Form 10-931 - Application For Special Use Permit Commercial Filming/still Photography - National Park Service

National   P ark   S ervice  

Cabrillo   N ational   M onument  

1800   C abrillo   M emorial   D rive  

San   D iego,   C A   9 2106  

(619)557-­‐5450  

 

Application   f or   S pecial   U se   P ermit  

Commercial   F ilming/Still   P hotography  

 

Please   s upply   t he   i nformation   r equested   b elow.   A ttach   a dditional   s heets,   i f   n ecessary,   t o   p rovide   r equired  

information.   A   n onrefundable   p rocessing   f ee   o f   $ 100.00   m ust   a ccompany   t his   a pplication   u nless   t he   r equested  

use   i s   a n   e xercise   o f   a   F irst   A mendment   r ight.     Y ou   m ust   a llow   s ufficient   t ime   f or   t he   p ark   t o   p rocess   y our   r equest;  

check   w ith   t he   p ark   f or   g uidelines.   Y ou   w ill   b e   n otified   o f   t he   s tatus   o f   t he   a pplication   a nd   t he   n ecessary   s teps   t o  

secure   y our   f inal   p ermit.   Y our   p ermit   m ay   r equire   t he   p ayment   o f   c ost   r ecovery   c harges   a nd   p roof   o f   l iability  

insurance   n aming   t he   U nited   S tates   o f   A merica   a s   a lso   i nsured.  

 

  E nter   e ither   a   s ocial   s ecurity   n umber   O R   a   t ax   I D   n umber:   w e   d o   n ot   r equire   b oth.  

Applicant   N ame:  

Applicant   C ompany:  

Social   S ecurity   # :  

Tax   I D   # :  

Street/Address:  

Street/Address:  

City/State/Zip   C ode:  

City/State/Zip   C ode:  

Telephone   # :  

Contact   n ame:  

Cell   p hone   # :  

Telephone   # :  

Fax   # :  

Fax   # :  

Email:  

Email:  

Project   n ame:  

Telephone   # :  

Location   m anager  

Cell   p hone   # :  

 

E-­‐mail:  

 

TYPE   O F   P ROJECT:   o   S till   p hotography         o   v ideo/motion   p icture/film    

Detailed   d escription   o f   o nsite   a ctivities   ( attach   a dditional   p ages   a s   n ecessary):    

 

 

 

 

LOCATION   S CHEDULE    

Each   d ate   a nd   e ach   l ocation   m ust   h ave   a n   i ndividual   e ntry   –   u se   a dditional   p ages   a s   n ecessary.  

Start   T ime   End  

Activity:   S et-­‐Up/  

#   o f   C ast   &  

Date  

Location  

Interior/  

Time  

Film   /   N on-­‐

Crew*  

Exterior  

Filming  

/Breakdown  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NPS   F orm   1 0-­‐931   r ev   0 6/2013                                  

                                                                                                                                      O MB   C ontrol   N o.   1 024-­‐0026    

 

 

Expires   0 8-­‐31-­‐2016