THE CITY
BARSTOW TEMPORARY USE PERMIT APPLICATION
Permit No. BTUP--
CALIFORNIAL APPLICATION DATE:-
CROSSROAD HOTEPS RENTLY
NON-REFUNDABLE FEE: $84 / $32 (Non-Profit)
APPLICATION MUST BE SUBMITTED A MINIMUM OF TWENTY (20) DAYS PRIOR TO THE EVENT.
APPLICANT INFORMATION
ORGANIZATION / APPLICANT'S NAME TELEPHONE NUMBER
Barstow Police Department (760 ) 256-3231
IF APPLICANT IS AN ORGANIZATION, PLEASE LIST THE PRIMARY CONTACT TELEPHONE NUMBER EMAIL ADDRESS Cpl. Catherine Greig (760)256-2211 [email protected]
ORGANIZATION / APPLICANT'S PHYSICAL ADDRESS CITY STATE ZIP 220 E. Mountain View Street, Suite B Barstow CA 92311
ORGANIZATION / APPLICANT'S MAILING ADDRESS CITY STATE ZIP Same as above
PROPERTY OWNER INFORMATION • SAME AS APPLICANT
PROPERTY OWNER'S NAME TELEPHONE NUMBER
City of Barstow -
CITY STATE ZIP
ADDRESS
220 E. Mountain View Street, Suite A Barstow CA 92311
EVENT INFORMATION
LOCATION / ADDRESS OF EVENT PRESENT USE OF PROPERTY (i.e. park, parking lot, etc.) East Mountain View Street from Barstow Road to Second Street, Barstow CA City Street
EVENT NAME / DESCRIPTION
Public Safety Fair
EVENT DATE EVENT TIME (Setup to Teardown) ESTIMATED NUMBER OF ATTENDEES May 6, 2023 10:00 AM/PMto 02:00 AM(PM) 200
EVENT DETAILS
WILL THE EVENT INCLUDE ANY OF THE FOLLOWING ACTIVITIES:
If yes, please provide a listing of your vendors with this application. Please include their VENDORS? • YES • NO business name, contact name, phone number and City of Barstow Business License No.
The use of City property or right-of-way includes the use of public parking lots, parks streets and sidewalks. If yes, please contact the City of Barstow's Engineering USE OF CITY PROPERTY Department regarding the Encroachment Permit application process at (760) 255-5121 @ YES • NO ifuse of a public sidewalk, street or right-of-way is being requested as part of your event.
OR RIGHT-OF-WAY?
If use of a public park or park facility is requested, please contact the Parks & Recreation Department at (760) 256-5617 for information regarding use of a City facility.
STREET CLOSURE/ If ves, please contact the City of Barstow's Engineering Department regarding the TRAFFIC CONTROL? • YES O NO Encroachment Permit application process at (760) 255-5121.
Ifyes, please provide a listing with the number and types of animals. Also, please contact ANIMALS? O YES @ NO the Barstow Humane Society at (760) 252-4800 for approval/inspection.
VEHICLES/EQUIPMENT? @ YES D NO If yes, please provide a listing of the types of vehicles/equipment being used.
If yes, please contact San Bernardino County, Environmental Health Services (EHS) FOOD/BEVERAGE? • YES • NO Department at (800) 442-2283 for permitting requirements. A copy of the Bhs permit must be furnished with this application.
If yes, please contact the State of California, Dept. of Alcohol Beverage Control (ABC) at ALCOHOL? O YES @ NO
(760) 324-2027. A copy of the ABC permit must be furnished with this application.
If yes, how many electrically driven? Mechanically driven? CARNIVAL RIDES • YES • NO Please contact the City of Barstow's Building Department at (760) 255-5161 for information on obtaining the necessary Building and Fire Permits.
SIGNS? • YES O NO If yes, how many?3 Please identify location of signs on site plan.
LOUD SPEAKER(S)? @ YES O NO If yes, how many?3 Please identify location of loud speakers) on site plan.
