Licence to Occupy, Retail Store - PDF - PDF

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					                                                                                 Food Primary, Licensee Retail
                                                                                  Store or Off-Site Retail Store
                                                                                                      Structural Change Application
                                                                                                 Liquor Control and Licensing Form LCLB 012c
INSTRUCTIONS:
Complete all applicable fields then submit with payment as outlined in Part 16 of this application form.
•  If you have any questions about this application, call the Liquor Control and Licensing Branch (LCLB) toll-free at: 1 866 209-2111.
•  LCLB forms and supporting materials referred to in this document can be found at: www.pssg.gov.bc.ca/lclb
NOTE: • The term Licence includes certificate of appointment to operate an on-site or off-site retail store
        • The term Licensee includes appointee authorized to operate an on-site or off-site retail store
        • There is no fee for Off-Site Retail Store Structural Changes.


PART 1: Licensee Information                                                             Licence # affected:

 Licensee name [as shown on licence]:

 Establishment name [as shown on licence]:
   Establishment
 Location address
 (as shown on licence):                         Street                                    City                     Province          Postal Code

 Contact Name:                                                                     Title/Position:
                                       last / first / middle

 Business Tel with area code:                                            Business Fax with area code:

                                                               Business e-mail:

 Business Mail address
 (if different from above):
                                                  Street                                  City                     Province          Postal Code

                                                                                                         Part # of this
PART 2: Type of Change Requested                                                                           form to
Please check () appropriate box(es) below:                                                               complete Sub- Job Number
                                                                                                                        Office Use ONLY

      1. New Outdoor Patio (Food Primary) - when the licensee proposes to construct one or more                    Outdoor Patio
         new patio areas attached to the establishment                                                         1   (C4-LIC)________________
      2.    New Restaurant Lounge (Food Primary) - when the licensee proposes a change to the                      Structural - capacity change
            establishment to create a lounge                                                                       (RL)
                                                                                                               2
                                                                                                                   (C4-LIC)________________
      3.    Structural Alterations or Addition of New Licensed Area - when the licensee proposes
            to make alterations to existing licensed areas or construct new areas (except new
            restaurant lounges or patios)
            OR                                                                                                     Structural - with capacity
                                                                                                                   change
            Gaming Facility: indicate the type of establishment and structural change for which you
                                                                                                                   (C4-LIC)________________
            are applying by checking the appropriate box below:
                                                                                                        3
                 Casino currently operating under a contractual agreement with the BC Lottery
                                                                                                                   Structural - no capacity
                 Corporation (BCLC) applying for a structural change to alter or add a new licensed
                                                                                                                   change
                 area within the gaming establishment.
                                                                                                                   (C4-LIC)________________
                 Commercial bingo hall currently operating under a contractual agreement with BCLC
                 applying for a structural change to alter or add a new licensed area within the gaming
                 establishment.
      4.    Capacity increase up to occupant load: when the licensee requests a capacity increase                  Capacity increase - no
            up to the building's occupant load. NOTE: If you have completed any alterations to your                structural
                                                                                                        4          (C2-LIC)________________
            establishment but have not provided current floor plans to the LCLB, proceed to # 3 above.

LCLB012c (Last updated 14 February 2011)                                1 of 5                                        Application for Structural Change
                                                                                                                                      C4 - LIC
PART 3: Addition of New Outdoor Patio
              (applies to Food Primary licences)           Fee: $440 per licence x               licences = $
The addition of a licensed outdoor patio must be approved by the Liquor Control and Licensing Branch. Floor plans must have
sufficient detail to be acceptable to the branch. The applicant is responsible for complying with any local bylaws related to the
licensed establishment patios.

Attach the following:
     Two large, (11" x 17" preferred) detailed furniture layout plans of the entire establishment and the proposed patio
      area(s). The occupant load of the establishment and proposed patio area(s) must be marked/stamped ON the plans by
      provincial (or designate) fire or building authorities. An alternate qualified professional may be used in locations where fire and
      building authorities are not available to provide an occupant load if accompanied by local government/First Nation written consent.

