Fill - Free fillable CITY OF INGLEWOOD Film Permit Application (Inglewood, CA) PDF form

CITY OF INGLEWOOD

Film Permit Application

One Manchester Blvd. - Inglewood, CA 90301

(310) 412-5500 Fax: (310) 330-5735

A film permit is required for the purpose of producing any commercial motion picture, television production or

commercial still photography in the City of Inglewood.

Listed below are the steps that must be completed to obtain a Film Permit:

Step 1) Complete the attached film permit application.

Step 2) Call for appointment to meet with each applicable department in person to review application and

obtain signed approval.

(First) Public Works Department – 3

rd

Floor City Hall – (310) 412-5333

(Second) Police Department – 2

nd

Floor City Hall – (310) 412-4301. Monday – Friday from

10:00 am to 1:00 pm.

(Third) Parks, Recreation & Library Services Department – 5

th

Floor City Hall – (310)

412-8750. (Required only if you are filming in a City park)

Step 3) Complete the attached County of Los Angeles Fire Department, Motion Picture/TV Filming Permit

form and fax to County of Los Angeles Fire Department at (818) 364-8242. County of Los Angeles

Fire Department Personnel must review, sign and return back to you the Motion Picture/TV Filming

Permit form. Should you require additional information or have questions, please contact County of

Los Angeles Fire Department by phone at (818) 364-8240.

Step 4) Complete and return the film permit application packet with the following forms signed and attached,

to Inglewood City Hall, Finance Department, 1

st

floor:

1) County of Los Angeles Fire Department Motion Picture/TV Filming Permit form

(attached)

2) Hold Harmless Agreement (attached)

3) Permission to Use Private Property, for all film locations including base camps

(attached)

4) City of Inglewood Business Tax Registration Form (attached)

5) Certificate of Insurance – additional information provided*

Step 5) On filming day(s), copies of both the Film Permit and Film Permit application must be on location,

visibly posted and/or available to present to any and all City Officials upon request. Failure to present

both documents will result in your film permit being rendered void and filmmakers and/or production

groups will be required to cease all film activity.

INSURANCE REQUIREMENT*

A certificate of insurance is required with a minimum of $1,000,000 protection against claims of third

persons for personal injuries, wrongful deaths, and property damage. The certificate shall not be

subject to cancellation or modification until after 30 days written notice to the City of Inglewood. The

City of Inglewood should be named as co-insured and listed on the certificate as follows:

The City of Inglewood, its Officers, Agents and Employees

One Manchester Blvd.

Inglewood, CA 90301

FEES

Permit Fee: $635.00 Non-refundable

Taxes (Private Property): $44.00 for 1

st

day and $22.00 for each additional day

Taxes (Public Property): $220.00 for 1

st

day and $110.00 for each additional day

City Staffing Fees: If applicable, fees will be calculated upon submission of application

Parks, City Hall Filming: Minimum $1,500.00 per day per location

Public Rights of Way: Minimum $1,032.00 per day per location

(Streets, Alleys and Sidewalks)

ADDITIONAL INFORMATION

Office Hours and Location

Inglewood City Hall office hours are from 7:30 am to 5:30 pm, Monday through Friday. City Hall is

closed on alternating Friday’s.

The film permit section is located at:

Inglewood City Hall

One Manchester Blvd.

Finance Department, 1

st

Floor

Inglewood, CA 90301

(310) 412-5500

Cancellation

Cancellation notice or changes to the film permit application must be submitted in writing to the Film

Permit Coordinator 24 hours prior to the scheduled start of filming. Cancellation of weekend or Monday

filming must be submitted in writing to the Film Permit Coordinator by Thursday afternoon. Please

note, last minute cancellations with less than 24 hour notice, will be charged a minimum of four (4)

hours for Inglewood Police Department Personnel and/or City staff and services.

Student Filming

Film students are required to obtain a film permit but are exempt from the $635.00 permit fee, however

depending on film activity, other fees may apply for personnel and/or services. Film students are

required to submit student identification and an original letter, from an accredited educational institution,

on letterhead, indicating that you are currently enrolled and that the film is a student project. The letter

must be signed by an instructor or other school official and dated within the last 30 days.

