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LicensingTeam 2 Floor Laurence House c I Cafford Road London SE64RU 020 8314 6400
Application for a premises licence to be granted under the Licensing Act 2003
PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST
Before completingthis form pleaseread the guidancenotes at the end of the form. if you are completing this form by hand please write legibLyin block capitals. In all cases ensure that your anstversare insidethe boxes and written in black ink. Use additionalsheets if necessary.
You may wish to keep a copy of the completed form for your records.
I RodolfoPiscina (Insert name(s) of applicant) apply for a premises licence under section 17 of the Licensing Act 2003 for the premises described in Part I below (the premises) and I am making this application to you as the relevant licensing authority in accordance with section 12 of the Licensing Act 2003
Part 1 — Premises Details
Postal address of premises or, if none, ordnance survey map reference or description Longhorn American Italian Diner 364 Brockley road Crofton Park
Post town London Postcode SE4 ZBY
Telephone number at premises (if any) 020 3581 2940
Non-domestic rateable value of premises £ £4 ‘7 co
Part 2 - ApplicantDetails
Please state whether you are applying for a premiseslicence as Please tick as appropriate
* a) an individualor individuals El please complete section fA) b) a person other than an individual
i. as a limited company please complete section(B) ii. as a partnership pleasecomplete section(8)
iii. as an unincorporatedassociationor (2J please complete section (B) iv. other (for example a statutorycorporation) El please completesection (B) c) a recognisedclub (21 please complete section(B) d) a charity El pleasecomplete section (8) e) the proprietor of an educationalestablishment El pleasecomplete section (B) f) a healthservice body El please complete section (B) g) a personwho is registered under Part 2 of the Care El please complete section (B) StandardsAct 2000 (c14) in respect of an independent hospital in Wales ga) a personwho is registered under Chapter 2 of Part I El pleasecomplete section(8) of the Health and Social Care Act 2008 (within the meaningof that Part) in an independenthospital in England
h) the chief officerof police of a police force in England El please completesection (8) and Wales
If you are applyingas a person describedin (a) or (b) please confirm:
Please tick yes
I am carrying on or proposing to carry on a business which involves the use of the premises for licensable activities; or
I am making the application pursuantto a statutory Ii.inctionor El a function dischargedby virtue of Her Majesty’sprerogative El
(A) INDiVIDUAL APPLICANTS (fill in as applicable)
M t”tr El Miss O El Other Title (for r ‘ example, Rev)
Surname First names Piscina Rodolfo
I am 18 years old or over Please tick yes
Current postal address if different from premises address
Post town London -- Posteode — Daytime contact telephone number E-mail address (optional) SECOND INDIVIDUAL APPLICANT (if applicable)
M fl Mrs Miss U Ms Other Title (for — r example,Rev)
Surname First names
I am 18years old or over U Please tick yes
Cunent postal address if different from premises address
Post town Postcode Daytime cotitact telephone number E-mail address (optional) fB) O’UIIERAPPLICANTS
Please provide name and registered address of applicant in full. Where appropriate please give any registered number. In the case of a partnership or other joint venture (other than a body corporate), please give the name and address of each party concerned.
Name Otello Lagia Address
Registered number (where applicable) Company No: 9749697
Description of applicant (for example,partner ip, company,unincorporatedassociation etc.) Panership
Telephone number (if any)
E-mail address(optional) Part 3 Operating Schedule
DD MM YYYY
When do you want the premises licenceto start? 12 k 14 ) Ii 16 1
DD MM YYYY If you wish the licence to be valid only fora limited period, when do you I I i i i want it to end? t
Please give a general description of the premises (please read guidance note 1)
Restaurantserving hot food and drinks. I am applying for a premises licence so I can serve alcohol to adults aged 18and above for consumptionon the premises only. I intend to serve alcohol in the dining area to which is situated at the front of the premises.There are nine tables where customerscan dine and we will only serve alcoholwhen customersintend to buy a meal. There is a bar which only staff are allowed to occupy whereat the moment hot drinksare served,There is also a kitchen, washingarea and cooking prep area which is situated at the back of the premises. We will not serve alcohol unless a customerbuys a meal, No alcohol will be sold off thepremises and customerswho intend to consumealcoholcan only do so white they are sitting eating their meaLWe intend to keep stock in fridgesboth in the kitchen and in a separate room which will not be availablefor customersto access.
