HomeMy WebLinkAbout05-Police Department
CIy{jOF SAN BERNARDIQ - REQUE~ FOR COUNCIL AC'ri1N
. ~ __c.-~ ,_
" ~.. ",. .V
From: DONALD J. BURNETT REC'D.-~ OIlfeNY PERMIT - Games of Amusement
Chief of Police ~~HONY J. KEALOHA, dba HI
Dspt: Pol ice Departmen t 1986 OCT -3 ^M lI:s~tJRES UNLI M I TED, 1035 Co 11 ege
Avenue, Redlands
Date: 9-30-86
Synopsis of Previous Council action:
Recommended motion:
That the Mayor and Common Council disapprove the issuance of the
permit for Games of Amusement requested by Anthony J. Kealoha dba
HI SCORES UNLIMITED and that a notice of their intention to deny the
application for said permit be forwarded to the applicant, by the City
Clerk.
Contact person:
Dan Hernandez, SerQeant/V ice Deta i lPhons: 383-5011. ext. 298
Supporting data attached:
Ward:
FUNDING REQUIREMENTS:
Amount:
Sou rce:
Finance:
Council Notes:
75-0262
Agenda Item No.
-
l~1
() CITY OF SA~ERNARDINCO
APPLICATION FOR BUSINESS LICENSE OR
~ (;.~
PERMIT
ICHECK ONE:) (FACE PAGEl
0 Dine and Dance 0 Theater 0 Solicitation D $po!c'al Officer
~P'''O' :::J Armored Car 0 City Mall D School Employee
Games/Amusement 0 Guard Service 0 Burglar Alarm 0 Taxi Driver
0 Uve Enter:tain 0 Oet. Agency 0 Police App. C Ambulance Driver
D Poolroom L:I Private Patrol 0 Police Reserve C Valley College
D Other 0 Security Guard n Massage Tech.
D Parade Permit (Location) 0 \''I!:apon Permit
GENERAL INFORMATION (Type or print in ink)
Name
OFFICE USE ONL V
POLice OEPARTMENT
Oat.
1.0. No.
Print/Photo Fee: $
Other Fee: S
Total Fees: S
Receipt No.
By:
CITY HALL
DeteSubm;ned: i1~8/8C
, ,
~ New 0 Renewal
Business Lie. Fee: S
Invest. Fee:
s Z5lJ.
Total: $
R...;pt No. '7 J'f '1")
By:
Length of Residence in
County \('} \.4~. CitY ':; R.
Nationality .
l..{a..wo.. ~ ,0....\1'\
No
/ C'
Next of Kin
o
"
lif '," please explain - Exclude Minor Traffic Offenses)
Have You Ever aeen Found Guilty Or Plead Guilty To Any Crime? ~o
Have you ever used another name?
JZL-NO 0 Ves
o
"'-
Please list the names
PLEASE READ AND SIGN:
I CERTIFY THAT ALL STATEMENTS IN THIS APPLICATION ARE TRUE, ACCURATE AND COMPLETE. FALSIFICATION OF ANY STATEMENT MAY
RESUL T IN THE CANCELLATION OF THIS APPLICATION
Signatu,.: ~t. ~ - ~ ^ I.L
-5 -
REFERENCE S (Business License Applicants Only)
eat.:
S(:HI<x1..
Name
Address
~t..
Name
Business/PrOfe'ision
Address
l (;"
Name
r
~ f
Business/Profession
Address
tI~ -
l..-
13 ,"".
(.)
JiilY OF SAN BERNJliiiln
BUSIN,,-^-ICENSE/PERMIT ~UPJI!(MENT
r::oe of Bu,'ne.. 0' Pe"nh- - -- m___ -~ate
.__m ~.A .I:=......~__~.____ 'i1"Z~/l?';'
4. Addr'3'S-\ 5. Phone No.
e c ",\\"-c.,,-~cl4.- l!..A.\(~\Mls ~., \>1 i<!o\ - ,"-II-
I
0_
-1~ Ntr.Tle o~ A~licant
_.A.ttk""-,,,_,,"_-X"-"'*~-
3. Proposed Nam~ of Business (DBA)
~\... ~c o~ \ s \...);U^:-+.e.J.
6. I Plan to start Business on lOate) 5j' I1...Cill~1..
I will be <:;.perating tDavs of the Week) &:\ d..~, (-
r... ..'..0)(
Between the hours of \ \ : or--.. P'fw\and ". 60 ? M. Maneger:Supervisor Name
7. Have you ever had a ausiness License revok.ed. susoend~ or cancelled for any reason?
If yes please explain: IUse additional pages if neces.;.aryl
~.."""'.
[J Yes'
'\fvlr "'n'.,C\O
~NO
11tt
G (Z I'\ID Gv ~ \ H~f
I
.- r:.
y'f.
8. Are you now or have you ever been engaged in al", a;Jsin~s as a Partn<!f or Corporate Owner
If yes please list firm/s namels and officers of each corporation. (Us.e additional pages if necessary)
Ye,
ba:. No
9. Live Entertainment
A licants Onl :
Detailed Description of the Entertainment:
"
location of the Entertainment
How many people will be engaged
in the Entertainment?
Admission Fee
S
RESIDENCES (List Addresses for the last live years with current at the top)
To
...-
('..l i\1A G~~~
2, From Adoress
>11 'k-... :,'\%'-\3 .Ru~ F u\^-.C-
Landlord i Addr-ass \
i
3. From To \ Adc'e$s
landlord I Ado~~ss
4. From c:=- i Add' ess
,
landlord I Ad~'ess
,
,
5. From To . Adc~;-ss
Zip
Phone No.
Zip
Phone No.
Zip
,
landlord \ AdC-9-s.s
EMPLOYMENT OR BUSINESS HISTORY (List Employers lor t:1e last five yearswith current at the top)
Phone No.
To
, Acc~ess
!(;,.-'-""'-'-., ?..><~..\.. 9~
I A==~e-ss ~- _ \
I \ 'ii' 'I IAA "..1-,,:r.i.
A=='~s
_ __"3:ijL~ llv-L--::t'="._ _ ..lJ..
A:;'J-ess ,
Supervisor
atom
2. From
~I"/J..
To
Superv; r
3. From
To
upervisor
4. From
Supervisor
5. From
To
A:;:::'~s
Supervisor
I certify that the above information is true and cor~ect. S'gned
Investigated By Dille
I Recommend this Licen$9 Permit be 0 Granted 0 Denied