Filming on Public Right of Way

The City has determined that a film is on public property if any of the following apply:

Traffic will be interrupted on City Streets

Pedestrian traffic on sidewalks will be interrupted

A tripod or dolly is used on sidewalks or streets

Wires or cables run across or over sidewalks

A generator is used on sidewalk or street

Public parking will be impacted

“No parking” signs posted on any public parking whether it is metered or not

Any person or apparatus associated with the film shoot is on public property

CITY OF INGLEWOOD

FINANCE DEPARTMENT

FILMING IN CITY OF INGLEWOOD

PROCEDURE CHECKLIST

APPLICATION CHECKLIST:

Application

Hold Harmless Agreement

Proof of Insurance with a Minimum of $1,000,000 Coverage

Permission to Use Private Property Sheet

Los Angeles County Fire Department Approval

Business Tax Application

Verification from School / Professor (Student Films Only)

Current Student ID (Student Films Only)

FEES:

Permit Fee ($635.00)

Staffing Charges (Police, Public Works, etc.)

Other Service Fees

Parks, City Hall Filming Minimum ($1,500.00 per day)

Public Right of Ways Including Streets, Alleys and Sidewalks Minimum

($1,032.00 per day)

Taxes:

Business Taxes Private Property ($44.00 for 1

st

day and $22.00 for each

additional day)

Business Taxes Public Property ($220.00 for 1

st

day and $110.00 for

each additional day)

CITY OF INGLEWOOD

Film Permit Application

One Manchester Blvd. - Inglewood, CA 90301

(310) 412-5500 Fax: (310) 330-5735

Date Received: _______________

Staff Initials: _______________

Customer Number: _______________

Activity Number: _______________

APPLICANT INFORMATION

COMPANY NAME:_________________________________________________TELEPHONE#:____________________

STREET ADDRESS:_______________________________________________________FAX#:____________________

CITY, STATE, ZIP CODE:_____________________________________EMAIL:_________________________________

PRODUCER:__________________________________DIRECTOR:__________________________________________

PRODUCTION MANAGER:___________________________PHONE#:________________CELL#:__________________

LOCATION MANAGER:______________________________PHONE#:________________CELL#:_________________

ON-SITE PRODUCTION COMPANY REP: NAME:_________________________________CELL#:_________________

PERMIT SERVICE COMPANY NAME:_________________________________________PHONE#:_________________

PERMIT COMPANY REP:_____________________________________EMAIL:_________________________________

FILMING DETAILS

PRODUCTION TITLE_______________________________________________________________________________

PRODUCTION TYPE: TV MOVIE TV SERIES STILL PHOTO MUSIC VIDEO

COMMERCIAL DRAMA STUDENT OTHER:__________________

FEES – OFFICE USE ONLY

APPLICATION FEE: _____________________

BUSINESS TAXES: _____________________

CITY FACILITY/ PUBLIC RIGHT OF WAY: _____________________

POLICE PERSONNEL: _____________________

PUBLIC WORKS: _____________________

OTHER: _____________________

TOTAL: _____________________

LOCATION 1

LOCATION ADDRESS:______________________________________________________________________________

LOCATION TYPE: PRIVATE PROPERTY PUBLIC PROPERTY CITY ROADS CITY FACILITIES

BASE CAMP ADDRESS:___________________________________________ LOCATION TYPE:__________________

CREW PARKING:_________________________________________________ LOCATION TYPE:__________________

CAST#:______________ CREW#:_________________ EXTRAS#:_______________ AUDIENCE#:________________

DATES

PREP DATE(S ) TIME(S):____________________________________________________________________________

FILMING DATE(S) TIME(S):__________________________________________________________________________

STRIKE DATE(S) TIME(S):___________________________________________________________________________

FILMING ACTIVITIES

SUMMARY OF SCENES (ATTACH ADDITIONAL SHEET IF NECESSARY):____________________________________

_________________________________________________________________________________________________

GENERAL INFORMATION

PERSONAL CARS:______ CATERING:______ SEMI-TRUCKS:______ MOTOR HOMES:______ TRAILERS:______

CUBE TRUCKS:______ VANS:______ CAMERA TRUCKS:______ PICTURE CARS:______ CONDOR:______

OTHER VEHICLES OR EQUIPMENT:________________________________________________________________

INT. DIALOGUE EXT. DIALOGUE CAMERA IN CURB LANE DRIVE UP/AWAY ITC

NUDITY CAM ON SIDEWALK RUNNING SHOTS WET DOWN STREET CLOSURE

LANE CLOSURE TOW SHOTS DRIVE BY’S DRIVE W/FLOW

DRIVING DETAILS:_____________________________________________________________________________

_____________________________________________________________________________________________

SPECIAL EFFECTS-DETAIL:_____________________________________________________________________

_____________________________________________________________________________________________

PYROTECHNICS-DETAIL:_______________________________________________________________________

_____________________________________________________________________________________________

OTHER:______________________________________________________________________________________

LOCATION 1 – PLOT PLAN

PLEASE INCLUDE THE FOLLOWING INFORMAITON FOR THE FILMING SITE:

