Form Ds-342 - Change Of Building Permit Record - City Of San Diego Development Services - 2015

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Change of Building
City of San Diego
Development Services
DS-342
1222 First Ave., MS-302
Permit Record
San Diego, CA 92101
(619) 446-5000
M
2015
ay
Complete the appropriate section below when there is a change of record AFTER issuance of a Building Permit. See
Information
Bulletin 250
for additional information.
1. Type of Request:
(Select all that apply)
Change of Owner
(complete Sections 2 and 3)
Change of Contractor
(complete Sections 2, 4, 6 and 8)
Change of Permit Holder
(complete Sections 2 and 7)
Change to Owner-Builder
(complete Section 2, 8 and 9)
Change of Licensed Design Professional
(complete Section 2, 4 and 5)
2. Existing Project:
Address:
Project No.:
Approval No.:
(Include Building or Suite No.)
3. New Property Owner:
Name:
Telephone:
E-mail Address:
Address:
City:
State:
Zip Code:
Declaration: By submitting this change of record I certify that I have a legal or equitable interest in the property where the
construction project is proposed. I assume full responsibility for satisfactory completion of all work authorized under the permit,
including work performed prior to assuming ownership, and agree to assume full responsibility for payment of any monies owed
or due to the City of San Diego for this project.
Signature: ____________________________________________________
Date: _________________________________________
4. Change of Contractor/Licensed Design Professional:
Must be completed by: (check one)
Property Owner
Authorized Agent of Property Owner
Permit Holder
Effective Date: _____________________________,
the Licensed Design Professional
and/or
Contractor
(listed in item 5)
(listed in item 6)
shall be the new contractor and/or licensed design professional.
Name: _______________________________________________________
Signature: ____________________________________
5.
Licensed Design Professional:
(if required)
(check one)
Architect
Engineer
License No.: __________________________
Name:
Telephone:
E-mail Address:
Address:
City:
State:
Zip Code:
Declaration: I assume all of the responsibilities and obligations related to that portion of the documents the original architect
or engineer of record prepared and will submit alternate plans/reports for any revisions to documents prepared by the previous
architect or engineer of record subsequent to the date of hire.
Print Name: ____________________________________________________
Date: _________________________________________
Licensed Design Professional Signature: _________________________________________________
6. New Contractor Information:
Name:
Telephone:
E-mail Address:
Address:
City:
State:
Zip Code:
State License No.:
License Class:
City Business Tax No.:
(Required per
SDMC Section
31.0301)
Licensed Contractor’s Declaration: I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
Print Name: ____________________________________________________
Date: _________________________________________
Contractor Signature or Authorized Agent: _________________________________________________
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Upon request, this information is available in alternative formats for persons with disabilities.
DS-342 (05-15)

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