CONTINUED ON REVERSE SIDE
EVENT DETAILS (Continued)
WILL THE EVENT INCLUDE ANY OF THE FOLLOWING ACTIVITIES:
TRASH/RECYCLE If yes, how many? 10 Please identify location(s) on site plan. To setup • YES O NO trash/recycling services for your event, please contact Burrtec Waste at (760) 256-2730 CONTAINERS?
LIGHTING (Portable or • YES • NO Please identify location (s) and specify type on site plan.
If yes, how many?
Otherwise?
PORTABLE STRUCTURES Tents How many? Approx 10
(Tents, Trailers, Portable • YES O NO Trailers How many? Aprox 5 Toilets? • Portable Toilets How many?
If yes, please provide the following information:
USE OF PRIVATE O YES B NO Name of Security Company
SECURITY? Phone Number: (. Business License No..
INSURANCE REQUIREMENTS
AMOUNT OF LIABILITY INSURANCE*: NAME OF INSURER
*If the event will be conducted within the City of Barstow's right-of way or on Clty property, the City must he named as an additional insured. A minimum of $1,000,000 per occurrence and in the aggregate are required. Depending on the event, additional coverage amounts may be required.
A COPY OF THE INSURANCE CERTIFICATION MUST BE ATTACHED TO THIS APPLICATION.
APPLICATION SUBMITTAL CHECKLIST
• Completed and signed application. Please note that this application MUST BE signed by the property owner, in addition to the applicant. If the property owner is unable to sign this application, a notarized, original letter of authorization must be attached.
Certificate of Insurance. If your event is located within the City of Barstow's right-of-way (i.e. sidewalks, streets) or on City property (i.e. parks, Harvey House or other City owned facility), the City of Barstow MUST BE named as an additional insured.
ALL TEMPORARY USE PERMIT APPLICATIONS must be accompanied by a site plan of the event which shows the event route (if the event is a parade, race (or similar event), street fair or block party). Additionally, as applicable to the event, the site plan must contain the locations of vendors, tents, trailers, portable toilets, electrical equipment (i.e. generators, lighting speakers, etc.), stages, signs, trash/recycle containers, animal cages, carnival rides and designated parking areas.
Application for City of Barstow Encroachment Permit, Building Permit and/or Barstow Fire Protection District Fire Permit, if Vendor Listing, if applicable.
Vehicle Listing, if applicable.
Animal Listing, if applicable.
Copy of Alcohol Beverage Control permit, if applicable.
Copy of San Bernardino County Environmental Health Services Permit if food/beverage will be sold or furnished.
CERTIFICATION
I (we) hereby certify under penalty of perjury that the information contained herein is true and that incomplete or false information may result in delay of the application, or denial thereof.
I (we) hereby understand approval of this Temporary Use Permit includes conditions and that failure to comply with those conditions will result in revocation ofthe Temporary Use Permit.
I, (we) hereby covenant and agree that if any claim, action or proceeding shall hereafter be brought seeking to hold the City liable on account of any debt, liability or obligation, I (we) will defend the City at my (our) sole expense against any claim or demand, or threats thereof, whether r not well founded and hold the City harmless there from, together with reasonable attorney fees and costs in connection with any defens ere against. Furthermore, I (we) shall indemnifv and hold thev Citv harmless from any such debt, liability or obligatior I (we) further certify that we have read Chapter 9.45 of the Barstow Municipal Code and understand the provisions contained therein.
I (we) understand that it is our responsibility to obtain necessary permits and approvals that may be required by other agencies other than the City of Barstow (e.g., Barstow Fire District, Environmental Health Department, Alcoholic Beverage Control) I, (we) further covenant and agree that if the City property or right-of-way is damaged, in the course of this event, I, (we) will repair and restore such property to its original condition. Alternatively, I agree that property will be restored by the City at permittee expense. I agree to pay City all such expenses as well as costs (attorneys' fees, etc.) associated with collection plus interest at prevailing rate.
Catherine PRINTED NAME
Catherine якиц Apsil 3 2033
PROPERTY OWNER'S SIGNATURE PRINTED NAME DATE