     Establishment occupant load from above plans:
     Occupant load of patio(s) from above plans:
      Patio #1:               Patio #2:

     Evidence of valid interest in the property on which the patio is to be located if the patio is on different property than the licensed
      establishment, such as a patio located on a public sidewalk. Evidence of valid interest may be in the form of a lease, letter of
      authorization or other agreement document.
     Briefly describe where the proposed patio(s) will be located and explain the general construction:




PART 4: New Restaurant Lounge                                                                                                         C4 - LIC
              (applies to Food Primary licences only) Fee: $440 per licence x                     licences = $
Only food primary establishments with an occupant load of 50 or greater may apply for a restaurant lounge endorsement. The
maximum size of the restaurant lounge is 20 per cent of the establishment occupant load or 40 seats, whichever is less. Two areas
may comprise the lounge, each equal to the total approved restaurant lounge capacity, and one area must be on a patio.
Example: Occupant load is 100 x 20 per cent = 20. 20 is less than 40, therefore 20 seats may be assigned to an interior or patio
lounge, or both (20 interior and 20 patio), but no more than 20 people can occupy the two lounge areas at any time.
Attach the following:
   Two large (11" x 17" preferred), scaled, detailed furniture layout plans of the entire establishment. The occupant load of the
    establishment must be marked/stamped ON the plans by provincial (or designate) fire or building authorities. An alternate
    qualified professional may be used in locations where fire and building authorities are not available to provide an occupant load,
    if accompanied by local government/First Nations written consent.
    Calculation of Occupant Load of existing interior principal area of establishment (do not include the capacities from banquet areas
     or patios in the total):              x 20% (or x 0.20) =
     Proposed restaurant lounge capacities, if planning to create two areas:
      Interior lounge:                           Patio lounge:

     Briefly describe where the proposed lounge(s) will be located and explain the general construction proposal, e.g. if exits will be
      added, full height or pony walls removed or added, etc.:




    Also complete Parts 8 and 9
LCLB012c                                                            2 of 5                                      Application for Structural Change
PART 5: Other Structural Alterations or an Addition of a Licensed Area                                                             C4 - LIC
              (NOT construction of new patios or restaurant lounges)
Check all applicable boxes:       Alteration      Addition         Removal
Attach the following:                                            Fee: $440 per licence x               licences = $
   Two large (11" x 17" preferred), scaled, detailed furniture layout plans of the entire establishment and the alterations or area/
    room addition(s). The occupant load of the establishment and proposed alterations or area/room additions(s) must be
    marked/stamped ON the plans by provincial (or designate) fire or building authorities. An alternate qualified professional may
    be used in locations where fire and building authorities are not available to provide an occupant load if accompanied by local
    government/First Nation written consent. (Occupant load is not required for licensee retail store or off-site retail store
    applications.)
   Gaming Facility: The British Columbia Lottery Corporation (BCLC) must also stamp the floor plans for the structural change
    application. The stamp indicates BCLC's final support of the application. Casinos and commercial bingo halls that do not
    have the support of the BCLC are not eligible to apply for a structural change.
   In order to be eligible for a structural change to a food primary licence within a gaming facility, the casino or commercial bingo hall
    must provide a letter of support from the BCLC.
   Establishment occupant load from above plans. (Occupant load is not required for licensee retail store or off-site retail store
    applications.)
   Briefly describe the proposed alterations or addition, including the general construction proposal, e.g. if exits will be added,
    full height or pony walls removed or added, etc.:




PART 6: Capacity Increase Up To Occupant Load                                                                                     C2 - LIC

                                                                   Fee: $220 per licence x               licences = $
Food Primary licensees may apply to increase the capacity of their establishment to its existing occupant load. If a licensee has made
alterations to their establishment and has not provided the LCLB with current floor plans, the licensee may need to apply using #3 on
page 1 of this form. If in doubt, contact the branch for assistance. The Liquor Control and Licensing Branch will enforce the capacity
appearing on the approved liquor licence. The licensee is responsible for complying with any local government/First Nation bylaws
related to the operation of their establishment.
Attach the following:
    Two large (11" x 17" preferred), scaled, detailed, furniture layout plans of the entire establishment. The occupant load of the
     establishment must be marked/stamped ON the plans by provincial (or designate) fire or building authorities. An alternate
     qualified professional may be used in locations where fire and building authorities are not available to provide an occupant load
     if accompanied by local government/First Nations written consent.
Also complete Parts 8 and 9
PART 7: Structural Application Floor Plan Guidelines
A floor plan is a view of each floor as seen if you were to remove the roof or ceiling and all construction above. Floor plans must be
acceptable to the Liquor Control and Licensing Branch for your application to be processed.
Floor plans should meet the following requirements:
    drawing scale of not less than 1/4" = 1'0" (1:50)
   OCCUPANT LOAD(S) MUST BE CLEARLY MARKED/STAMPED ON THE PLANS by provincial (or designate) fire or building
    authorities. An alternate qualified professional may be used in locations where fire and building authorities are not available to
    provide an occupant load, if accompanied by local government/First Nations written consent.
  provide dimensions of room sizes, partial height walls, planters, etc.
  location of doors and windows
  stairs showing direction of travel
  all rooms labelled for intended use including washrooms, kitchen, storage, bars, restaurant lounges, patios, furniture layout of
   tables, chairs and barstools clearly marked, plus kitchen equipment and large appliances clearly labelled.
Gaming Facility:
  The BCLC must also stamp the floor plans for the structural change application. The stamp indicates BCLC's final support of the
   application. Casinos and commercial bingo halls that do not have the support of BCLC are not eligible to apply for a structural
   change.
LCLB012c                                                         3 of 5                                     Application for Structural Change
PART 8: Declaration
My signature (the licensee) below indicatesI understand and acknowledge:
    All of the information given is true and complete to the best of my knowledge. Section 15(2) of the Liquor Control and Licensing
    Act states, "A person applying for the issue, renewal, transfer or amendment of a licence who fails to disclose a material fact
    required by the form of application or makes a false or misleading statement in the form of application, commits an offence".
Signature of applicants (signature of signing officer of a company or society, sole proprietor or all individuals in a partnership. An
agent or lawyer acting on behalf of the applicant may not sign the application on behalf of the applicant.):

