HomeMy WebLinkAboutApplication 2024District # _______________
Non-Profit # ____________
OCR# _________________
Tier 1/Tier 2 ____________
576-A DES-12 (REV 7/24)
APPLICATION TO OPERATE A TEMPORARY FOOD FACILITY
Riverside County Code 4.52 and the California Health and Safety Code
NAME OF OWNER:______________________________________________________________________________________________________
FACILITY NAME: ______________________________________________________________________________________________________
BILLING ADDRESS: ____________________________________________ CITY: ______________________ STATE: _______ ZIP: ______
BUSINESS TELEPHONE: ________________________________________ HOME TELEPHONE: ____________________________________
EMAIL ADDRESS: ______________________________________________________________________________________________________
NAME AND LOCATION OF EVENT: ______________________________________________________________________________________
DATE(S) OF EVENT:______________NUMBER OF DAYS: ______________ NUMBER OF PARTICIPANTS EXPECTED:_________________
DATE SITE PLAN SUBMITTED:__________________________________________________SITE PLAN APPROVED BY: _________________
*SUBMIT THIS APPLICATION AT LEAST TEN (10) DAYS PRIOR TO THE EVENT.
COMMUNITY EVENTS: TEMPORARY EVENTS
[ ] OPERATIONAL PERMIT (PER BOOTH) $223.00
OCCASIONAL EVENTS
$108.00
100% PREPACKAGED BOOTH $121.00 $68.00
COMMUNITY EVENT DISCOUNTED PERMIT FEES:
[ ] 1-5 VENDORS $719.00 $219.00
[ ] 6-10 VENDORS $1,347.00 $352.00
[ ] 11-15 VENDORS $1,977.00 $480.00
[ ] 16-20 VENDORS $2,605.00 $610.00
[ ] 21-25 VENDORS $3,233.00 $740.00
[ ] 26-30 VENDORS $3,863.00 $871.00
[ ] 31-35 VENDORS $4,490.00 $1,001.00
[ ] 36-40 VENDORS $5,120.00 $1,131.00
[ ] 41-45 VENDORS $5,749.00 $1,261.00
[ ] 46-50 VENDORS $6,377.00 $1,390.00
[ ] 51-55 VENDORS $7,006.00 $1,521.00
[ ] 56-60 VENDORS $7,634.00 $1,651.00
[ ] 61-65 VENDORS $8,263.00 $1,782.00
[ ] 66-70 VENDORS $8,893.00 $1,911.00
[ ] 71-75 VENDORS $9,520.00 $2,041.00
[ ] 76-80 VENDORS $10,147.00 $2,171.00
[ ] 81-85 VENDORS $10,777.00 $2,302.00
[ ] 86-90 VENDORS $11,406.00 $2,432.00
[ ] 91-95 VENDORS $12,035.00 $2,561.00
[ ] 96+ VENDORS $12,633.00 $2,691.00
*EVENT ORGANIZER FEE
Event organizers will be required to submit a “Temporary Food Facility Community Event Coordinator’s Application” form and all applicable fees at least two (2) weeks
prior to the event. If the event organizer does not wish to purchase one of the discounted blanket permits listed above, a separate fee will be required. See current fee
schedule for a complete list of organizer fee amounts as they vary depending upon the number of vendors operating at the event.
Please submit payment WITH YOUR APPLICATION. Permit fees may be paid with cash, or select major credit card (contact area office for
details) or money order payable to Riverside County Department of Environmental Health.
I HEREBY APPLY FOR A RECEIPT/PERMIT, WITH APPROPRIATE FEES ATTACHED, TO OPERATE AT THE ABOVE COMMUNITY EVENT.
DATE: ______________ OWNER/OPERATOR: ___________________________________________ _____________________________
SIGNATURE DRIVERS LICENSE#/ EXP. DATE
THIS APPLICATION IS FOR: [ ] TEMPORARY EVENT (4-25 DAYS IN A 90 DAY PERIOD)
[ ] OCCASIONAL EVENT (3 DAYS OR LESS IN A 90 DAY PERIOD)
Department of Environmental Health
P.O. Box 7909
Riverside, CA 92513-7909
Valid 7/1/24 - 6/30/25