Annual Verification Of Farmworker Or Animal Caretaker Employment

  1. This employment verification is required in accordance with the conditions of the Conditional Use Permit (CUP) or Zoning Clearance issued for a farmworker or animal caretaker dwelling on the subject site and pursuant to the Ventura County Non-Coastal Zoning Ordinance (NCZO), Section 8107-26.4, which states (in pertinent part) that the owner of the property, or his/her designated agent, must submit an annual verification report by May 15th of each year to the Planning Director, demonstrating that the farmworker(s) and/or animal caretaker(s) residing in the farmworker and/or animal caretaker dwelling unit(s) meet(s) the employment criteria established in Section 8107-26.3 of the NCZO.

    Pursuant to Section 8107-26.3 of the NCZO, farmworker and animal caretaker dwelling units shall only be rented or provided under the terms of employment to persons who are employed full time (minimum 32 hours per week) as farmworkers or animal caretakers by the property owner or lessee of the lot upon which the dwelling unit sits, or on other land in Ventura County that is under the same ownership or lease as the property with the dwelling unit. Additionally, a farmworker or animal caretaker who has been renting or occupying a farmworker or animal caretaker dwelling unit and who subsequently retires or becomes disabled, may continue to reside in the dwelling unit.

    Prior to May 15th of each year, either mail a completed Annual Verification Report to Ventura County Planning Division L#1740, Condition Compliance Program, 800 S. Victoria Ave., Ventura, CA 93009, or complete the online form below.

    If you have any questions about completing the Annual Verification Report, please contact the Planning Division at (805) 654-2045 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it..

    Note: All information provided on this declaration is subject to audit by the Planning Division.
    (*) Required
  2. I certify or declare under penalty of perjury under the laws of the State of California that all information hereon, including any accompanying statements or documents, is true, correct and complete to the best of my knowledge and belief.
  3. Name:(*)
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  4. Signature of Owner/Designated Agent:(*)
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  5. Note: Please Use Mouse or Trackpad to Sign
  6. Date:(*)
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  7. Email Address:(*)
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  8. * Reporting Year:(*)
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  9. * The Reporting Year is the prior year's date. For example, the Reporting Year is 2017 for a Verification Form submitted in 2018.

  10. Property Owner/Designated Agent Name:(*)
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  11. Phone:(*)
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  12. Assessor’s Parcel Number:(*)
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  13. CUP Number:(*)
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  14. Zoning Clearance Number:(*)
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  15. Is each farmworker / animal caretaker dwelling unit occupied by at least one person employed by the property owner for at least 32 hours per week on the subject site and/or on other land in Ventura County that is owned by the same property owner?
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  16. If you answered “No” above, is the farmworker/animal caretaker dwelling unit occupied by a farmworker/animal caretaker who was previously employed by you, but subsequently retired or became disabled?
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  17. Dwelling - 1

  18. Occupant Name:
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  19. Occupant Signature:
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  20. Date:
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  21. Dwelling Address:
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  22. Occupant Phone #:
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  23. How many family members live in this dwelling, not including the farmworker / animal caretaker?
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  24. Monthly rent amount:
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  25. Dwelling - 2

  26. Occupant Name:
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  27. Occupant Signature:
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  28. Date:
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  29. Dwelling Address:
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  30. Occupant Phone #:
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  31. How many family members live in this dwelling, not including the farmworker / animal caretaker?
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  32. Monthly rent amount:
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  33. Dwelling - 3

  34. Occupant Name:
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  35. Occupant Signature:
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  36. Date:
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  37. Dwelling Address:
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  38. Occupant Phone #:
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  39. How many family members live in this dwelling, not including the farmworker / animal caretaker?
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  40. Monthly rent amount:
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  41. Dwelling - 4

  42. Occupant Name:
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  43. Occupant Signature:
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  44. Date:
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  45. Dwelling Address:
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  46. Occupant Phone #:
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  47. How many family members live in this dwelling, not including the farmworker / animal caretaker?
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  48. Monthly rent amount:
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  49. Dwelling - 5

  50. Occupant Name:
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  51. Occupant Signature:
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  52. Date:
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  53. Dwelling Address:
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  54. Occupant Phone #:
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  55. How many family members live in this dwelling, not including the farmworker / animal caretaker?
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  56. Monthly rent amount:
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  57. Dwelling - 6

  58. Occupant Name:
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  59. Occupant Signature:
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  60. Date:
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  61. Dwelling Address:
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  62. Occupant Phone #:
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  63. How many family members live in this dwelling, not including the farmworker / animal caretaker?
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  64. Monthly rent amount:
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  65. Note: If you have more than six farmworker or animal caretaker dwelling units, please complete another online verification form.