HomeMy WebLinkAbout06-Police Department
. cOy OF SAN BERNARoQO - REQUQ-r FOR COUNCIL ~
REt~.~^m~F'AUTHORIZED PERMIT, GAMES OF
~SEMENT - ALLAN R. THOMAS,
1986 OCT -3 AM \I: 21941 Grand Ave., Colton, CA
From:
DONALD J. BURNETT,
CHIEF OF POLICE
POLICE DEPARTMENT
Dept:
Date: 9/30/86
Synopsis of Previous Council action:
Recommended motion:
That the application for a permit for Games of Amusement submitted
by Allan R. Thomas, 941 Grand Ave., Colton, CA, be approved.
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Contact person: Dan Hernandez. Sergeant/Vice
Phone: 383-5011, ext 298
Supporting data attached:
Ward:
FUNDING REQUIREMENTS:
Amount:
Sou rce:
Finance:
Council Notes:
75-0262
Agenda Item No.4
(> CITY OF SAtt:13ERNARDINCO
APPLICATION FOR BUSINESS LICENSE OR PERMIT
(CHECK ONE: I (FACE PA":;E)
0 Dine and Dance 0 Theater 0 Solicitation 0 Special Officer
0 Massage Parlor 0 Armored Car 0 City Mall 0 School Employee
IRl Gamesl Amusement 0 Guard Service 0 Burglar Alarm 0 Taxi Driver
0 Uve Entertain 0 Del. Agency 0 Police ApP. 0 Ambulance Driver
0 Poolroom 0 Private Patrol 0 Police Reserve 0 Valley College
0 Other 0 Security Guard 0 Mauage Tech.
0 Parade Permit ILocation) 0 WlIJpon Permit
GENERAL INFORMATION (Type or print in ink)
Name
Pun,) (/l... r40VYl "j-f
q I ~a,l'I,Jo I1J~
Occupation
'If.::
Address
City
r.:.A:;L 7", J
Employer
~.l.S -,}-o'1'1
Zip
(h"l ., J.. 3.l.
~o
Addreu
Zip
Phone
Are You a U.S. Citizen?
I3l Ves 0 No
Color of Hair
i!#-1J/<i:Arr. M. tI....-
OFFICE USE 0 V
POLICE DEPARTMENT
Da,.
1.0. No.
Print/Photo Fee: $
Other Fee; $
Total Fees: $
Receipt No.
Sy:
~t~~b~::~A~J;k;
W New 0 Renewal
Busines. Lie. Fee; $
_~",.^e<:>
Invest. Fee: ~
Total: $
Roc.;p, No. g"~
Sy: (I,A
Length of Residence in
County . City
Nationality
MI+, ;-,=-.
Sex
tit
Color of Eyes
&u..r-.
Next of Kin Relationship
C$UJ7t! M .MJ.rJ{.
Have You Ever Been Found Guilty Or Plead Guilty To Any Crime?
f21No
~,""NO /1u,",: _ c...ot.-,-vJ, 4'/ '1)..J)'~
(if Y.s please explain - Exclude Minor Traffic Offenses)
Have you ever used another name?
~NO 0 Ves
If Ves - Please list the names
-
PLEASE READ AND SIGN:
I CERTIFY THAT ALL STATEMENTS IN THIS APPLICATION ARE TRUE. ACCURATE AND COMPLETE. FALSIFICATION OF ANY STATEMENT MAY
RESULT IN THE CANCELLATION OF THIS A~L~T10N
S'gnatu,.: cff&, cJ( ~__ Dat.: /lu<.....2 7 , 19 ye.
REFERENCES
(Business License Applicants Only)
Name
:11 f-lJ, ()
~;;' f>~ 1- f.,8
;;>
Address
Business/Profession
~6(J. s S rtL<l,,~
s-~~
Name
r:;:'I~ ..he. rn /1 0 o1!.J /)
Business/Profession FE.o (,A
~L6JM1../ m6.J ( ~,lo n-I
S/-liU
Address
1<\ J.l mTJ~...J~,
13 hwJ~()"u;
Address
fdoJ r~ "I-
J~ ~iAuJ~/NI;.
o
~TY OF SAN BERNARO}MoQ
BUS~_. LICENSE/PERMIT SUUM_ENT
2 y~ of Business or Permit
_tCEkn"$/j'fvrtu..'- ~ I"'='-L
I will be operating (Days 01 the Week)
J.~ GLt.J
( 7)
_ _ 0__
=t:".
- "7- Sk,
___ "--l'---<r-____
5. Phone No.
, U--JC'-",r
1. Name or Applican+
_ __,-~lhf-.I1,-L J~ T7 -tel!>-' 4.1
3. Proposed Name 01 Business IDBA)
4Uj~ -n rYll1c
4. Address
"'116;1. N
6. I Plan to start Business on (Datel ~ - ~ 7 --KG,
s ,~ C-,.J
Between the hours 01 1 flrvt,... and J)." "". Manager :Supervisor Name
7. Have you.ever had a Bus;ness License revoked. sus;)end~ or cancelled for any reason) [J Yes
If yes please explain: IUse additional pages if n~essarvJ
~NO
8. Are you now or have you ever been engaged in any Busin~s as a Partner or Corporate Owner ~ Yes
If yes please list firm!s namels and oHicers of each Corp0l"8tion. (Use additional pages if nece5sary)
::.J No
,~j ,q.D.
r t>"tI....J -r,:,-t1...;~O
..,r", 4 R
'- f!.rr(\-r,::.. J'"
~tc:...:- 6.......'~N.~-S"t (rl..'/L<:L..., o'..A.-IIL(.;'
71-/r.. "" 1'1< 11~ WCl"" tJ ItJ<- -. 11.1
I w, rr{ .o~u-J SI+t,Il..7" .,..,~!
9. Live Entertainment
A licants Onl :
~o t.A-IJIOS. 71-1" D'D AJe.;-
{ of ('f"-.t. T ,.J('4- \ JJ
u.s",,,-', 0'-<., h>"- h1 ~ ~
~o<...J~
u.J.o0D
Location of the Entertainment
How many people will be engaged
in the Entertainment?
Admis.sion Fe!
S
RESIDENCES (List Addresses for the last five years with current at the top)
1. From To I Address
'5:?-(l, /11;.J.-- ,f-:IUH1.-,.Ji '1..;., .v,a.th-J.[) fN"-.. G..:.'-7...... .<:.1
l.andJ<><d ~Add.'ess
~(.0 -r ~ .
2. From To Adaress
Landlord Address
Zip
,..L3.....,.
I Phone No.
Zio
Phone Nc.
3_ From To I Add...,
landlord
'4. From ro Address
I Ajdress
Landlord Address
5. From I To Addre<.;s
Landlord Address
Zip
Phone No.
ZIP
I Phone No.
Zia
I Phone No.
EMPLOYMENT OR BUSINESS HISTORY (list Employers for t~e last five years with current at the top)
1. From To , Address ..!;'mt:.7 Sup!t"\Iis.;::r
! ~- nrT*~fi:co
--- :---->L:;r_
2. From To i A:::l-::ress Supervisor
3. From To i A::jress Super..-iioO'
----- --
4. From To AC'j'ess Super-v SOt
..__...u_____ -- ,
-- n.__.
5. From To I A::d'ess Superv,sof
I .
-
I certify that the above information is true and cor reel.
Investigated By --
S9n.d /..//~I!--.
-: O.te
this License/Permit be ........-.: Granted
Den:o!(j
<
o
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11. J T c> lL '1
o
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