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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
Name State License No.
Address City State Zip Code
Signature
ENGINEER INFORMATION
Name State Li cense No.
Address City State Zip Code
Signature
PROPERTY OWNER I NFORMATION
Name
A ddress City State Zip Code
Signature
As the cert i fi ed, li cens ed , o r regis t ered prof 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 undersigned has
requested co pies o f yo ur signed pla ns . W e are requ ired, in return , to reques t wri tten permis sio n to do so
from the certifi ed, licensed, or registered profes sio na l, o r his s uccessor and o riginal o r curre nt pro perty
owner.
Healt h a nd Safety C ode Section 1 98 51 Inspe ction and d up li cation 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 permis sio n, w hi ch
perm i ss io n s ha ll not be unrea sonably 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
regist ered pro f es sio na l or hi s o r her s uccess o r, if any, w ho signed t he o ri gi nal do c uments and the written
permissio n of the o riginal or current o wner o f t he building, o r , i f the bui lding is pa rt of a co m mo n
interes t develo pment, wi th th e writte n permis sio n of the boa rd of di rectors 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 ) b y o rder of a proper co urt.
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AFFIDAVI T
I, the undersigned, hereby request dupli cation o f the o fficial co py of the pla ns for t he pro ject lo cated at
I certify 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 maintenance, o peration and us e of th e
buildi ng .
2. Tha t dra wings are instruments of prof essi o na l s ervi ce and a re incomplet e witho ut th e
i nterpreta tio n of the c erti fi ed, li cens e d o r regi stered pro f essi o na l of reco rd.
3. That subdivisio 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, repor ts , o r documents s ha ll no t be
responsi 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 agenci es , a re not a utho ri zed o r a ppro ved by the li cens ed architect
who o rigina lly signed the p lans, specifi catio ns , repo rts , o r documents , pro vi ded t hat t he
a rchi tectura l s ervice ren dered by the a rchitect who signed 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 PROFES SIONA L O F
R EC OR D OR HI S OR HER SUCCESSOR ; 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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