If 5,000 or more people are expected to attend the premises at any one time, N/A [ pleasestate the numberexpected to attend.
What licensableactivitiesdo you intend to carry on from the premises?
(Please see sections 1and 14 of the Licensing Act 2003 and Schedules 1 and 2 to the LicensingAct 2003)
Please tick any that Provision of regulated entertainment apply a) plays (if ticking yes, fill in box A) 0 b) films (if tickingyes, fill in box B) c) indoor sporting events (if ticking yes, fill in box C) 0 ci) boxing or wrestlingentertainmentfif Lickingyes, (ill in box D) U e) live music (if ticking yes, fill in box E) f) recorded music (if ticking yes, fill in box F) g) performancesof dance (if tickingyes, fill in box 0) 0 anything of a similar descriptionto that falling within (c), (I) or (g) i:i (if ticking yes, fill in box H)
Provision of late nlht refreshment (if ticking yes, fill in box I)
Supply of alcohol (if ticking yes, fill in box J) In all cases complete boxes K, L and M
A Plays Will the performat pf a p)y take place indoors Indoors Standard days and timings or outdoors or both —9leaIe tick (pleaseread (please read guidance note guidancenote 2) / 6) / Outdoors Day Start finish / Both Mon Please five further’details here (please read guidance note 3)
Tue //
Wed State any seaoiI ynjiations for performing plays (please read guidance note 4)
Thur
Fri Non standard timings. Where you Intend to use the premises for the pertormance of plays at different times to those listed in the column on the left, please list (pleaseread guidance note 5) Sat /1’
Sun
1
:‘•
I, - ,
-• •‘l••. 7 4,
•• 1, • 4, • . 4 •
4 ‘4 / 7
• • I .,, • •. , - • ‘I- ,k: ;-
4 --4 4 4’ B / Films Will the exhibition of films take place indoorx’or -- indoors C Standard days and timings outdoors or both — please tick (pleaseread%iidance (please read guidancenote note 2) 7’ 6) / Outdoors Day Start Finish Both LI Mon Ptease give further detailshE’e (please read guidance note 3) Tue // Wed State any seasonal variations for the exhibition of films (please read guidancenote 4)
Thur
Fri Non standard timings. Where you intend to use the premises for the exhibition of films at different times to those listed in the column on the )ft. please list (pleaseread guidance note 5) Sat Sun /
- :
• • • • • • •
$• • •• • • ,•• •• • • •• •I__ - ••
• • • •
•s’, • • • •• C
Indoor sporting events Please give further details (pleaseread guidance note 3) / Standard days and timings (please read guidancenote 6) / Day Start finish / Mon //
Tue State any seasonal varIationsA indoor sporting events (please read guidancenote 4)
Wed / -I Thur Non standv timings. Where you Intend to use the premises for indoor sportI,r7Ivcnts at different times to those listed in the column on the ——-—— ase list (please readguidancenote5)
Sat 1,1/ Sun /‘ 5/
/ S
S ;5
S S S D
Boxing or wrestling Will the boxing or wrestling entertainment take 0 entertainments place Indoors or outdoors or bath — please tick Standarddaysandtimings (pleaseread guidancenote2) (please read guidance note / Outdoors 6) / — Day Start finish both 0 Mon Please give further details here (P5 read guidancenote 3) Tue // Wed State any seasonal varjtions for boxing or wrestling entertainment Wleaserend guidan4ote 4) Thur /1/
Fri Non stand6d timings. Where you intend to use the premises for boxing or wrest%ngentertainment at different times to those listed in the coluny(on the left1please list Qlease read guidancenote 5) Sat // Sun / E
Live music Will the performance of live music take place Indoors Standard days and timings indoors or outdoors or both — please tick (please (please read guidance note read guidancenote 2) — 6) Outdoors Day Start Finish Both U Mon Please give further details here (please read guidancenote 3) To host live music events suchas an aOpenMic nightson Friday and Saturdaynights Tue
Wed State any seasonal variations for the performance of live music (please read guidancenote 4) Thur
Fri , Non standard timings. Where you intend to use the premises for the performance of live music at different times to those listed In the column on the left, please list (please read guidance note 5) Sat
Sun
4 F
Recorded music Will the playing of recorded music take place Standard days and timings indoors or outdoors or both — please tick (please 9 ° (please read guidance note read guidance note 2) — 5) / Outdoors Day Start Finish Both D Mon Please dye further details here leaser, guidance note 3)
