Applicant's Name. Mailing Address. City State Zip Code. Telephone 8 a.m.- 5 p.m. Fax. Production Title. Applicant's Signature

Transcription

1 CALAVERAS COUNTY COMMUNITY DEVELOPMENT AGENCY GOVERNMENT CENTER 891 MOUNTAIN RANCH ROAD SAN ANDREAS, CA Phone: (209) Fax: (209) FILM PERMIT APPLICATION Permit No. Supervisorial District Applicant's Name Mailing Address City _State Zip Code Telephone 8 a.m.- 5 p.m. Fax Production Title Type of Filming: Feature Educational Stills Television Commercial Other Applicant's Signature Authorization for this application is hereby given by: Property Owner's Signature (Written Authorization May be Attached) NOTE: If more than one person is involved in the ownership of the property being utilized, a separate page must be attached to this application with the names and addresses of all persons having an interest in the ownership of the property. If County-owned property is to be utilized, signature of the agency or department responsible for the property is not required, the Film Permit Coordination Officer will permit the use of County-owned property. 1

2 FEES AND CHARGES 1. Film Permit Fee $ Rider Fee $ 2. Other Permit Fees $ $ $ $ 3. Basic Fees AGENCY/DEPT. FEE AMOUNT PAID DATE Administration Building Dept. Public Works Sheriff Fire Dept. Fire District Animal Control Other The Permitee will be billed by the County for any additional expenses incurred by the County in conjunction with operation of this permit (machinery, manpower, clean-up, etc). SITE INFORMATION: Location Manager: Location: County Owned Property: Private Property: Summary of Scene: Exterior Interior Total No. of Days Prep Film Strike ( ) ( ) ( ) (s) Hour(s) ( ) ( ) ( ) (s) Hour(s) ( ) ( ) ( ) (s) Hour(s) Total No. of: Personnel Vehicles Vans Trucks Cast/Crew Cameras Generators Dressing Rooms 2

3 CALAVERAS COUNTY STANDARD USER AGREEMENT FOR COUNTY COMMUNITY BUILDING Name of requesting agency: Person submitting request: Building being requested: /s requested Hours of use Type of function being held: Will beer or wine be served? Have you obtained a temporary liquor license from ABC? How many people do you expect to attend? I have read the policies and procedures for the use of County community buildings and the rules and regulations pertaining to said use and agree to abide by those policies and regulations. Name/Title Organization Address Phone Number *************************************************************************** Approved Robert Sellman, Planning Director Charges Rev 07/06 3

4 1. The undersigned INDEMNIFICATION AGREEMENT (Print: Applicant(s) / Landowner(s) names) Applicant hereby agrees, as a condition of approval of (Permit # / license / other entitlement assigned by Planning Department) to defend, indemnify, and hold harmless the County of Calaveras (County) and its agents, officers, and employees from any claim, action, or proceeding against the County or its agents, officers, and employees arising from such approval. The obligation of Applicant to defend, indemnify, and hold harmless arises only if the County notifies Applicant of any claim, action, or proceeding within a reasonable time after the County knows of the claim, action, or proceeding. 2. Applicant shall, upon written request of the County, prepare a defense for the County at Applicant s sole expense. Alternatively, the County, at the County s sole discretion, may prepare its own defense, with Applicant paying the reasonable costs of the County s defense. Such costs shall include attorney fees and other related costs of defense, including without limitation, travel, postage, photocopies, and County staff costs. 3. Applicant shall not be required to pay or perform any settlement unless the settlement is approved in advance by the Applicant. The County must approve any settlement affecting the rights and obligations of the County. 4. In all cases, regardless of whether the County or the Applicant defends the County, the Applicant shall indemnify the County for any judgment, order, or settlement rendered as a result of any claim, action, or proceeding arising from the approval. 5. At no time shall Applicant file any complaint, cross-complaint, or any offensive pleadings in an action arising out the County s approval without first obtaining the County s written approval. 6. The Applicant shall pay to the County, within thirty calendar days upon written demand, any amount owed to the County as a result of the County incurring costs or expenses due to its defense under the terms of this Agreement. 4

5 7. The obligations specified herein shall be binding on any successors or assigns of Applicant. 8. This Agreement may be signed in counterpart but must be signed by all applicants and landowners. *Signatures must be notarized. (Include additional applicant and/or landowner signatures on an attached sheet.) If the deed shows the owner(s) to be a corporation, partnership, or limited liability company, a copy of a Resolution or other official document (consistent with California Corporations Code , , ) shall be provided, authorizing the signatory(ies) to approve and execute this agreement. COUNTY OF CALAVERAS APPROVED AS TO LEGAL FORM By: Planning Director By: County Counsel Rev: 07/06 5