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City of San Luis Obispo `:��.u_:ul I Y��
Request for Public'Records _
The Califorrriei• Rublic Records.Act (Government Code 6250. et set.) was enacted to ensure public
records are available for inspection by mem- hers Hof the public: Completion. of this,fptrn will.assist;staff
in identifying related, records to. a qurately complete your request.
Requested records4ill be distributed to the email address that is listed on this form, unless'directed
otherwise by City staff. Requests for printed records will require payment subject to the City's
Comprehensive Fee Schedule. Payment must berenderedzprior to production of printed materials.
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Address: I ?, LI p s,)A ST. S. L.O. CP4-. '13401
Street & Unit # City State Zip
Email-
Phone:_0543-,Z7aZ
Release Forms
Requests for certain public records legally require release forms to be submitted fide-?ecords to -be,
distributed to the requestor. To help expedite your request, please read below and..ensure additional
information is submitted along with this public records request form.
Personal health information
Records containing personal health information require a HIPAA Release Form. Examples
include fire incident reports, worker's compensation claims, etc.
o HIPAA Release Form
• Printed residential and/or commercial building plans
The Public Records Act does not allow the release of printed copies of this material without the
permission of the architect/engineer copyright owner. The public records requestor is
responsible for obtaining said authorization by completing all three release forms listed
below. You may call the Community Development Department at (805) 781- 7170 to find out
the name of the copyright owner. In -person viewing of plans do not require release forms.
o Copies of Plans Affidavit
o Plan Request Architect/Engineer Authorization
o Plan Request Owner Authorization
Continued
Record Information: List the records you are requesting. Specify relevant information such as:
subject, title, incident number, location/address, person(s) involved, project name, etc.
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Date and Time: Specify the incident dale or date and time range of the requested records
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Questions may be directed to the City Clerk's Office at (805) 781-7100.
Submit Completed Forms To:
cityclerk(a7slQcit ,or
OR
City Clerk's Office
990 Palm Street
San Luis Obispo, CA 93401
YOUR REQUEST WILL BE PROCESSED IN COMPLIANCE WITH THE PUBLIC RECORDS ACT (PRA). California
Government Code Section 6253 (PI. An Agency shall notify the requestor within 10 days from receipt of request with a
Determination which states if the Agency is in possession, in whole or in part, of the requested documents, and possible legal
exemptions which prohibit the release of non-disclosable documents, as outlined per the PRA. In some instances, an Agency
may require up an extension of up to 14 days to provide a Determination, as authorized by the PRA_ A notice will be provided to
the requestor setting forth the reasons for the extension and the date on which a Determination is expected to be supplied.