Debris Removal Right of Entry Permit (00011201.DOCX;1)

www.VenturaCountyRecovers.org EHDWoolsey-HillFire@ventura.org

Residential Debris Removal Right-of-Entry Permit

Checklist for Property Owners

Ventura County Environmental Health is working with CalOES and other federal and

state partners in a program to facilitate safe removal and handling of burn debris and

ash. To obtain this service, a homeowner must complete the proper paperwork to allow

these agencies to clean up their property.

Documents needed for submittal of the Debris Removal Right-of-Entry Permit:

 Residential Debris Removal Right-of-Entry Permit form

 Government Issued ID (e.g. Driver’s license, passport, etc.) (provide a copy if

submitting electronically)

 Insurance Policy

• Declaration page

• Debris Removal Coverage page

 Assessor’s Parcel Number (APN)

 Signatures of All Owners, Trustees or Power of Attorney

 Trust or LLC Documents (If applicable)

• 1

st

page of Trust, LLC etc.

• Signature Authorization page

• Power of Attorney signature page

• Any other relevant pages

 Signed and notarized document for authorized agent

Home owned by 1 or More People

All owners listed on the title of the home must:

 Sign the Residential Debris Removal Right-of-Entry Permit form

 Show government issued ID

Home owned by a Trust, LLC or other Legal Entity

If a home is owned by a trust, LLC or other legal entity, please bring:

 The first page of the trust, LLC or other agreement

 The Signature Authorization page

 The power of Attorney Signature page

 Any other relevant pages

All trustees or signatories must sign the Residential Debris Removal Right-of-Entry

Permit form

SUBMITTAL CAN BE MADE AT THE VENTURA COUNTY GOVERNMENT CENTER,

ENVIRONMENTAL HEALTH DIVISION OR THOUSAND OAKS CITY HALL

Property Address: ____________________________ Page 1 of 6

APN: ___________________________

Residential Debris Removal Right-of-Entry Permit

(For Providing Debris Removal on Private Property)

Owner Name:

Phone Number & Email:

Property Address:

☐Unincorporated

or

☐City

Assessor’s Parcel Number (APN):

Age of Structure(s):

The undersigned hereby certifies they/he/she are/is (check):

______ The owner(s) with authority to grant access to the property at the above address.

______ The authorized agent of the Property Owner resident at above address.

I / we, ______________________________________________________________________,

certify that I am / we are the owner(s) or authorized agent of the real property located at the

above address (hereinafter “Owner”). I hereby certify that I have full power and authority to

execute this Right of Entry (ROE) Permit without the need for any further action, including, but

not limited to, notice to or approval from any other party.

I / we hereby grant the County of Ventura (County), as well as the State of California, and the

Federal Government, and their officers, employees, agencies, and independent contractors

(collectively, the “Government”), a ROE upon the real property specified above by address and

APN (hereafter the “Property”).

1. Time Period: This ROE shall expire 36 months after the date of the Owner’s signature(s),

below, or when the debris removal activities described below are complete, as determined in the

sole discretion of the Government, whichever date is sooner.

PRINT

Property Address: ____________________________ Page 2 of 6

APN: ___________________________

2. Purpose: The Government is granted this ROE to inspect, test, remove, and clear wildfire-

generated debris of whatever nature including but not limited to burned or partially burned

structures, ash, concrete foundations, contaminated soil, vehicles, trailers, waste or other debris

from the Property (“Debris Removal”). Tree or tree limbs and shrubbery deemed hazardous to

work crews, or obstructing their access to the debris clearance site, may also be removed to

accomplish this work.

3. Authorized Activities: Owner hereby grants to the Government, the right to determine, in the

Government’s sole discretion, which materials and items on the Property are eligible for Debris

Removal. Owner is responsible for removing, at Owner’s expense, any items not eligible for

Debris Removal. Owner’s failure to remove items not eligible for Debris Removal may later be

deemed a public nuisance by local officials.

4. Reimbursement: All Debris Removal activities are provided by the Government at no direct

cost to Owner. However, the Owner agrees hereby to file an insurance claim if Owner possesses

homeowner’s or property insurance. Most homeowner’s insurance policies include coverage for

debris removal. State and federal law require Owner to assign any debris removal insurance

proceeds to the Government to avoid a duplication of benefits (42 USC 5155; 44 CFR 204.62).

In consideration of the Government’s agreement to perform Debris Removal, Owner agrees to

inform the insurance company listed below of this assignment and agrees to release their

insurance information to the Government.

