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HomeMy WebLinkAboutFire Special Effect ApplicationOffice of the Fire Marshal Cove Communities Indian Wells 44950 El Dorado Drive, Indian Wells, CA 92210 •Phone (760)776-0239 •Fax (760)346-0407 Palm Desert 73-510 Fred Waring Drive, Palm Desert, CA 92260 •Phone (760) 346-1870 •Fax (760)779-1959 Rancho Mirage 69825 Hwy 111, Rancho Mirage, CA 92270 •Phone (760) 324-4511 • Fax (760) 324-8169 Rev 03/2016 SPECIAL EFFECTS PERMIT APPLICATION APPLICATION INFORMATION Permit Number: ________________________ Applicant Name: ______________________________________________________________ Address: ____________________________________________________________________ Phone No: ____________________________ Fax No: _______________________________ EVENT INFORMATION [ ] Public Dispaly [ ] Film/Motion Picture [ ]Indoor/Theatrical [ ] Special Effects(Other) Event Name: __________________________Event Sponsor/RP:_______________________ Address: ____________________________________________________________________ Phone No: ___________________________ Fax No:________________________________ SITE INFORMATIONS Location/Area of Event: ________________________________________________________ Date(s) & Time(s) of Event: _____________________________________________________ PYROTECHNIC OPERATOR - Include copy of current license. Name of Operator Supervisor: __________________________________________________ License Class:__________________________ Licenses No: _________________________ DESCRIPTION OF PRODUCT TO BE FIRED AND STORGE ARRANGEMENT - Attached an additional page (City of Rancho Mirage prohibits Salutes) Type of Display: [ ] Aerial [ ]Low Level [ ]Set Piece [ ]Devices [ ]Maual [ ]Electric [ ] Reloading/Refueling will be necessary [ ] Affect airport traffic [ ]Explosives Certifications of Insurance - provide a copy that include City, County, State, Riverside County Fire Department and CalFire. Site Map/Plot Plan - provide a diagram of the area with placement of devices, fall out zone distance, location of operator, locations of audience and/or performers and ceiling height (if indoors). Include location of roadways, overhead obstructions, and structures. Provide a copy of agreement/letter from property owner giving permission to use property for this event. Licenses - provide a copy of the Wholesaler's State & Importer/Exporter State License. Conditions of Approval: Application and fees (if applicable) shall be submitted in advance of the date of the display/ event. An additional standby fee for Fire Safety Officer may be required. The display/event shall not proceed unless the assigned Fire Safety Office is present. The following inspections are required to be performed by the Fire Safety Officer: -Morter set-up prior to load in produce -Site & produce inspection & weather condition confirmation prior to shoot -Final Inspection after Pyrotechnician Supervisor clear the event/site Any permit issued by the Fire Department may be susupended or revoked if it is determined that there are/has been any false statement made or misrepresentation provided. Any event may be stopped or modified at the discretion of the Fire Safety Officer. I CERTIFY THAT I HAVE READ THE ABOVE STATEMENT OF CONDITIONS OF APPROVAL AND THAT ALL INFORMATION SUBMITTED IS CORRECT. I AGREE TO COMPLY WITH ALL LOCAL LAWS RELATED TO FIRE PREVENTION, AND TO THE RULES AND REGUATIONS ADOPTED BY THE CALIFORNIA STATE FIRE MARSHAL. I HEREBY AUTHORIZE REPRESENTATIVE OF THE FIRE DEPARTMENT TO ENTER UPON THE ABOVE-MENTIONED EVENT PREMISES FOR INSPECTION PURPOSES. Signature:_____________________________________ Date: _____________________ Print Name: ___________________________________ FIRE DEPARMTENT USE ONLY TRANSPORATION & DISPLAY PERMIT CITY OF RANCHO MIRAGE [ ] Granted [ ] Denied COUNCIL APPROVAL _________(Date) Signature:__________________________________ Date:_____________________ FSO assigned: __________________________ Contact No. ___________________ FSO FIELD INSPECTIONS-THIS SIGNATURE IS REQUIRE PRIOR TO LUANCH [ ] Morter set-up prior to load in produce [ ] -Site & produce inspection & weather condition confirmation prior to shoot/show FSO Signature: ____________________________ Date:_______________________ NOTIFICATIONS: [ ] Applicatant [ ] Pyrotechnician Supervisor [ ] City/County Staff [ ] PIO & ECC/Dispatch Center [ ] Fire Chief/Fire Stations (Local) [ ] Sheriff (Explosives only) [ ]Other: _____ (Initial) City of Rancho Mirage ordinance prohibits the use of Salutes.