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Home My WebLink AboutPRR23219 Clark - Building and UST/HazMat Permits APN 053-412-025 & 053-412-026 Updated 05/2023 City of San Luis Obispo Request for Public Records TheCaliforniaPublic Records Act (Government Code .etset.) was enactedto ensure public records are available for inspection by members of the public. Completion ofthis form will assist staff inidentifyingrelatedrecordsto accurately complete your request. Requested recordswill be distributed tothe email addressthat is listed onthis form,unless directed otherwiseby City staff. Requestsfor printed recordswill require payment su Comprehensive FeeSchedule.Payment mustbe rendered prior to production ofprinted materials. Dmbsl-Bvesfz90203134 Name:_______________________________________________ Date:______________________ LastFirst 6261FbtuQbdjgjdDpbtuIjhixbz-Tvjuf561-MpohCfbdi-Dbmjgpsojb:1915 Address:________________________________________________________________________ Street & Unit #City StateZip bdmbslAspvyjod/dpn421.98:.5:41 Email: _____________________________________________Phone: _______________________ Release Forms Requests for certain public records legally require release forms to be submitted for records 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 healthinformation Records containing personal health information require a HIPAA Release Form. Examples 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 withoutthe permission of the architect/engineer copyright owner.The public records requestor is responsiblefor obtaining said authorization by completing allthree release formslisted 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 relevantinformation such as: subject, title, incident number, location/address, person(s) involved, project name, etc. CvjmejohefqbsunfousfdpsetjodmvejohqfsnjutuibubsfopubwbjmbcmfpomjofsfmbufeupuifBQOt; 164.523.136 164.523.137 Date and Time:Specify theincidentdate or date and time range of the requested records Questions may be directed to the City -7100. Submit Completed Forms To: cityclerk@slocity.org OR 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 7921.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 an extensionofup 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 onwhich a Determination is expected to be supplied. Updated 05/2023 City of San Luis Obispo Request for Public Records The California Public Records Act (Government Code 7921. et set.) was enacted to ensure public records are available for inspection by members of the public. Completion of this form will assist staff in identifying related records to accurately complete your request. Requested records will 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 be rendered prior to production of printed materials. Name: _______________________________________________ Date: ______________________ Last First Address: ________________________________________________________________________ Street & Unit # City State Zip Email: _____________________________________________ Phone: _______________________ Release Forms Requests for certain public records legally require release forms to be submitted for records 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 HIP AA 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 YOUR REQUEST WILL BE PROCESSED IN COMPLIANCE WITH THE PUBLIC RECORDS ACT (PRA). California Government Code Section 7921. 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 lega l exemptions which prohibit the release of non-disclosable documents, as outlined per the PRA. In some instances, an Agency may require 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. 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. Date and Time: Specify the incident date or date and time range of the requested records Questions may be directed to the City Clerk’s Office at (805) 781-7100. Submit Completed Forms To: cityclerk@slocity.org OR City Clerk’s Office 990 Palm Street San Luis Obispo, CA 93401 Colunga-Lopez, Andrea From:FireRequest@enotify.visioninternet.com Sent:Tuesday, August 1, 2023 5:20 PM To:CityClerk; Timpano, Mika Subject:Online Fire Records Request This message is from an External Source. Use caution when deciding to open attachments, click links, or respond. A new entry to a form/survey has been submitted. Form Name: Fire Record Requests Date & Time: 08/01/2023 5:20 PM Response #: 281 Submitter ID: 1457 IP address: 136.226.66.192 Time to complete: 1 min. , 16 sec. Survey Details Page 1 1. Contact Information First Name Audrey Last Name Clark Agency Not answered Address 5150 E PCH Address 2 Not answered City, State, ZIP Code long beach Email Address ACLARK@ROUXINC.COM Phone Number 310-879-4930 2. Please provide detailed, specific information (date, time, event, location, incident number). Record Description Fire department records, including records for hazardous materials, chemical inventory, inspection reports, aboveground and underground storage tanks, environmental cleanup, and/or wells related to the APNs: 053-412-025 053-412-026 If you prefer to contact us in person or US mail and/or have HIPAA documentation to submit in support of your request, please download and use the following form(s).  Fire Incident Request Form  HIPAA Release Form Deliver or mail to: City of San Luis Obispo Fire Department, 2160 Santa Barbara Avenue, San Luis Obispo, CA 93401 1 YOUR REQUEST WILL BE PROCESSED IN COMPLIANCE WITH THE PUBLIC RECORDS ACT. California Government Code Section 6253 (c). Each agency, upon a request for a copy of records, shall, within 10 days from receipt of the request, determine whether the request, in whole or in part, seeks copies of disclosable public records in the possession of the agency and shall promptly notify the person making the request of the determination and the reasons therefore. In unusual circumstances, the time limit prescribed in this section may be extended by written notice by the head of the agency or his or her designee to the person making the request, setting forth the reasons for the extension and the date on which a determination is expected to be dispatched. No notice shall specify a date that would result in an extension for more than 14 days. Pursuant California Government Code Section 6254 (c) Personnel, medical, or similar files, the disclosure of which would constitute an unwarranted invasion of personal privacy \[are exempt from disclosure\]. With the exception of certain records, report photocopies are 40¢ per page. If you need assistance with this request or wish to review the records on site, please call the City Fire Department in advance at 781-7380 to schedule an appointment. To access public documents, contact the City Clerk's Office, City Records Program. Thank you. Thank you, City of San Luis Obispo, CA This is an automated message generated by Granicus. Please do not reply directly to this email. 2