Business Registration Form

Special Inspector Registration Form

Please email completed form with a copy of your certification to the Special Inspector Registration Inbox to complete the registration process: SIRegistration@paramountcity.com The Building & Safety Division will reply with a city approved daily form.
Inspector Name*

First NameLast Name
ICC Certification #
*
Contact Number*

Area CodePhone Number
E-mail*
example@example.com
Permit Number*
Job Site Address*
Inspector Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I will inspect and certify the following procedures*
I hereby certify that I am qualified by training and experience to perform the inspections for which I hold the above listed Special Inspectors licenses and will provide all certifications required by the City.
Type of inspection*

ConcreteEpoxyGunite / ShotcreteWeldingMoment Resisting FrameStructural MasonryStructural FrameHigh Strength BoltOther
I will certify not only to the job conditions, but that they are in conformance with the approved plans. If at any time, progress occurs on the above-mentioned job relating to my area(s) of responsibility, without my knowledge or approval, I will stop the job’s progress immediately with notification in writing to the job superintendent and notify the Building Division of the situation. A record of my tests and/or inspections as agreed to above will be available upon request by the Building Division. Upon request, I will submit a complete package of testing and inspection results. A letter certifying satisfactory completion will be provided by me upon completion.
Signature*

Clear
Should be Empty:

Special Inspector Registration Form