Fillable Form 1632 Film Permit Procedures And Application (City of Irwindale)

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Form 1632 Film Permit Procedures And Application (City of Irwindale)

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Film Permit Procedures
This worksheet provides required information for companies wishing to apply for a film
permit. The information listed below shall be submitted prior to issuance of a film permit;
otherwise, we will not accept the application. If you should have any questions regarding this
process, please contact Iris Espino at (626) 430-2252.
1. The application should be completely filled out by the applicant.
2. Determine where the filming will take place.
a. If on private property, the property owner must sign a letter authorizing the use
of the property.
b. A site plan may be required if filming is planned on City streets and/or City
property. The site plan must include the location(s) of cast, crew, vehicle(s), and
the route to be used in order to film a scene.
c. If filming at the Irwindale Speedway, then a signature is required on the hours
agreed upon and the Typical Draft Conditions of Approval on Time and Activity
Limits for filming at the Irwindale Speedway.
3. A Certificate of Liability must be turned in identifying the City of Irwindale as
additionally insured with a minimum of $1,000,000.
a. A Certificate of Workers Compensation is also required. This may be included in
the Certificate of Liability.
4. The applicant needs to have a current Business License to do any type of work in
the City of Irwindale. Please fill out and pay for your license as part of this
application process.
5. The County of Los Angeles Fire Department Motion Picture/TV Filming Permit
approval must be submitted with the film application.
6. A pyrotechnician is required if pyrotechnics will be used.
7. Once all documents are properly filled out, management approval will be required.
8. The film permit fee is $215. The film permit can be processed in one day; however,
there is an additional $150.00 charge. Additionally, there is a business license fee if
you do not have a business license to work in the City of Irwindale.
Department of Public Works
5050 N. Irwindale Ave., Irwindale, CA 91706
(626) 430-2252 phone (626) 430-2295 fax
City of Irwindale Film Permit Application
City of Irwindale
5050 North Irwindale Avenue, Irwindale, California 91706
(626) 430-2252 Fax (626) 430-2295
FILMING PERMIT APPLICATION
*PERMIT TO BE ON LOCATION AT ALL TIMES
Permit No:
Date: Fire Department Permit No:
Company: Pyrotechnic Permit No:
Address: Project Title:
Location Manager:
Phone:
Production Manager:
Company Phone: Phone:
Company Fax: Other Contact:
Production Dates:
1. Production Type:
❏ TV Episodic ❏ Feature Film ❏ Music Video ❏ Corporate Video ❏ TV Commercial ❏ TV Movie
❏ Other:
2. Filming Action: ❏ INTerior Dialogue ❏ EXTerior Dialogue ❏ Other ____________________________
❏ Camera in Curblane ❏ Camera on Sidewalk ❏ Street Closure ❏ Drive By s ❏ Drive Ups/Aways
❏ Running Shots ❏ Tow Shots ❏ Wet Down ❏ Nudity ❏ Police Escort
❏ Lane Closure ❏ Music Playback ❏ Drive w/flow of Traffic ❏ Other __________
Description of Filming Activities:
3. Total Personnel: Total Vehicles/Equipment:
4. Equipment Detail: Generators: ______ Cars: ______ Trucks: ______ RVs: ______ Other:
5. Insurance: Before a film permit is issued, a certificate of insurance must be submitted. Requirements are:
❏ Minimum $1,000,000 General Liability Limit. ❏ Proof of Workman s Compensation.
❏ City of Irwindale Named as Additional Insured.
❏ Insurance Certificate Attached.❏ Insurance Certificate on File.
Insurance Company: Expiration Date:
Policy No:
City of Irwindale Film Permit Application
6. Location Shoot Specifics: Please give specifics about your shoot below, attach sheets if more space is
needed. You must include the mane(s) of property owner(s), address(es), nearest cross streets and telephone
number(s) of the filming location(s). Also describe all Scene(s) to be filmed (including pyrotechnics and
stunts).
Date Time Location and Activity
PREP
FILM
STRIKE
7. Traffic: If filming is planned on City street(s) and/or City property, please submit a site plan showing
location(s) of cast, crew, vehicle(s) and the route to be used in order to film a scene.
❏ Site plan Attached. ❏ Site plan will be submitted by time ___________ and date __________.
Describe your plan for controlling traffic, (i.e. police services, personnel and devices to direct traffic):
8. Stunts/Special Effects: If your filming will involve stunts or special effects, please provide detailed
information about the specifics planned:
Pyrotechnics Specifics:
Pyrotechnician: License Number:
Hazardous Materials to be used:
9. Special Restrictions:
• Written notice to be given to all surrounding residents and/or businesses within a three hundred-foot
radius of the filming activity stating date(s) and time(s) filming is to take place.
• All parking to occur on private property.
• Police Officers required.
______ officers for ______ hours at $_________ per hour for a total fee of $_________
City of Irwindale Film Permit Application
OFFICE USE ONLY
Date Application Received: Fees: Application/Investigation Fee*
Date Fees Paid: Police Fee
Public Works Fee
Business License Fee
Other Fee
Total
*Non-Refundable
Approvals and Conditions:
Controller
Planning _ _________
Public Works
Police
City Manager
Attachments:
Other provisions:
Permittee agrees to comply with all applicable laws and to maintain the premises I good condition and to return said
premises in the same condition as they were before said use.
Unless greater or lesser coverage is requested, premittee agrees to furnish the City of Irwindale evidence of $1 million
comprehensive general liability insurance including contractual liability and automobile liability when applicable, in the
form of a certificate, covering the entire period of this permit, naming the City of Irwindale as additional insured.
Permittee waves all claims against the City of Irwindale, its officers, agents and employees, for fees or damage caused by,
arising out of, or in any way connected with the exercise of this permit and permittee agrees to save harmless, indemnify
and defend city, its officers, agents and employees from any and all loss, damage of liability which may be suffered or
incurred by City, its officers, agents and employees caused by, arising out of or in any way connected with exercise by
permittee of the rights hereby permitted, except those arising out of the sole negligence of City.
Permittee agrees to all the terms and conditions of this permit including any provisions listed and any attachments.
Applicant s Name: Representative of:
(Company Name)
City of Irwindale Film Permit Application
City of Irwindale
Permission to use Property for Filming
In accordance with city of Irwindale s Municipal Code Section 9.65.050 I hereby give
permission for to use the property
(Film Company)
located at for the purpose of filming on
(Address)
the following dates(s) and
time(s) .
We agree to save harmless said City of Irwindale, its officers and employees from any and all
claims, damages or losses to persons or property resulting from use of the above mentioned
property by applicant, their invitees, or anyone attending the event whether or not caused by
negligence of such person.
OWNER OF PROPERTY
Signature(s)
Name (Please type or print)
Telephone Number
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
Date: to
Y
N
Other
PLEASE ATTACH ADDITIONAL PAGES IF NECESSARY
Office
Phone #: *
Ext:
Cell
Phone #: *
Prep Date: Strike Date:
*Required
*Required
*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):
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Form 1632 Film Permit Procedures And Application (City of Irwindale)

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Completed 14 July 2020

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