1) ADJACENT STREETS 2) LOCATION OF EXISTING STUCTURES AND ANY PROPOSED TEMPORARY STRUCTURES

3) ANY PROPOSED BARRICADES, FENCING AND OTHER BARRIERS 4) GENERATOR / ELECTRICITY / UTILITY SOURCES

5) REQUESTED PLACEMENT OF TRAILERS, VEHICLES AND STORAGE FACILITIES 6) PARKING AREAS 7) SAFETY ACCESS POINTS

8) ALL OTHER RELEVANT ITEMS AT FILMING LOCATION

INTERIOR FILMING INCLUDE: 1) DOOR AND WINDOW LOCATIONS 2) LEVEL OF BUILDING 3) MAIN ELECTRICAL PANEL

FILMING LOCATION SKETCH

LOCATION 2

LOCATION ADDRESS:______________________________________________________________________________

LOCATION TYPE: PRIVATE PROPERTY PUBLIC PROPERTY CITY ROADS CITY FACILITIES

BASE CAMP ADDRESS:___________________________________________ LOCATION TYPE:__________________

CREW PARKING:_________________________________________________ LOCATION TYPE:__________________

CAST#:______________ CREW#:_________________ EXTRAS#:_______________ AUDIENCE#:________________

DATES

PREP DATE(S ) TIME(S):____________________________________________________________________________

FILMING DATE(S) TIME(S):__________________________________________________________________________

STRIKE DATE(S) TIME(S):___________________________________________________________________________

FILMING ACTIVITIES

SUMMARY OF SCENES (ATTACH ADDITIONAL SHEET IF NECESSARY):____________________________________

_________________________________________________________________________________________________

GENERAL INFORMATION

PERSONAL CARS:______ CATERING:______ SEMI-TRUCKS:______ MOTOR HOMES:______ TRAILERS:______

CUBE TRUCKS:______ VANS:______ CAMERA TRUCKS:______ PICTURE CARS:______ CONDOR:______

OTHER VEHICLES OR EQUIPMENT:________________________________________________________________

INT. DIALOGUE EXT. DIALOGUE CAMERA IN CURB LANE DRIVE UP/AWAY ITC

NUDITY CAM ON SIDEWALK RUNNING SHOTS WET DOWN STREET CLOSURE

LANE CLOSURE TOW SHOTS DRIVE BY’S DRIVE W/FLOW

DRIVING DETAILS:_____________________________________________________________________________

_____________________________________________________________________________________________

SPECIAL EFFECTS-DETAIL:_____________________________________________________________________

_____________________________________________________________________________________________

PYROTECHNICS-DETAIL:_______________________________________________________________________

_____________________________________________________________________________________________

OTHER:______________________________________________________________________________________

LOCATION 2 – PLOT PLAN

PLEASE INCLUDE THE FOLLOWING INFORMAITON FOR THE FILMING SITE:

