Fillable PUBLIC RECORDS REQUEST Editable Form 2017 (City of San Pablo)

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PUBLIC RECORDS REQUEST Editable Form 2017 (City of San Pablo)

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N:\RESOURCES\City Forms\Public Records Requests\PUBLIC RECORDS REQUEST Form 2017.docx
PUBLIC RECORDS REQUEST
*Requestor Name: _________________________________
*Agency/Company: _________________________________
*Address: _________________________________________
_________________________________________________
*You are not required to provide this information but it assists us in responding
to your request.
Request Date: ____________________
*Phone No.: ______________________
*Email: __________________________
_________________________________
ADDRESS FOR WHICH YOU ARE REQUESTING INFORMATION:
Documents Requested:
□ Business License □ Permit History □ Residential Health & Safety Inspection
□ Business Permit □ Plans (**for inspection only) □ Zoning
□ Code Violation History □ Other
** Building plans are available for inspection only, unless authorizations requested under CA Health & Safety Code 19851 are provided.
Services Requested: □ Inspection □ Copying (hard copy – generally 10 cents per page)***
□ Electronic Copy □ CD/DVD ( $10.00)***
*** Certain larger documents, plans or electronic medium may have a higher duplication cost.
Please see reverse side for instructions:
FOR OFFICE USE ONLY
Date Request Received: ___________________
Forwarded on _______________ to: □ City Attorney □ Finance
□ City Clerk □ Human Resources
□ City Manager □ Information Systems
□ Community Services □ Police Department
□ Development Services □ Public Works
Release Approved by City Attorney: ___________________
Date Requestor Notified: __________________ via phone _____ via email ______
Date Records Produced: ___________________ Copy Charge: $__________________
N:\RESOURCES\City Forms\Public Records Requests\PUBLIC RECORDS REQUEST Form 2017.docx
INSTRUCTIONS FOR REQUESTING RECORDS
(California Public Records Act, Government code Section 6250 et. seq.)
1. Requests for records should be submitted to the City Clerk’s Office at 13831 San Pablo Avenue,
Building #1, San Pablo, CA 94806. Requests will be processed in the order in which they are
received. Requests may be submitted by mail, email (include email address) or by fax to
(510) 215-3011.
2. Requests must be for records in the possession of the City of San Pablo. Requests must also be
focused and specific and must reasonably describe identifiable records (Gov. Code Sec. 6253).
Requests not meeting these criteria may be returned. If you need assistance in making a focused
and effective request that reasonably describes an identifiable record, please let us know and we
will be glad to assist you.
3. The City intends to notify you within ten (10) days whether your request seeks copies of
disclosable public records in the possession of this agency. The City may invoke an extension of
time to determine whether to comply with your request if there is a need to:
a. Search for and collect the requested records from field facilities.
b. Search for and examine a voluminous number of records.
c. Consult with another agency or City departments having a substantial interest in the
determination of the request.
d. Compile data or construct a computer report to extract data (the cost of which you will be
billed).
4. Particularly for larger requests, you will be notified of the approximate number of pages and/or
length of time it will take to process your request.
5. If your request is to review records (rather than receive copies), an appointment will be made
with you for review once the records are gathered.
6. There is a charge for the direct cost of duplication of $.10/per page, or $10.00 for a CD/DVD.
Payment must be made prior to release of records requested. If the documents requested
exceed 50 pages or include larger, difficult to copy items, a deposit may be required before the
copies are made.
7. Records available for review and/or copies of records requested will be available for 30 days after
notification of their availability. If you are unable to pick-up or view your records during this time
period, notification is required or your request will be considered fulfilled and a new request
must be made, as the records will be returned to filing.
8. Certain records are generally exempt for disclosure pursuant to Government Code Section 6255,
where the public interest served by not making the records public clearly outweighs the public
interest served by disclosure of the records. The Government Code further provided that certain
other records are specifically exempt from disclosure.
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PUBLIC RECORDS REQUEST Editable Form 2017 (City of San Pablo)

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Completed 26 February 2021

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