Specified Debris Removal Insurance Coverage: If Owner’s insurance in effect at the time of

the wildfire provides specific coverage for debris removal, Owner hereby assigns any and all

rights, benefits, and proceeds with respect to these particular specific coverages to the County

and hereby authorizes that any benefits or proceeds be paid directly to County. Owner shall not

be liable for any further costs to County.

No Specified Debris Removal Insurance Coverage: If Owner’s insurance in effect at the time

of the wildfire does not provide specific and separate coverage for debris removal, but debris

removal coverage is included within another larger coverage category, payment to County shall

be limited to the unused benefit amount, after the residence is rebuilt. Owner shall not be liable

for further costs to County. Owner hereby assigns any and all rights, benefits, and proceeds of

any unused benefit amount that is eligible for debris removal remaining in a larger coverage

category to County.

In the event the insurance companies listed below issues insurance proceeds for Debris Removal

directly to Owner, Owner shall promptly inform the County of the amount of such proceeds and

remit such insurance proceeds to County.

Insurance Company: _____________________________________________________

Policy Number: _________________________________________________________

Claim Number: _________________________________________________________

Agent’s Name: _________________________________________________________

Property Address: ____________________________ Page 3 of 6

APN: ___________________________

Agent’s Phone / e-mail: __________________________________________________

Secondary Insurance, or personal property insurance for other damaged items on the Property:

Insurance Company: _____________________________________________________

Policy Number: _________________________________________________________

Claim Number: _________________________________________________________

Agent’s Name: __________________________________________________________

Agent’s Phone / Email: ____________________________________________________

If Owner does not have homeowner’s or other similar insurance, Owner certifies under penalty

of perjury by his/her signature below that no insurance coverage for the costs fire debris removal

at the Property was in effect at the time of the wildfire:

_______________________________________ ________________________________

Owner’s signature Date

Any property that is sold prior to issuance of the cleanup certification will be withdrawn from the

program and billed for cleanup services, unless both new and former Owners sign a property

transfer affidavit. Costs for work completed will be billed to the insurance company listed above

if applicable.

5. Waiver of Liability: Owner acknowledges that the Government’s decisions about when,

where, and how to provide Debris Removal services on Owner’s property are discretionary

functions. Owner hereby acknowledges that the Government is not liable for any claim based on

the exercise or performance, or failure to exercise or perform, a discretionary function, and

promises not to make such a claim. Owner further releases and agrees to hold and save

harmless the Government from all liability for any damage or loss whatsoever that may

occur during or after performance of the Government’s Debris Removal activities. Please

also see paragraph 9, below. Owner therefore waives any claims or legal action against the

Government. This indemnification is required by state and federal law, including the California

Emergency Services Act, California Government Code section 8655 and the Stafford Act, 42

United States Code, sections 5148 and 5173.

6. Foundations: In order to participate in this program, Owner must allow removal of all

foundations. Stem walls and retaining walls may be left on a case-by-case basis, as approved by

the Operations Chief and/or his or her designee. Owner acknowledges and understands that

removal of a foundation may leave a depression in the ground, and that it is Owner’s

responsibility to fill any depression(s) following the removal of a foundation.

7. Soil Sampling: Debris Removal includes taking soil samples in the debris footprint to ensure

Property Address: ____________________________ Page 4 of 6

APN: ___________________________

that all contaminants have been removed. If initial soil samples do not meet the cleanup goals

for this project, additional soil will be removed from the debris footprint and more soil samples

will be taken. Owner acknowledges and hereby authorizes the Government to remove enough

soil to ensure cleanup goals have been met. Owner acknowledges this may leave a depression on

the property and that it is Owner’s responsibility to fill any depression left on the property.

8. Markings of Infrastructure Facilities: Owner agrees to make their best efforts to mark

subgrade utility lines (sewer, water, electricity, gas, cable, solar), and to mark the location of

septic tanks, wells, or other subgrade structures. Owner should carefully complete the attached

Property Information Form and append any maps, diagrams, or legible notes that may be useful

to the Government’s contractor in locating subgrade structures.

9. Driveway, Roadway and Other Incidental Damage: Multi-ton excavators must perform

much of the demolition, consolidation and loading of fire debris into trucks for removal to

appropriate landfills. The scale and weight of this equipment, and the weight of loaded trucks

hauling debris out of fire-damaged neighborhoods, often exceeds the design capacity of

residential driveways, sidewalks, and private roadways. Cracking and damage to asphalt and

concrete pavement is a common and often unavoidable consequence, and is therefore considered

incidental to Debris Removal. The Government, where feasible, will make reasonable efforts to

mitigate such damage. However, by accepting Government Debris Removal at this Property, the

Owner acknowledges the risk of such incidental damage as well as responsibility for the cost of

any repairs to private property or jointly-owned private roadways that may be caused by

Government contractors in the performance of Debris Removal operations. Owner hereby

promises to hold and save harmless the Government from any repair claims described above, or

any other incidental and unavoidable damage occurring as a result of routine operations.