1) ADJACENT STREETS 2) LOCATION OF EXISTING STUCTURES AND ANY PROPOSED TEMPORARY STRUCTURES

3) ANY PROPOSED BARRICADES, FENCING AND OTHER BARRIERS 4) GENERATOR / ELECTRICITY / UTILITY SOURCES

5) REQUESTED PLACEMENT OF TRAILERS, VEHICLES AND STORAGE FACILITIES 6) PARKING AREAS 7) SAFETY ACCESS POINTS

8) ALL OTHER RELEVANT ITEMS AT FILMING LOCATION

INTERIOR FILMING INCLUDE: 1) DOOR AND WINDOW LOCATIONS 2) LEVEL OF BUILDING 3) MAIN ELECTRICAL PANEL

FILMING LOCATION SKETCH

LOCATION 3

LOCATION ADDRESS:______________________________________________________________________________

LOCATION TYPE: PRIVATE PROPERTY PUBLIC PROPERTY CITY ROADS CITY FACILITIES

BASE CAMP ADDRESS:___________________________________________ LOCATION TYPE:__________________

CREW PARKING:_________________________________________________ LOCATION TYPE:__________________

CAST#:______________ CREW#:_________________ EXTRAS#:_______________ AUDIENCE#:________________

DATES

PREP DATE(S ) TIME(S):____________________________________________________________________________

FILMING DATE(S) TIME(S):__________________________________________________________________________

STRIKE DATE(S) TIME(S):___________________________________________________________________________

FILMING ACTIVITIES

SUMMARY OF SCENES (ATTACH ADDITIONAL SHEET IF NECESSARY):____________________________________

_________________________________________________________________________________________________

GENERAL INFORMATION

PERSONAL CARS:______ CATERING:______ SEMI-TRUCKS:______ MOTOR HOMES:______ TRAILERS:______

CUBE TRUCKS:______ VANS:______ CAMERA TRUCKS:______ PICTURE CARS:______ CONDOR:______

OTHER VEHICLES OR EQUIPMENT:________________________________________________________________

INT. DIALOGUE EXT. DIALOGUE CAMERA IN CURB LANE DRIVE UP/AWAY ITC

NUDITY CAM ON SIDEWALK RUNNING SHOTS WET DOWN STREET CLOSURE

LANE CLOSURE TOW SHOTS DRIVE BY’S DRIVE W/FLOW

DRIVING DETAILS:_____________________________________________________________________________

_____________________________________________________________________________________________

SPECIAL EFFECTS-DETAIL:_____________________________________________________________________

_____________________________________________________________________________________________

PYROTECHNICS-DETAIL:_______________________________________________________________________

_____________________________________________________________________________________________

OTHER:______________________________________________________________________________________

LOCATION 3 – PLOT PLAN

PLEASE INCLUDE THE FOLLOWING INFORMAITON FOR THE FILMING SITE:

1) ADJACENT STREETS 2) LOCATION OF EXISTING STUCTURES AND ANY PROPOSED TEMPORARY STRUCTURES

3) ANY PROPOSED BARRICADES, FENCING AND OTHER BARRIERS 4) GENERATOR / ELECTRICITY / UTILITY SOURCES

5) REQUESTED PLACEMENT OF TRAILERS, VEHICLES AND STORAGE FACILITIES 6) PARKING AREAS 7) SAFETY ACCESS POINTS

8) ALL OTHER RELEVANT ITEMS AT FILMING LOCATION

INTERIOR FILMING INCLUDE: 1) DOOR AND WINDOW LOCATIONS 2) LEVEL OF BUILDING 3) MAIN ELECTRICAL PANEL

FILMING LOCATION SKETCH

SIGN-OFF SHEET --- FOR CITY USE ONLY

PUBLIC WORKS DEPARTMENT - 3

RD

FLOOR PHONE: (310) 412-5333

CITY EMPLOYEE ASSIGNED:________________________________________________________________________

ENCROACHMENT PERMIT GRANTED: YES NO

TEMPORARY PARKING SIGNS POSTED: YES NO

AUTHORIZED SIGNATURE:_____________________________________________ DATE:______________________

FACILITIES MANAGER’S OFFICE (ONLY IF USING CITY FACILITY)

CITY-OWNED FACILITY TO BE USED:________________________________________________________________

CITY ELECTRICAL POWER TO BE USED: YES NO

AUTHORIZED SIGNATURE:_____________________________________________ DATE:______________________

POLICE DEPARTMENT - 2

ND

FLOOR PHONE: (310) 412-5464

POLICE STAFFING REQUIRED: YES NO

RECOMMENDATIONS:_____________________________________________________________________________

________________________________________________________________________________________________

AUTHORIZED SIGNATURE:_____________________________________________ DATE:______________________

RECREATION, PARKS & COMM. SER. DEPT. - 5

TH

FLOOR PHONE: (310) 412-8750

*Required only if you are filming on a City park*

CITY EMPLOYEE ASSIGNED:________________________________________________________________________

RECOMMENDATIONS:_____________________________________________________________________________

________________________________________________________________________________________________

AUTHORIZED SIGNATURE:_____________________________________________ DATE:______________________

CITY OF INGLEWOOD

FINANCE DEPARTMENT

FILMING IN CITY OF INGLEWOOD

HOLD HARMLESS AND INDEMNIFICATION AGREEMENT

The Undersigned, individually and on behalf of the applicant named below, agrees to

indemnify, defend and hold harmless, release and discharge the City of Inglewood and

its elected officials, and its employees, officers and representatives, from any and all

liability, any claim or demand made, and every loss, damage, or expense of any nature

whatsoever, arising from or relating to filming within the City’s limits by the undersigned,

by any member of any organization named below, or by guest of the undersigned or the

organization named below. This includes but is not limited to liability for damaged

property or injury or death to persons, attorney’s fees and court costs arising out of or in

connection with the activity herein described, regardless of whether the City was

actively or passively negligent either solely or contributory in connection with such

liability.