                Name of Official:
                                                                   (last/first/middle)
                Position:                                                           Date:
                                                                                             (Day/Month/Year)



                Signature:_________________________________________________________________

                Name of Official:
                                                                  (last/first/middle)
                Position:                                                          Date:
                                                                                             (Day/Month/Year)



                Signature:_________________________________________________________________

                Name of Official:
                                                                  (last/first/middle)
                Position:                                                          Date:
                                                                                             (Day/Month/Year)



                Signature:_________________________________________________________________

                Name of Official:
                                                                  (last/first/middle)
                Position:                                                          Date:
                                                                                             (Day/Month/Year)



                Signature:_________________________________________________________________




LCLB012c                                                        4 of 5                                    Application for Structural Change
PART 9: Application Fees
 Fees may be paid by cheque, money order, debit or credit card and are non-refundable. Debit transactions can only be made in
 person at the Victoria Head Office. Submit the payment with the application form. Do not mail cash.
Fee: (non-refundable):                                                                            TOTAL FEE Submitted: $
     Payment is by (check () one):
           cheque, payable to Minister of Finance (if cheque is returned, non-sufficient funds, a $20 fee will be charged)
           money order, payable to Minister of Finance
           VISA                MasterCard                AMEX
           If paying by credit card, please provide credit card details below . . .


    Credit card Number:                                                                             Expiry Date:                    /

     Name of cardholder (as it appears on card):



            Signature of cardholder: __________________________________________________________

         Or you may send in the application without credit card information, but you must telephone LCLB Head Office directly to
         provide the credit card number details. If so, please confirm by checking the box (þ) below:
                  I will call Victoria Head Office at 250-387-1254 or 1-866-209-2111 to provide credit card information and
                  understand that no action can proceed with my application until the application fee is paid in full.


                                            Ministry of Public Safety and Solicitor General
                                                Liquor Control and Licensing Branch
                                   Location: 4th Floor, 3350 Douglas St., Victoria BC V8Z 3L1
                                For Mail Only: PO Box 9292 Stn Prov Govt Victoria, BC V8W 9J8
            Phone: 250 387-1254 Fax: 250 387-9184 Web: www.pssg.gov.bc.ca/lclb E-mail: liquor.licensing@gov.bc.ca




Applying for other permanent changes to your licence?
•     To apply for changes to your licensee name or share structure, changes in hours or entertainment, use the Application for a
      Permanent Change to a Liquor Licence (LCLB012).
•     To apply to have a third party management firm or lessee operate your licensed establishment, or for a resident manager to
      operate your establishment, complete the applicable form: Application for Third Party Operator (LCLB026) or Application for
      Resident Manager (LCLB025).




    Freedom of Information and Privacy Act - The information requested on this form is collected for the purpose of obtaining or making changes to
    a liquor licence application. All personal information is collected under the authority of Section 15 of the Liquor Control and Licensing Act
    (RSBC 1996, c.267). Questions should be directed to: Liquor Control and Licensing Branch, Freedom of Information Officer, PO Box 9292
    STN PROV GOVT, Victoria, BC V8W 9J8. Ph: In Victoria, 250 387-1254 Outside Victoria, 1 866 209-2111. Fax: 250 387-9184

LCLB012c                                                                  5 of 5                                             Application for Structural Change

				
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