Registered Deputy Inspector'S Certificate Of Compliance Form
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1REGISTERED DEPUTY INSPECTOR’S
CERTIFICATE OF COMPLIANCE
Address _____________________________________________ Date of Certificate _________________________
Fabricator ___________________________________________
Permit ______________________________________________
TO THE SUPERINTENDENT OF BUILDING:
CITY INSPECTOR: _________________________________
I hereby certify that the following portion of the work at the above job address which required continuous
and/or periodic inspection, and which I was employed to inspect, was inspected and approved by me and complies
with provisions of the building Codes applicable thereto:
Type of inspection:
[ ] Steel Construction
[ ] Sprayed Fire-Resistant Materials
[ ] Prestressed Concrete
[ ] Concrete Construction
[ ] Smoke Control
[ ] Drilled-in Anchor
[ ] Masonry Construction
[ ] Methane
[ ] Gunite / Shotcrete
[ ] Wood Construction
[ ] Exterior Insulation & Finish System
[ ] Seismic Resistance
[ ] Soils
[ ] Wind Resistance
[ ] Other:
Location and Description of work completed ________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Size of Structure: ______________________________
Time Arrived: _________________________
No. of Stories: ________________________________
Time Left Job: _________________________
Conc. Mix Design No.: _________________________
P.S.I.: ________________________________
Registration Number: __________________________
Employed by: ________________________________
Lab: ________________________________________
Independent:
[ ]
Signature: ____________________________
Registered Deputy Building Inspector:
Print Full Name: _______________________
Cell Phone Number: ____________________
E-Mail Address: _______________________
DO NOT AMEND, ALTER, CHANGE, DELETE OR APPEND ANY PRINTED PORTION OF THIS CERTIFICATE AS IT WILL
RENDER IT NULL AND VOID.
As a covered entity under Title II of the Americans with Disabilities Act, the City of Los Angeles does not discriminate on the basis of
disability, and upon request, will provide reasonable accommodation to ensure equal access to its programs, services and activities.
IN.Form 07 (Rev. 03-18-2016)
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