HomeMy WebLinkAboutPRR24314 Evans - 603 & 623 Johnson Ave records
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.
Fwbot-!Disjtupqifs220203135
Name:_______________________________________________ Date:______________________
LastFirst
Address:________________________________________________________________________
Street & Unit #City StateZip
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.
Nz!obnf!jt!Disjtupqifs!Fwbot!boe!J!xpsl!gps!Qbsuofs!Fohjoffsjoh!boe!Tdjfodf-!b!obujpobm!Sfbm!
Ftubuf!Evf!Ejmjhfodf!Gjsn/!!Xf!bsf!qsfqbsjoh!b!Qibtf!2!Fowjsponfoubm!Tjuf!Bttfttnfou!)FTB*!gps!
uif!cfmpx.obnfe!efwfmpqnfou!gps!b!gjobodjbm!tfswjdft!dmjfou/!!Jo!bddpsebodf!xjui!svmft!boe!
sfhvmbujpot!pg!dpowfoujpobm!Gsffepn!pg!Jogpsnbujpo!Bdu!qspwjtjpot-!xf!bsf!sfrvftujoh!uif!gpmmpxjoh!
jogpsnbujpo!up!jodmvef!jo!pvs!sfqpsu;
Beesftt;!714!boe!734!Kpiotpo!Bwfovf-!Tbo!Mvjt!Pcjtqp-!DB!:4512
BQOt;!112.234.138!boe!112.234.121
2/!Dpqz!pg!boz!bwbjmbcmf!cvjmejoh!sfdpset!boe0ps!dfsujgjdbuf!pg!pddvqbodjft!jttvfe!up!uif!qspqfsuz
3/!Dpqz!pg!boz!epdvnfout!bttpdjbufe!xjui!dvssfou0gpsnfs!Voefshspvoe!tupsbhf!ubolt!boe0ps!
hfofsbujpo!0!tupsbhf.iboemjoh!pg!ib{bsepvt!nbufsjbmt
4/!Dpqz!pg!boz!jotqfdujpot!0!jotqfdujpo!sfqpsut!bttpdjbufe!xjui!uif!qspqfsuz
5/!Sfdpse!pg!pqfo!0!pvutuboejoh!dpef!wjpmbujpot!gspn!cvjmejoh!efqbsunfou!boe0ps!dpef!fogpsdfnfou!
efqbsunfou
6/!Sfdpse!pg!pqfo0pvutuboejoh!gjsf!dpef!wjpmbujpot!gspn!gjsf!efqbsunfou
7/!\[pojoh!jogpsnbujpo!0!{pojoh!wjpmbujpot
Uibol!zpv!gps!zpvs!bttjtubodf/
Date and Time:Specify theincidentdate or date and time range of the requested records
20202:11!.!2201203135
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.