HomeMy WebLinkAboutDrone Permit Fillable Application OnlyRequest to Use Unmanned Aircraft
Systems in the City of Palm Desert
PERMIT APPLICATION #:
Date Production Company
Type of Production Production Title
Proposed Film Date(s) Production Contact
Contact’s Cell# Email Address
Location Address Hours of UAS Activity
From [ ] a.m. [ ] p.m. to [ ] a.m. [ ] p.m.
Location Address #2 Hours of UAS Activity
From [ ] a.m. [ ] p.m. to [ ] a.m. [ ] p.m.
UAS Company Primary Contact
Address Cell#
Email Address
UAS / AIRSPACE INFORMATION
Make/Model of Aircraft Registration#
Make/Model of Aircraft Registration#
Total Payload Weight (incl. UAS/camera/additional equipment)
Class of Airspace UAS Activity Will Occur in: □B □C □D □E □G
Restricted Areas or Temporary Flight Restrictions (TFR) Within Proposed Time/Area of Operation? □Yes □No REMINDER: if you are flying in Class B, C, D or E airspace, ATC authorization is required for all UAS activity.
UAS OPERATING AUTHORITY:
□14 CFR Part 107 □ Title 49 (“Hobbyist” Rules) – For Students Only
Part 107 Requirements
Name of Remote Pilot in Command
Remote Pilot’s Phone# Remote Pilot’s Certificate#
If Remote Pilot will not be operating UAS, name of person operating UAS under the direct supervision of
Remote Pilot
Visual Observer: □Yes □No
Please provide the following:
□Copy of Remote Pilot Certificate
□Copy of Part 47 or Part 48 Registration Certificate for each UAS listed above
□Description of planned flight operations, including diagrams, charts and maps as applicable
□Certificate of Insurance & Endorsement □Copy/screen shot of ATC approval to operate in restricted airspace
For Students Enrolled at an Accredited Educational Institution Operating Under “Hobbyist” Rules
Name of Operator Operator’s Phone#
Name of School Please provide the following:
□Copy of UAS Registration □Certification letter from school (on school stationery)
□Detailed description of proposed UAS activities □ Name of community-based organization’s safety guidelines
□Certificate of Insurance & Endorsement under which you will be operating
WAIVERS: Please note that students may not apply for FAA waivers. For Part 107 Remote Pilots: if
you are requesting any of the following activities, please check all that apply and furnish proof of waiver
from the FAA upon submission of this document.
□Flight over non-participants (§107.39)□Night flight (§107.29)
□Operating from a moving vehicle (§107.25)□Flight altitude restrictions (§107.51)
□Operating multiple small UAS’ (§107.35)
Remote Pilot in Command is responsible for the safe operation of all UAS activities and declares that he/she
will be in compliance with all Part 107 standards and requirements.
Signature of Remote Pilot in Command or Authorized Company Representative
Print Name Title
Student enrolled at an accredited educational institution is responsible for the safe operation of all UAS
activities and declares that he/she will be in compliance with all community-based safety guidelines.
Signature of Student Operator Print Name