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London SE64RU 020 8314 6400 Application for a Premises Licence

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London SE64RU 020 8314 6400 Application for a Premises Licence t Licensing Team 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 completing this form please read the guidance notes at the end of the form. if you are completing this form by hand please write legibLy in block capitals. In all cases ensure that your anstvers are inside the boxes and written in black ink. Use additional sheets if necessary. You may wish to keep a copy of the completed form for your records. I Rodolfo Piscina (Insert name(s) ofapplicant) 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 - Applicant Details Please state whether you are applying for a premises licence as Please tick as appropriate * a) an individual or individuals El please complete section f A) b) a person other than an individual i. as a limited company please complete section (B) ii. as a partnership please complete section (8) iii. as an unincorporated association or (2J please complete section (B) iv. other (for example a statutory corporation) El please complete section (B) c) a recognised club (21 please complete section (B) d) a charity El please complete section (8) e) the proprietor of an educational establishment El please complete section (B) f) a health service body El please complete section (B) g) a person who is registered under Part 2 of the Care El please complete section (B) Standards Act 2000 (c14) in respect of an independent hospital in Wales ga) a person who is registered under Chapter 2 of Part I El please complete section (8) of the Health and Social Care Act 2008 (within the meaning of that Part) in an independent hospital in England h) the chief officer of police of a police force in England El please complete section (8) and Wales If you are applying as a person described in (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 pursuant to a statutory Ii.inction or El a function discharged by virtue of Her Majesty’s prerogative El (A) INDiVIDUAL APPLICANTS (fill in as applicable) M ‘ El O El t”tr Miss 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 18 years 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’UIIER APPLICANTS 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, unincorporated association etc.) Panership Telephone number (if any) E-mail address (optional) Part 3 Operating Schedule DD MM YYYY When do you want the premises licence to start? ) 16 12 k 14 Ii 1 DD MM YYYY If you wish the licence to be valid only for a limited period, when do you i i i want it to end? I I t Please give a general description of the premises (please read guidance note 1) Restaurant serving hot food and drinks. I am applying for a premises licence so I can serve alcohol to adults aged 18 and above for consumption on 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 customers can dine and we will only serve alcohol when customers intend to buy a meal. There is a bar which only staff are allowed to occupy where at the moment hot drinks are served, There is also a kitchen, washing area and cooking prep area which is situated at the back of the premises. We will not serve alcohol unless a customer buys a meal, No alcohol will be sold off the premises and customers who intend to consume alcohol can only do so white they are sitting eating their meaL We intend to keep stock in fridges both in the kitchen and in a separate room which will not be available for customers to access. If 5,000 or more people are expected to attend the premises at any one time, N/A please state the number expected to attend. [ What licensable activities do you intend to carry on from the premises? (Please see sections 1 and 14 of the Licensing Act 2003 and Schedules 1 and 2 to the Licensing Act 2003) Please tick any that Provision of regulated entertainment apply a) plays (if ticking yes, fill in box A) 0 b) films (if ticking yes, fill in box B) c) indoor sporting events (if ticking yes, fill in box C) 0 ci) boxing or wrestling entertainment f if Licking yes, (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) performances of dance (if ticking yes, fill in box 0) 0 anything of a similar description to 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 (please read (please read guidance note guidance note 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 (please read 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 (please read%iidance (please read guidance note 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 guidance note 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 (please read guidance note 5) Sat Sun / - : • • • • • • • • •• • •• • • ,•• • $ • •• •I__ - •• • • • • • •s’, • • •• C / Indoor sporting events Please give further details (please read guidance note 3) Standard days and timings (please read guidance note 6) / / Day Start finish // Mon Tue State any seasonal varIationsA indoor sporting events (please read guidance note 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 read guidance note 5) 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 Standard days and timings (please read guidance note 2) (please read guidance note / Outdoors 6) / — Day Start finish both 0 Mon Please give further details here (P5 read guidance note 3) Tue // Wed State any seasonal varjtions for boxing or wrestling entertainment Wlease rend guidan4ote 4) Thur /1/ Fri Non stand6d timings. Where you intend to use the premises for boxing or wrest%ng entertainment at different times to those listed in the coluny(on the left1 please list Qlease read guidance note 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 guidance note 2) — 6) Outdoors Day Start Finish Both U Mon Please give further details here (please read guidance note 3) To host live music events such as an aOpen Mic nights on Friday and Saturday nights Tue Wed State any seasonal variations for the performance of live music (please read guidance note 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.
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