10. Damage to Improved Property: Debris and ash removal crews will attempt to minimize

impacts to improved property that was not damaged by the fire. The California Governor’s

Office of Emergency Services Operations Chief may, at their sole discretion, authorize attempted

repair or replacement of improved property that was negligently damaged during the Debris

Removal operations. However, Owner acknowledges paragraphs 5 and 9 of this ROE limit the

liability of the Government and their contractors.

11. Modification: The provisions of this ROE may not be modified. Owner may cancel this

ROE only by submitting an executed Withdrawal Form to the County (see attached).

12. Fraudulent or Willful Misstatement of Fact: An individual who fraudulently or willfully

misstates any fact in connection with this agreement may be subject to penalties under state and

federal law, including civil penalties, imprisonment for not more than five years, or both, as

provided under 18 United States Code, section 1001.

_________________________________________________________________________

Property Address: ____________________________ Page 5 of 6

APN: ___________________________

Printed name of Owner or Agent

_____________________________________________ __________________________

Signature of Owner or Agent Date

______________________________ _____________________________________________

Phone number of Owner or Agent E-mail address of Owner or Agent

_____________________________________________________________________________

Mailing address of Owner or Agent

Approved by County of Ventura and verified that the Property, APN, and Owner are

accurate and meet the eligibility requirements of program:

_____________________________________________ __________________________

William C. Stratton, Director Date

Environmental Health Division

Property Address: ____________________________ Page 6 of 6

APN: ___________________________

Disaster Debris Removal Program

Property Information

Please identify all that apply on the Property:

Vehicles

Location

Description

Comments

Car

Boat or Trailer

Other vehicles

Other:

Underground

Tanks

Location

Construction

Date (If

Known)

Comments

Septic

1

Fuel/Oil

2

Water

Other:

1. Septic tanks will be pumped of all waste as part of the debris removal project only if they pose

a hazard to crews.

2. Owner must provide documentation of ownership for large propane tanks to be removed.

Underground

Structures

Location

Construction

Date (If

Known)

Comments

Basement

Root Cellar

Other:

Property Address: ____________________________

APN: _____________________________

Special Instructions

(i.e. directions to contractors to access the Property or notable items Owner wishes to try to

recover):

______________________________________________________________________________

_____________________________________________________________________________

______________________________________________________________________________

Attach additional documents if needed.

Property Accessibility: Due to the need for property access by County and/or County’s Agents,

the Property will be made accessible throughout the cleanup process (i.e., Owner(s) will provide

gate code/keys to ensure property access.) Owner shall provide a gate code: __________ or key

which shall be dropped off at the Debris Removal Operations Center.

RIGHT OF ENTRY-PERMIT – REQUEST FOR CANCELLATION

To cancel a previously-granted Right of Entry Permit, this cancellation form must be signed by the

Owner(s), and either delivered to the Ventura County Environmental Health at 800 S. Victoria Ave.,

Ventura CA 93009-1730, or emailed to EHDwoolsey-hillfire@ventura.org as a signed PDF.

All owners who signed the Right of Entry Permit must sign this request. Phone-in and verbal

cancellations cannot be accepted. Cancellations can only be accepted up until CalOES or CalRecycle

attempts to notify the property owner 24-48 hours in advance of Ash and Debris Cleanup (as described in

the Right of Entry Permit).

CANCELLATION

By canceling the Right of Entry Permit, I/we am acknowledging that I/we must perform cleanup of the

parcel to the standards set by the City of Thousand Oaks or the County of Ventura, and that if I/we do not

do so by the deadlines set by the City and County, my/our property will be subject to abatement.

I/we have read and understand the foregoing statement concerning cancellation policies. I hereby certify

that I/we request to cancel my/our Right of Entry Permit.

I/we represent and warrant that I/we have authority to execute this document. I/we agree to accept all

responsibility for loss or damage to any person or entity, and to defend and indemnify,

hold harmless, and

release County from any actions,

claims, or damages that may be asserted by any person with respect to

my/our private removal of debris and any hazardous

material from the below mentioned real estate

property.

Property Owner Name(s):

Property Address:

City:

Assessor’s Parcel Number (APN):

Application for Private Cleanup Program Submitted (circle one): Y / N

Property Owner Signature:

Date:

County Approval:

Date:

The Owner should make a copy of the signed cancellation prior to submitting this form.