County of San Diego, Land Use and Environment Group
FINANCIALLY RESPONSIBLE PARTY
AGREEMENT
PDS SUPPORT SERVICES DIVISION
5510 OVERLAND AVE, SUITE 110, SAN DIEGO, CA 92123
(858) 565-5981
(858) 694-2055
http://www.sdcounty.ca.gov/dpw http://www.sdcounty.ca.gov/pds
PDS-126A (Rev. 03/29/2017) PAGE 1 of 2
I understand that all funds deposited in the Trust Account shall be held by the County in an account under
the name of the Financially Responsible Party (FINRESP), and the FINRESP shall be considered the
owner of all funds in said account, and Depositor (if different from Financially Responsible Party) releases
any interest in said funds. Except as provided below, any funds remaining in said account at the
completion of work shall be refunded to the FINRESP at the address below. In the case that the
FINRESP wishes to transfer responsibility of the Trust Account to a new owner, a Change of Financial
Responsibility form must be completed to authorize transfer of ownership of funds in said account. The
FINRESP may contact the Trust Account Customer Service Unit at: PDSDevDep@sdcounty.ca.gov or by
calling (858) 694-2320 to request the Change of Financial Responsibility form.
FINANCIALLY RESPONSIBLE PARTY
Have you had a Trust Account with the County of San Diego before? Yes No 
The information of the Financially Responsible Party provided below must be 100% accurate. All Developer
Deposit customer statements and refund checks, if any, will be mailed to the name and address stated
below. If the information stated on this form is inconsistent with our system, then the Financially
Responsible Party must clarify and correct before the application can be accepted.
If the Financially Responsible Party is a Company or Organization please complete below (additional
information may be required if an agent signed this form);
Company/Business/Trust Name: _______________________________________________________
If Attention/Care of/Doing Business as: ___________________________________________________
Billing Address: ____________________________________________________________________
City: _______________________________________ State: ______ Zip Code: ________________
Preferred Phone: _______________________________ Alt. Phone: __________________________
Email: _________________________________________________
If the Financially Responsible Party is an Individual please complete below:
First Name: ______________________ MI: ___ Last Name: ________________________________
Billing Address: _____________________________________________________________________
City: _______________________________________ State: ______ Zip Code: ________________
Preferred Phone: ______________________________ Alt. Phone: ___________________________
Email: _________________________________________________
I have read this form and understand all funds deposited into the Trust Account are owned by and
any refund will be sent to the Financially Responsible Party (FINRESP) listed above. I understand
and agree that the Financially Responsible Party is responsible for payment of all fees associated with this
project including all hourly or other fees which may accrue during the review and/or post-issuance whether
the permit is issued or whether the application is canceled or denied before the permit is issued.
Financially Responsible Party’s Signature: _____________________________ Date: ______________
Print Name: ____________________________________________________
County of San Diego, LUEG, PDS Support Services Division
FINANCIALLY RESPONSIBLE PARTY AGREEMENT
Continued
5510 OVERLAND AVE, SUITE 110, SAN DIEGO, CA 92123
(858) 565-5981
(858) 694-2055
http://www.sdcounty.ca.gov/dpw http://www.sdcounty.ca.gov/pds
PDS-126A (Rev. 03/29/2017) PAGE 2 of 2
Did you know you can request access to your Trust Account onlinewhich allows you to review
charges, make deposits, and see your account balancesin real time? Please go to
http://www.sandiegocounty.gov/content/sdc/pds/AccelaUpdates.html for additional instruction.
--- OFFICIAL USE ONLY
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Trust Account #
-
Reference Contact ID Trust Account Type Unique Identifier
The Trust Account shown above has been linked to the following Records ID(s):
Counter Staff:
Trust Account Types
A
PDS
Cash Guarantees for Resource Management
Plans
N
ALL
Future Use - Dept Trust Account Type
B
PDS
Cash Guarantees for Model Homes
O
DEH
Hazardous Materials Division (HMD)
C
PWS
Construction & Demolition Recycling
P
DPW
Cash guarantee for Prior-to-Occupancy
D
ALL
DEH, PKS, PDS, PDS LD, PWR, PWW --
Trust Accounts
Q
DEH
Cash guarantee for Land & Water Quality Well
Bond (LWQD Well Bond)
E
DEH
Land & Water Quality (LWQD PP)
R
DPW
Cash guarantee for Right-Of-Way
F
DPW
Cash guarantee for Future Improvements
S
DPW
Cash guarantee for SWMP Maintenance
Agreement
G
DPW
Cash guarantee for Grading
T
PDS
Cash guarantee for Misc. PDS Guarantees
H
PDS
Cash guarantee for Health Care Trailers
U
DPW
Cash guarantee for Improvements Labor &
Maintenance and Faithful Performance
I
PDS
Cash Guarantees for Defense and Indemnity
Agreement
V
DPW
Cash guarantee for Misc. DPW Guarantees
J
DEH
Land & Water Quality Site Assessment
Mitigation (LWQD SAM)
W
DPW
Cash guarantee for Lien Contract
K
DEH
Community Health Division (CHD)
X
DPW
Cash guarantee for Restoration
L
PDS
Cash Guarantees for Landscape / Re-Vegetation
Plans
Y
ALL
Future Use - Dept Trust Account Type
M
PDS
Cash Guarantees for Surface Mining and
Inspection
Z
ALL
Future Use - Dept Trust Account Type