Form Ds-3242 - Deposit Account/financially Responsible Party - City Of San Diego Development Services- 2014
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City of San Diego
Development Services
Deposit Account/Financially
Attn: Deposit Accounts
DS-3242
Responsible Party
1222 First Ave., MS-401
San Diego, CA 92101
A
2014
(619) 446-5000
ugust
Project Address/Location:
Project No.:
Internal Order No.:
F
C
U
o
F
C
U
o
or
ity
se
nly
or
ity
se
nly
approval type: Check appropriate box for type of approval requested :
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Grading
Public Right-of-Way
Subdivision
Neighborhood Use
Coastal
Neighborhood Development
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Site Development
Planned Development
Conditional Use
Variance
Vesting Tentative Map
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Tentative Map
Map Waiver
Other: _______________________________
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is the project subject to a Reimbursement agreement?
No
Yes
If yes, provide Reimbursement Agreement Application Project Number or Resolution/Ordinance No.: ______________________
Deposit trust Fund account information: A deposit into a Trust Fund account with an initial deposit to pay for the re-
view, inspection and/or project management services is required. The initial deposit is drawn against to pay for these services.
The Financially Responsible Party will receive a monthly statement reflecting the charges made against the account, and an
invoice when additional deposits are necessary to maintain a minimum balance. The payment of the invoice will be required
in order to continue processing your project. At the end of the project, any remaining funds will be returned to the Financially
Responsible Party.
Financially Responsible paRty
Name/Firm Name:
Address:
E-mail:
City:
State:
Zip Code:
Telephone:
Fax No.:
Financially Responsible party Declaration: I understand that City expenses may exceed the estimated advance deposit
and, when requested by the City of San Diego, will provide additional funds to maintain a positive balance. Further, the sale or
other disposition of the property does not relieve the individual or Company/Corporation of their obligation to maintain a positive
balance in the trust account, unless the City of San Diego approves a Change of Responsible Party and transfer of funds. Should
the account go into deficit, all City work may stop until the requested advance deposit is received.
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This is a continuation of existing Project No.: ______________________
Internal Order No.: ______________________
note: Using an existing opened account may be allowed when:
1. Same location for both projects;
2. Same Financially Responsible Party;
3. Same decision process (Ministerial and discretionary projects may not be combined);
4. Same project manager is managing both projects; and
5. Preliminary Review results in a project application.
please be advised: Billing statements cannot distinguish charges between two different projects.
Please Print Legibly.
Print Name:________________________________________________
Title: ________________________________________________
Signature*: ________________________________________________
Date: ________________________________________________
*the name of the individual and the person who signs this declaration must be the same. if a corporation is listed,
a corporate officer must sign the declaration (president, Vice-president, chairman, secretary or treasurer).
FoR city Use only
Project Title: __________________________________________________
Date Requested: _____________________________
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Keep existing Project No.: _____________________as lead
or
Use new Project No.: _____________________as lead
accoUnt closURe aUtHoRiZation
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Date Requested: ______________________________________
Completed
Inactive
Withdrawn
Collections
Print Name:
________________________________________
Signature: _______________________________________
Printed on recycled paper. Visit our web site at
Upon request, this information is available in alternative formats for persons with disabilities.
DS-3242 (08-14)
Clear Form
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