Wed State any seasonal variations’for the playing of recorded music (please read guidance note 4) Thur //
Fri Non standard titfngs. Where you intend to use the premises for the playing of reced music at different times to those listed In the column on the left, p)6ase list (please read guidance note 5) Sat
.Snn H
Anything oVa similar Please give a description of the type of entertainmentyou will be providing description to that falling within (e), (f) or (g) Standard days and timings (please read guidancenote 6)
Day Start Finish Will this entertainment take place iudoors or Indoors ci outdoors or both — please tick (please read didance Mon Outdoors fl note2) / / Both U Tue Please give further details here (plea éread guidance note 3)
Wed
Thur State any seasonal variatioih for entertainment of a similar description --—-— to that falling wit or (g) (please read guidance note 4)
Sat Non standard tijiings. Where you intend to use the premises for the entertainmenLif a similar description to that falling within (e), (f) or (g) —— at different ünes to those listed in the column on the left, please list rca guidance note 5)
Sun I
Late night refreshment Will the provision of late night refreshment take doors Standard days and timings place indoors or outdoors or both — please tick (please read guidancenote (please read guidancenote 2) — 6) Outdoors Day Start finish Both U Mon Please give further details here (please read guidance note 3)
As we are situated very close to the Rivoli Ballroom here in Croflon Park, Tue we will occasionallystay open to serve food and alcohol on a limitedbasis
. when they are hostinga function and will ensure that customerswho wish to consumealcoholare in an appropriatecondition to do so. Wed State any seasonal variations for the provision of late night refreshment
1 Same as above Thur
Fri Non standard ou intend to USC the remises for the provision of Ia itis1iment at different times, to those listed in the column on the left, please list (please read guidance note 5) Sat - 23:00 02:00
Sun
.1 J
Supply of alcohol Will the supply of alcohol be for consumption — On the Standard days and timings please tick (please read guidance note 7) premises read guidancenote (please Off the 6) premises Day Start Finish Both Mon State any seasonal variations for the supply of alcohol (please read guidancenote 4)
Tue 12:00 22:00 I intend to serve alcohol at the following times (see column left) and I will be the Designated PremisesSupervisor.
Wed 12:00 22:00
Thur 12:00 22:00 Non standard timings. Where you intend to use the premises for the supply of alcohol at different times to those listed in the column on the left, please list (please read guidance note 5) Fri 12:00 22:30 No. I will only serve alcohol in the followingtimes unless the Rivoli
Ballroomis hosting a function.Please see Section 1for further information. Sat 12:00 ‘O2:C
Sun 12:00 16:00
State the name and details of the individual whom you wish to specify on thelicence as designated premises supervisor:
Name Rodolfo Piscina Address
Postcode Personal licencenumber (if known) 0502382LAPER Issuing licensingauthority (if known) London Boroughof Bromley -.
K
Please highlight any adult entertainment or services, activities, other entertainment or matters ancillary to the use of the premises that may give rise to concern in respect of children (please read guidance note 8). To ensure a safe environment for children,I wilt only serve alcohol to adutis aged over 18.1wilt ensure that my staff do not offer alcohol to any children that are under 18.If children wanted to consume alcohol, I would prevent them from doing so and ask them to leave,I would ensureI would apply a 7hink 25’ poLicyand if 1believed someone was aged under 25, 1would ask the customer for proof of ID such as a valid driving licenceor passport. As most of our customersare families,I would advise parents to make sure that alcoholwas not given to their children and would expect parents to keep alcohol away from their children. If 1was to witness an adult giving alcohol to a child, I would address them end politely remind them it is againstthe law to give alcoholto a child in a public place andpromptly ask the customers to leave.
