Daly City, CA · San Mateo County
Declaration of Request for Plan Review, Inspection, and Verification of OSHPD 3 Requirements
This form lets a clinic project owner request OSHPD 3 plan review, inspection, and verification from Daly City when submitting a building permit application.
What this form is
Use this declaration to tell Daly City whether a clinic will be a state-licensed OSHPD 3 clinic and to request plan review, inspection, and verification of OSHPD 3 requirements. The form asks for facility and permit information, applicable clinic types, and the authorized signer's declaration and details. Submit it with the building permit application at the time of permit application.
Who needs it
A building owner or authorized representative requesting OSHPD 3 review, inspection, and verification for a clinic project needs this form.
How to submit it
Email the completed form with the building permit application to [email protected] at the time of permit application.
About notarization
This document is signed without a notary; the signer certifies under penalty of perjury and signs and dates the declaration.
How to submit this form
- 1
Download The Form
Download the OSHPD 3 declaration PDF.
- 2
Complete Project Information
Enter the facility name, address, and permit number, then check the applicable clinic and request options.
- 3
Sign And Date
The authorized signer completes the declaration and provides a signature, date, printed name, and title.
- 4
Submit With Permit Application
Email the completed form with the building permit application to [email protected] at the time of permit application.
Frequently asked questions
- What does the OSHPD 3 declaration request?
- It lets the applicant request plan review and verification, inspection and verification, or both for OSHPD 3 requirements for a clinic project.
- Do I need a notary for the OSHPD 3 declaration?
- No. The document has no notary block. The signer certifies under penalty of perjury and signs and dates the declaration.
- How do I submit the OSHPD 3 declaration?
- Email the completed form with the building permit application to [email protected] at the time of permit application.
Need something notarized?
This Declaration of Request for Plan Review, Inspection, and Verification of OSHPD 3 Requirements doesn’t need a notary — but if you have another Daly City form that does, a commissioned online notary can help.