HomeMy WebLinkAboutPublic Records Request - Affidavit and Authorization Form (HS 19851)_B&S.Updated City of Diamond Bar
21810 Copley Drive | Diamond Bar, CA 91765-4178
909-839-7020 | Fax 909-861-3117
www.DiamondBarCA.gov
REQUEST FOR DUPLICATION OF PLANS AND AFFIDAVIT
(Health & Safety Code 19851)
Request Date: __________ Permit Numbers: _____________________________________
Site Address: ___________________________ City: _________________ Zip: _________
Assessor's Parcel Number: ___________________ Tract/PM: ___________ Lot #:________
Requestor: Name: ______________________________
Phone: (_____) _______________________
Address: _____________________________
City: ____________________________ State: ___________Zip: ___________
In accordance with Health and Safety Code Section 19851, the Requestor affirms under
penalty of perjury:
1) That the copy of the plans shall be only used for the maintenance, operation, and
use of the building.
2) That the drawings are instruments of professional service and are incomplete
without the interpretation of the certified, licensed, or registered professional of
record.
3) That subdivision (a) of Section 5536.25 of the Business and Professions Code
states that a licensed architect who signs plans, specifications, reports, or
documents shall not be responsible for damage caused by subsequent changes
to, or use of, those plans, specifications, reports, or documents where the
subsequent changes or uses, including changes or uses made by state or local
governmental agencies, are not authorized or approved by the licensed architect
who originally signed the plans, specifications, reports, or documents, provided
that the architectural service rendered by the architect who signed the plans,
specifications, reports, or documents was not also a proximate cause of the
damage.
4) In consideration of the City’s approval of this application, I do hereby agree to
indemnify and hold harmless the City of Diamond Bar, its officers and employees
from any and all claims, suits and liability which may arise due to my receipt of the
copy of the official plan and any use to which my copy of the plan may be applied.
Signature of Requestor: ________________________ Date: ________________
The official copy of plans maintained by the City of Diamond Bar Planning Division under
Health and Safety Code Section 19851 are open for inspection only. The official copy of
plans may not be duplicated in whole or in part except (1) with the written permission of the
certified, licensed or registered professional or his or her successor, if any, who signed the
original documents and written permission of the original or current owner of the building, or
(2) by order of a proper court.
DUPLICATION OF PLANS – AUTHORIZATION FORM
I. Owner's Authorization:
As the [ ] current owner / [ ] original owner of the building(s) subject to this request for
duplication of plans, I grant permission to duplicate the official copy of building plans
maintained by the city of Diamond Bar.
____________________________ _______________________
Signature of Building Owner Date
____________________________
Print Name of Building Owner
II. Professional's Authorization:
As the certified, licensed or registered professional, or his or her successor, who signed the
building plans dated ______________ for the building(s) subject to this request, I grant
permission to duplicate the official copy of building plans maintained b y the city of Diamond
Bar.
(Seal)
_________________________ ________________
Signature of Professional Date
____________________________
Print Name of Professional
_____________________________________________
Professional Designation (e.g.,architect,engineer, designer)
Please return completed form to: City of Diamond Bar
Building & Safety Division
21810 Copley Drive
Diamond Bar, CA 91765