L
Hours premises are open State any seasonal variations (please read guidance note 4) to the public Standard days and timings We will open during the hours as stated (see column). (please read guidance note 6) Day Start finish Mon
Tue 12:00 22:00
Wed 12:00 22:00 Non standard timings. Where you intend the premises to be open to the public at different times from those listed In the column on the left, Thur 12:00 22:00 please list (please read guidance note 5)
Fri 12:00 22:30 See section I.
Sat 12:00
Sun 12:00 16:00 M Describe the steps you intend to take to promote the four licensing objectives:
a) General — all four licensing objectives (b, c, d and e) (please read guidance note 9) I aim to run a dining establishmentthat is a law-abiding,family-friendlyand a safe environmentfor all our customers. I will ensure that customerstake into considerationour neighbours and leave my restaurant quietly and peacefuLly.I will ensurethat my restaurantis protected from any dangers such as fire or flooding and take measures to make sure that customersdo not injure themselves.Any alcohol that we do serve will be served in moderationand accessibilitywill be completelybarred from children. Should any customers decide to endanger other customersor breach any of the statementsmade above,(if necessary) said customers will be promptly reportedto the police. b) The prevention of crime and disorder
If I witness any customerscommittingany illegal offences, I will report the customersto the police. Should I sense a dispute to become violent between two customers, I will ask the customers to leave immediately to avoid any innocentbystandersbeing injured. Consequently,I tvillcall the police to prevent any further damage being caused.
c) Public safety I will ensure that my customers are safe by putting up safety signs should the floor be wet during cleaning. I will ensure that all fire exits are clear and that there are no hazards such as loose packaging, loose wires on the floor and any spillages (these would be cleaned up immediately).Should a fire occur, I would ensure that all customers and staff leave the buildingcalmly and safely and make sure that everyone is accounted for. I would then proceedto call the fire brigade.
d) The prevention of public nuisance
I would remind all my customers to leave the premisesquietly and calmly, especially at night where residents will be trying to rest. I will ensure that customerswho are drinking alcoholare aware of their limits and if I deem them to have consumedtoo much, I will politely refuse to serve any more alcohol to them and I would ensure that they did not cause any nuisance to other customers.
e) The protection of children from harm I would ensure that all children are protected from harm and shoulda customermake a child fear for their safety, 1would ask that customer to leave; if necessary the police would be called. I will ensure that children will not enter the kitchen where they could be in danger. Alcohol would not be accessible for children and I will do this by keeping it away from children’s reach.
Checklist: Please tick to Indicate agreement
• 1have made or enclosedpayment of the fee.
• I have enclosed the plan of the premises.
• I have sent copies of this applicationand the plan to responsible authoritiesand otherswhere applicable. • I have enclosed the consent form completedby the individual I wish to be designatedpremises El7 supervisor, if applicable.
I understand that I must now advertise my application.
‘ I understand that if 1do not comply with the above requirements my applicationwill be rejected.
IT IS AN OFFENCE, LIABLE ON SUMMARY CONVICTION TO A FINE NOT EXCEEDING LEVEL 5 ON THE STANDARD SCALE, UNDER SECTION 158 OF THE LICENSING ACT 2003, TO MAKE A FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION.
Part 4 — Signatures (please readguidance note 10)
Signature of applicant or applicant’s solicitor or other duly authorised agent (see guidancenote Ii), If signing on behalf of the applicant, please state In what capacity.
Signature
Date
Capacity a/E C TZ)/(..
For joint applications, signature of 2” applicant or 2’ applicant’s solicitor or other authorised agent (please read guidance note 12), If signing on behalf of the applicant, please state in what capacity.
Signature
Date
Capacity
Contact name (where not previously given) and postal address for correspondenceassociatedwith this application (please read guidance note 13)
Post town Postcode Telephone number (if any) If you would prefer us to correspondwith you by e-mail, your e-mail address (optional)
Notes for Guidance
I. Describe the premises, for example the type of premises, its general situationand layout and any other informationwhich could be relevant to the licensing objectives.Where your application includesoff-supplies of alcohol and you intend to provide a place for consumptionof these off-