ARRESTS OR CONVICTION (MISDEMEANOR OR FELONY) OF OWNERS, PARTNERS OR CORPORATE OFFICERS WITHIN THE PAST TEN (10) YEARS: HAVE YOU AS APPLICANT OR ANYONE HAVING A BENEFICIAL INTEREST IN THIS PERMIT, DIRECTLY OR INDIRECTLY, HAD A PERMIT FOR THE SAME OR SIMILAR BUSINESS LICENSE SUSPENDED, REVOKED OR DENIED? YES___ NO___ IF YES, PLEASE EXPLAIN: CIRCUMSTANCES: THE APPLICATION HEREBY APPLIES FOR AN ARCADE DEVICE LICENSE AS STATED ABOVE, AND DEFINED IN SECTION 5.20.010 THROUGH 5.20.100 OF THE GLENDALE MUNICIPAL CODE, OR ANY AMENDMENT THEROF, IN THE CITY OF GLENDALE, AND AGREES TO ABIDE BY ALL ORDINANCES AFFECTING SUCH LICENSE NOW IN FORCE OR ANY AMENDMENT THEREOF, AND CERTIFIES THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT UNDER PENALTY OF PERJURY. SIGNED_______________________ TITLE________________________ DATE_________________________ SUSCRIBED AND SWORN TO BEFORE ME THIS________DAY_________,___________ (Notary Public or any other person authorized to administer oaths) NOTE: This application will be reviewed by the Police Building Inspector, Fire and Zoning Departments and the City Clerk who reserve the right to grant same at their own discretion as to whether the applicant is a responsible person, firm or corporation. This application must be accompanied with a personal affidavit from each owner, partner or corporate officer listed on the application. Should the license holder fail to file an application for renewal at least thirty (30) days prior to the expiration date, or operate an arcade establishment or a location with arcade devices without obtaining a license therefore, the City Clerk shall collect a late fee of one hundred dollars ($120.00) per month for each arcade device for which a license has not been obtained, per GMC Sec.5.20.040(f).
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"Glendale Arcade Devices-Arcade Establishment Permit Application"Please download to view full document