Renovation Request Form

RENOVATION REQUEST FORM

Property Identification

Property Address:

Unit/Suite:   Parcel / APN:

Requesting Party (Tenant / Owner)

Landlord / Property Manager

Proposed Work

Brief Description of Work:

Proposed Start Date:   Proposed Completion Date:

Contractor / Vendor Information

Contractor carries general liability insurance:   Worker's compensation:   Will provide certificate of insurance:

Permits, Inspections & Code Compliance

Are permits required? Yes No

Work involves structural elements:   Plumbing:   Electrical:

Materials, Appearance and Temporary Conditions

Storage of materials on premises permitted subject to safety rules: Yes    No

Attachments and Supporting Documentation

Disclosures

Is property subject to lead-based paint disclosure? Yes No

Known prior water intrusion or mold in work area? Yes No

Any known structural damage or prior repairs? Yes No

Financial and Restoration Obligations

Security deposit adjustment required to cover renovations: Yes    No

Tenant agrees that all work will be completed in a workmanlike manner, in compliance with law and codes, and that tenant shall restore premises to original condition at lease termination unless otherwise agreed in writing. Tenant will bear cost of restoration unless landlord gives written waiver.

Indemnification and Insurance

By submitting this request, requestor certifies that contractor is licensed and insured, that requestor will cause contractor to name landlord as an additional insured and provide a certificate of insurance prior to commencement of work. Requestor agrees to indemnify and hold landlord harmless from liability, claims, damages, losses and expenses arising from the renovation, except for damages caused by landlord's gross negligence or willful misconduct.

Requestor initials acknowledging indemnification requirement:

Conditions of Approval; Inspections

All work is subject to inspection by landlord or landlord's agent at reasonable times. Landlord may require corrective work if conditions do not conform to approved scope or code requirements. Landlord's approval, if any, is limited to the matters expressly described in the approval and does not waive other rights under the lease.

Administrative Decision

Landlord Decision (check one): Approved Denied Approved with Conditions

Acknowledgement and Certification

By signing below, the requestor certifies that the information provided is true and complete to the best of requestor's knowledge, that all work will comply with applicable laws and building codes, and that requestor will obtain all required permits and approvals before commencing work. Requestor further agrees to promptly correct any nonconforming work identified by landlord and to pay any costs incurred by landlord to remedy violations caused by the work.

Requestor acknowledgment (check to confirm):

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