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
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(858) 565-5981
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(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: ____________________________________________________
