A. All applications shall be completed on a form prepared and supplied by the Department. The application shall be signed under penalty of perjury. The following information shall be included, without limitation, on the application:
1. The name, address and telephone number of the proprietor, including, for non-corporate proprietors, the names of all principals. Corporate proprietors shall include the name of the designated agent for service of process.
2. A single name and mailing address authorized by each proprietor to receive all communications and notices (the “authorized address”) required by, authorized by, or convenient to the enforcement of this Chapter. If an authorized address is not supplied, each proprietor shall be understood to consent to the provision of notice at the business address specified on the application.
3. The business name, address and telephone number of the tobacco retail establishment for which the application is submitted.
4. Proof that the tobacco retail establishment for which the application is submitted has been issued a valid state tobacco retailer license by the California Board of Equalization.
5. Whether any other licenses have been issued to the proprietor for tobacco retail sales within the city, and, if so, the name and address of each of the tobacco retail establishments for which these licenses have been issued.
6. Whether or not any proprietor or any agent or employee of the proprietor has admitted violating, or has been found to have violated, this Chapter, and, if so, the dates and locations of all such violations within the previous five (5) years.
7. A statement by the proprietor, under penalty of perjury, that the contents of the application are true and correct.
8. Such other information as the Department deems necessary for the administration or enforcement of this Chapter, as specified on the application form required by this section.
B. For proprietors with multiple tobacco retail establishments within the City, a separate application is required for each proposed tobacco retail establishment.
C. Any change to the information required to be submitted in order to apply for a tobacco retailer license shall be provided to the Department within ten (10) business days of such change in information.
D. The proprietor shall be required to disclose any violations of the state tobacco licensing laws at any tobacco retail establishment within the five (5) years prior to the application for which the proprietor's state tobacco retailer's license was either suspended or revoked.
(Ord. No. 2009-006 § 1 (part))