The Undersigned at their own expense, cost, and risk, shall defend any and all actions,

suits, or other proceedings that may be brought or instituted against the City, its officers,

agents or employees, on any judgments’ that may be rendered against the City, its

officers, agents or employees in any action, suit or other proceedings as a result

thereof.

In addition, it is hereby agreed, the Undersigned shall and hereby does indemnify, hold

harmless and defend the City for any and all claims, demands and liability, including

attorney fees and medical, court, appeals board and any other costs, related to any

worker’s compensation claim and benefits resulting from any injury to any off-duty

police, fire or other City personnel to the extent arising or resulting directly or indirectly

from any activity related to the filming within the City’s limits; provided, however, that the

Undersigned retains all rights of subrogation for any worker’s compensation claims or

benefits.

NAME OF APPLICANT: ____________________________________

NAME OF ORGANIZATION: _________________________________

________________________ ___________________

SIGNATURE OF APPLICANT DATE

CITY OF INGLEWOOD

FINANCE DEPARTMENT

FILMING IN CITY OF INGLEWOOD

PERMISSION TO USE PRIVATE PROPERTY

The undersigned is the owner /lessee of the real property located at the following address:

____________________________________________________________________________,

City of Inglewood, CA

Name of Business (if applicable): _________________________________________________

I have granted permission to (film company name): __________________________________

To use my property for the purpose of: _____________________________________________

____________________________________________________________________________

On the day/date (s) ____________________________________________________________

from _________am/pm to _________am/pm.

Further, I hereby hold harmless and agree to indemnify the City, its elected officials, its officers,

agents and employees against any and all claims, demands, or liabilities arising out of the

Permittee’s conduct or activities while on, or using, my property in connection with any filming

permit(s) issued by the City of Inglewood.

I certify under penalty of perjury that the foregoing is true and correct.

Executed at __________________________, California on this _____day of ________20____.

Signed: ________________________________

(Property Management/Lessee must attach written authorization to consent to filming,

e.g.: lease or property management contract)

Telephone: _____________________________

Questions: Contact the City of Inglewood Finance Department at (310) 412-5500.

Name: *

Address: * State: * ZIP: *

E-Mail: *

Production

Company Name: *

Address: * City: * State: * ZIP: *

E-Mail: *

Office

Phone #: *

LOS ANGELES COUNTY FIRE DEPARTMENT

FIRE PREVENTION DIVISION - PUBLIC SAFETY & FILM UNIT

14425 Olive View Drive, Sylmar, California 91342

Office (818) 364-8240 FAX (818) 364-8242

psfu@fire.lacounty.gov

MOTION PICTURE / FILMING PERMIT REQUEST

IN ACCORDANCE WITH CHAPTER 1, SECTION 105 OF THE 2011 L.A. COUNTY FIRE CODE AND/OR IN ACCORDANCE WITH TITLE 19, CALIFORNIA CODE OF

REGULATIONS, FOR THE FOLLOWING:

This permit shall constitute permission to conduction motion picture, television and commercials and related filming productions. Such permit shall not take the

place of any license required by law. The Motion Picture/Filming fee is $282.00.

APPLICANT INFORMATION

PRODUCTION COMPANY INFORMATION

Open to Public

Closed to Public

Exterior Dialogue

Interior Dialogue

Driving Scene

Drive Ups/Away

Drive By’s

Still Photo

Special FX

Breaking Glass

Bullets/Squib Hits

Bum Barrels

Car Explosion

Dust Hits

Explosions

Fire Ball

Fire Bars

Fire Effects

Sparks

Posted Parking

Street Closure

Aircraft Landing

Aircraft Flyovers

Aircraft Refueling

Helo Activity

Landing

Helo Activity

Take Off

FILMING ACTIVITIES

FIRE DEPARTMENT REQUIREMENTS – PUBLIC SAFETY & FILM UNIT USE ONLY (Form 394A Rev 5/2011)

FSO FSA FI WATER TRUCK ISSUED BY DATE REMARKS

City: *

Ext:

Agency Permit #:

