City of Moorpark
Building and Safety
799 Moorpark Avenue
Moorpark, CA 93021
(805) 517-6272 FAX (805) 532-2520
Plan Check Application
This Plan Check Application expires 180 days after first submittal date. Issue 1 Rev. 3
Revision Date: 12/16/2020
Site Information Plan Check Number:
(Office Use Only)
Site Address:
Tract: Lot: APN:
Property Owner Applicant
Name: Name:
Street Address: Street Address:
City, State & Zip: City, State & Zip:
Phone: Phone:
Email: Email:
Architect/Designer Engineer
Name: Name:
Street Address: Street Address:
City, State & Zip: City, State & Zip:
Phone: Phone:
Email: Email:
Project Information
Estimated Valuation (total cost of labor and materials): $
Existing floor area: New/Addition floor area: Remodeled floor area:
Scope of Work:
I attest by my signature below under penalty of perjury that I have read this application and the information I have provided is true and correct. I attest that I am the
Property Owners Authorized representative and authorize representatives of the city of Moorpark to enter the above-identified property for inspection purposes.
Business Name:
Applicant /Owner Signature: Date:
Applicant/Owner Name:
(Print)
License No.:
Exp.:
License No.:
Exp.:
