CITY OF MOORPARK
TEMPORARY USE PERMIT
APPLICATION
Please Print or Type SECTION 17.44.040 A MOORPARK MUNICIPAL CODE
Minor Temporary Use Permit need to be submitted 2 weeks prior to activity
Major Temporary Use Permit need to be submitted 30 days prior to activity
APPLICANT: PROPERTY OWNER:
_______________________________________________
______________________________________________
(Name)
(Name)
_______________________________________________
______________________________________________
(Street Address) (City, State and Zip Code)
(Street Address) (City, State and Zip Code)
_______________________________________________
_______________________________________________
(Phone) (Email)
(Phone) (Email)
_______________________________________________
_______________________________________________
Email
Signature Or
Attached property owner’s authorization / Landlord Approval
LOCATION ADDRESS (Location description if no street address.):
____________________________________________________________________________
DESCRIPTION OF ACTIVITIES (Describe event to be conducted):
______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Date(s) of proposed event: ____________________ Hours of proposed event: _____________________
I HEREBY ACKNOWLEDGE THAT I HAVE COMPLETED THIS APPLICATION IN ITS ENTIRETY AND
STATE THAT THE INFORMATION GIVEN IS CORRECT AND AGREE TO COMPLY WITH ALL
PROVISIONS OF THE CITY CODE AND ANY SPECIAL CONDITIONS AS MAY BE INCLUDED BY STAFF.
MY SIGNATURE BELOW AND INAUGURATION OF THIS USE INDICATES UNDERSTANDING AND
ACCEPTANCE OF ALL CONDITIONS THAT MAY BE INCLUDED.
FURTHER, I UNDERSTAND THAT THE TEMPORARY USE PERMIT IS NOT ASSIGNABLE AND DOES
NOT RUN WITH THE LAND, THAT THE TEMPORARY USE PERMIT SHALL EXPIRE UPON ITS
TERMINATION DATE, AND THAT REGARDLESS OF THE DEGREE OR AMOUNT OF USE UNDERTAKEN
PURSUANT TO THE TEMPORARY USE PERMIT, NO VESTED RIGHTS SHALL BE ACQUIRED IN ANY
SUCH USE.
APPLICANT SIGNATURE: _______________________ DATE: ____________________________
Attachments Required:
Copy of Insurance Policy/Rider and certificates. (Endorsement form ISO Forms CG 20-10 and CG
20-37 must say the following, “City of Moorpark and its officers, employees, servants, and agents”).
State Board of Equalization Form DOE 530-B is required for temporary sales.
For City Use Only:
Date Submitted: Case No.:
Fee Amount: Business Registration No:
Received By: Case Planner:
click to sign
signature
click to edit
click to sign
signature
click to edit
C:\Users\mdouglass\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BT8A3UUH\Temporary Use Permit.docx
Rev. 12/04/15
SUPPLEMENTAL INFORMATION
Company, policy number, agency, amount of liability insurance agreement, and endorsement, if on public
property (submit certificate of insurance naming the City of Moorpark as additional insured):
____________________________________________________________________________________________
____________________________________________________________________________________________
Attendance expected per day Number of event employees
Admission Fee? ____Yes ____No Date of final clean-up of site:
Number of security guards/parking attendants/traffic control:
Will any temporary structures or tents be used? Yes No
If so, describe:
Will alcoholic beverages be served? Yes No
If so, describe type, locations, license holder (ABC)
(Requires an additional permit)
Note: The sale of alcoholic beverages requires a separate permit prior to the event.
1. Streets or sidewalks to be closed:
2. Will offsite parking be required? Yes No
Where provided?
3. Will street/traffic travel patterns be modified? Yes No
Name streets and describe change:
4. Are signs proposed? Yes No
If yes, where will they be placed?
5. Do you require any City Services? Yes No
If yes, please state which services and duration:
6. Number of vehicles expected:
7. Please describe type, variety, and location of food vendors:
8. Is the site paved? Yes No
9. What is the source of water?
10. Will electricity/lighting be needed? Yes No
If yes, please state where electricity or lighting will be needed:
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome