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CITY OF PALM DESERT
Building & Safety Department
73-510 Fred Waring Dr., Palm Desert, CA (760) 776-6420
AFFIDAVIT REQUEST TO DUPLICATE PLANS
ARCHITECT INFORMATI ON
Nam e State License No.
Address City State Zip Code
Signature
ENGINEER INFORMATION
Nam e State Li cense No.
Address City State Zip Code
Signature
PROPERTY OWNER I NFORMATION
Nam e
A ddress City State Zip Code
Signature
As the cert i fi ed, li cens ed , o r regis t ered pro f es sional who signed the ori gi nal documents f o r the pro ject
a ddres s below, or his o r her s ucces sor , we a re re qui red by law to notif y you that the undersigne d has
reques ted co pies o f yo ur signed pla ns . W e are requ ired, in ret urn , to reques t wri tten permis sio n to do so
from the cert ifi ed, licensed, or reg istered pro fes sio na l, o r his s uccessor and o rigin al o r curre nt pro perty
owner.
Hea lt h a nd Safety C ode Section 1 98 51 Inspe ction and d up li catio n of p la ns
The copy may not be d upli ca ted in who le o r in part except (1 ) wi th t he wri tten perm is sio n, w hi ch
perm i ss io n s ha ll not be unrea son ably wi thheld as speci fied i n s ubdiv is io n (f ), of t he certi fi ed, li cens e d o r
regis t ered pro f es sio na l or hi s o r her s ucce ss o r, if any, w ho sign ed t he o ri gi nal do c uments and the written
perm issio n of the o riginal or current o wner o f t he bu ilding, o r , i f the bui lding is pa rt of a co m mo n
interes t dev elo pment, wi th th e writte n perm is sio n of the boa rd of di rec tors or go v erning bo dy of the
associa tio n es ta blis hed to ma nage the co mmo n i nteres t develo pm ent , or (2 ) by o rder of a pro per co urt.
Page 2 of 2
AFFI DAVI T
I, the unders igned , hereby reques t dupli cation o f the o ffic ial co py of the pla ns for t he pro je ct lo cated at
I cert ify the f o llo wing co ndi tio ns :
1. That the co py of the pla ns s ha ll o nly be us e d for the mai ntenance, o peration and us e of th e
buildi ng .
2. Tha t dra wings are instruments of pro f essi o na l s ervi ce and a re incomplet e witho ut th e
i nterpret a tio n of the c ert i fi ed, li cens e d o r regi stered pro f essi o na l of rec o rd.
3. That subdivis io n (a ) of Sectio n 5 536.25 o f the Busi ness a nd Pro f es sions Code states that a
li cens e d a rchitect who s ig ns the pla ns , s peci fications, rep or ts , o r documents s ha ll no t be
res ponsi ble fo r damage caused by subs equent chang es to , or us e o f , those plans, s peci fica tio ns,
repo rts , or do cuments w here th e subsequent cha ng es o r us es, i ncluding cha nges or uses ma de by
s tate o r lo cal g ov ernmen t a l ag enci es , a re not a utho ri zed o r a ppro ved by the li cens ed architect
who o rigina lly signe d the p lans, specifi catio ns , repo rts , o r documents , pro vi ded t hat t he
a rchitect ura l s ervic e ren dered by the a rchitect who signe d the plan s , s pe cifi catio ns , repo rts , or
documents was not a lso a pro xi mate cause o f the da mag e.
DUPLICA TION O F T H E O R IG INAL COP Y OF P LA NS W ILL NOT BE MA DE UNTIL WR ITTEN PERMI SS ION
A ND/OR SIG NA TUR E I S RECEIV ED FR OM THE CER TIFIED , LICENS ED OR R E G ISTER ED PRO FES SIONA L O F
R EC OR D OR HI S OR HER SUCCESSO R ; OR A PER IOD OF 3 0 DA YS HA S ELA PSED A ND NO RESPONSE HA S
BEEN RECE IV ED.
APPLICANT INFORMATION
Name Date
Address City State Zip Code
P hone Number
Comp any
Signatur e
FOR OFFICE USE ONLY
D ate Req ues t Sent:
Architect Response: APP ROVED D ENIED
Engineer Resp onse: APP ROVED DENIED
Owner Resp onse: APP ROVED D ENIED
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