STATE OF CALIFORNIA )
) SS.
COUNTY OF____________ )
I, _____________________________, after being duly sworn, submit this affidavit in support of giving permission to locate Collection Box on real property and state as follows:
1. I am (check applicable one below):
_____ owner of the real property located at ______________________________, Alhambra, CA.
_____ an officer, director, member or manager of an entity owing the real property located at ______________________________, Alhambra, CA.
2. The operator of a Collection Box, ____________________, has requested permission to place a Collection Box on the property owned by me or the entity I represent in the location as shown on the drawing attached as Exhibit “A.”
3. I have been provided and have read a copy of the City of Alhambra Collection Box Ordinance and understand the requirements contained therein for issuance, renewal, revocation and penalty/remedies of the Permit.
4. I understand that in addition to the Collection Box operator, the owner is also responsible for: a) ensuring the requirements of the City of Alhambra Collection Box Ordinance are met; b) the maintenance of the Collection Box and that the area surrounding the Collection Box are free from any junk, debris or other material, c) violation of any provision of the Collection Box Ordinance, and d) payment of any fines and costs of abatement, which if not paid, shall be placed on the property as a tax lien.
5. As owner of the property described above or as an officer, director, member or manager thereof, I give permission to place a Collection Box on the property by the operator named above.
DATED: _______________, 20____
______________________________
(Ord. 4678, passed 10-12-15)