Application

Date: *

FAX #: *

Production Type: *

Cell

Phone #: *

Location Manager: *

Production Title: *

Date: * Time: *

Primary Location

Address: *

FILMING LOCATION/DATES/TIMES

Cross Street:

# of

Generator(s): *

TG Map:

Aircraft*

# Extras

on Site: *

# Crew

on Site: *

# Cast

on Site: *

Summary of

Scene: *

Time:

Secondary

Location Address:

Cross Street:

Summary of

Scene:

Time:

Additional

Location Address:

Cross Street:

Summary of

Scene:

Base Camp

Location/Address:

TG Map:

to

Date: to

Y

N

Other

PLEASE ATTACH ADDITIONAL PAGES IF NECESSARY

Office

Phone #: *

Ext:

Cell

Phone #: *

Prep Date: Strike Date:

*Required

Vacant

Building

# of

Generator(s):

TG Map:

Aircraft

# Extras

on Site:

# Crew

on Site:

# Cast

on Site:

Y

N

TG Map:Aircraft

# Extras

on Site:

# Crew

on Site:

# Cast

on Site:

Y

N

# of

Generator(s):

CITY OF INGLEWOOD

ONE MANCHESTER BOULEVARD

INGLEWOOD, CA 90301 - (310) 412-5500

www.cityofinglewood.org

APPLICATION FOR

BUSINESS TAX REGISTRATION

OFFICE USE ONLY

Customer

No.

Activity No.

Zoning

Sign-off

It is the business owner's responsibility to renew the Business Tax Certificate each calendar year. All Gross Receipt taxe s are delinquent

if not paid by the last day of February. All Flat Rate taxes are delinquent if not paid by the last day of January.

PLEASE TYPE OR PRINT CLEARLY

Please

Check One

 New Business

 Change of Owner

 Change of Address

 Change of Bus. Name

 Home Occupation

Business Name/DBA

Business Location

(Cannot be P. O. Box )

City

State

Zip

Start

Date

in

City

/

Mailing Address

Web Address

Email Address

City

State

Zip

Bus. Phone ( )

Bus. Fax ( )

Description of Business Activity in Detail

CHECK ALL APPROPRIATE BOXES

 Retail Sales

 Wholesale

 Professional Services

 Commercial Rental

 Residential Rental

 New Merchandise

 Buidling Contractor

 Restaurant

 Vending Machine

 Booth Rental Only

 Used Merchandise

 Manufacturing

 Office Only

 Storage/Warehousing

 Educational/Institutional

No. of Employees

Square Feet Occupied

No. of Parking Spaces

Former Use of Business Address

Ownership:

 Corporation

 State of Incorporation

 Corp-Ltd Liability

 Partnership

 Sole Proprietor

 Trust

State Lic. No.

State Lic. Type

Expire Date

Resale No.

Federal ID No.

State ID No.

Enter below names of Owners, Partners, or Corporate Officers (attach additional sheet, if

necessary)

Owner Name

Title

Soc. Sec. No.

Home Address

Phone No. ( )

Cell Phone ( )

(Cannot be P. O. Box )

Drivers Lic. No.

Owner Name

Title

Soc. Sec. No.

Home Address

Phone No. ( )

Cell Phone ( )

(Cannot be P. O. Box )

Drivers Lic. No.

In case of emergency, please contact (attach additional sheet, if

necessary)

Name

Title

Phone No. ( )

Address

Cell Phone ( )

Alarm Company (if applicable)

Name

Phone No.

Address

I hereby certify, under penalty of perjury, that the information in this

application is true, correct and complete.

AMOUNT DUE

Gross Receipts

$

Date:

/

Title:

No. of Rentals Units

#

Amount of Tax Due

$

Signature:

Penalty

$

Return Entire Application form to above address and

make check payable to the City of Inglewood.

Fire Inspection Fee

$

State Disability Access Fund

1

$1.00

(1) Under federal and state law, compliance with disability access laws is a serious and significant responsibility that

applies to all California building owners and tenants with buildings open to the public. You may obtain information

about your legal obligations and how to comply with disability access laws at the following agencies:

 The Division of the State Architect at www.dgs.ca.gov/dsa/Home.aspx.

 The Department of Rehabilitation at www.rehab.cahwnet.gov.

 The California Commission on Disability Access at www.ccda.ca.gov.

TOTAL DUE

$

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Fill Online, Printable, Fillable, Blank CITY OF INGLEWOOD Film Permit Application (Inglewood, CA) Form

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