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Applicant Information

Applicant is required to fill out all portions of the application where applicable.
First Name *
Last Name *
Company Name *
Phone Number *
Email*
Emergency 24 Hr. Contct Person & Phone No. *
Street Number *
Street Name*
Street Type*
Apt #
City*
State*
Zip*
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Permit Information

Location*
Location of where all work is being requested to take place.
Purpose*
Estimated Start Date
Estimated duration of work
Excavation*
1. Yes
2. No
Length and Width of Excavation
Type of Surface
1. Lanscape
2. Sidewalk
3. Street
Scope of Work*
Describe in detail the work requesting to be preformed.
Document Upload
All documents must be in a PDF format.
Note:
• Inspection is available Monday through Friday, from 8:00 am to 5:00 pm. Applicant is responsible for all inspectors’ overtime. • All Work shall comply with the City’s permit conditions and any field conditions that may occur during the permittee’s work or as so directed by the City inspector.
THIS PERMIT EXPIRES SIX (6) MONTHS AFTER THE DATE OF ISSUANCE
I,(Permittee)_________________________________of (Company)____________________________________hereby make application for permit to construct/excavate/encroach in the Public Right-of-way at the locations described above, subject to the provisions required by the Municipal Code of the City of Westlake Village, the latest edition of the "Greenbook" AND THE SPECIFIED CONDITIONS OF THE CITY'S PERMIT HEREON SPECIFIED AND ATTACHED. In consideration of the granting of this permit, it is agreed by the applicant that the City of Westlake Village, and any of their officers or employees thereof shall be saved harmless by the applicant from any liability or responsibility for any accident, loss, or damage to persons or property, happening or occurring as the proximate result of any of the work undertaken under the terms of this application and the permit or permits which may be granted in response thereto, and that all of said liabilities are hereby assumed by the applicant. It is further agreed that if any part of this installation interferes with the future use of the right-of-way by the general public, it must be removed or relocated, as designated by the City Engineer at the expense of the Permittee or his successor in interest.
Insurance Forms*
Please submit the PDF forms of the Certificate of Liability and separate additional insured endorsement forms, both naming the City of Westlake Village.
Permittee Name*
The name submitted here represents (Permittee) in the above statement.
Company*
The name submitted here represents (Company) in the above statement
E-Signature*
By inserting your name in this field you are agreeing to the above statement and information by signing this document electronically (E-Signature).
DATE*

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1. Receive an email copy of this form.
Email address

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