SALT RIVER
PIMA-MARICOPA INDIAN COMMUNITY
ECS COMPLIANCE DIVISION
10005 EAST OSBORN ROAD / SCOTTSDALE, ARIZONA 85256-9722
PHONE (480) 362-7910 FAX (480) 362-5908
CERTIFICATE OF SPECIAL INSPECTIONS
CERTIFICATE OF SPECIAL INSPECTION BY OWNER
(To be filled out by Owner before permit is issued)
In accordance with Section 1704 of the International Building Code, which requires that certain construction work to be placed
under the inspection of the Engineer or Architect of record. I, as owner/ legal agent, do hereby certify that I have retained
__________________________________ (an Arizona registered Engineer/Architect) to be responsible for the Special Inspections.
Signed: Print Name:
Relation to Project ( Owner / Legal Agent): Date:
CERTIFICATE OF RESPONSIBILITY
(To be filled out and sealed by registered Engineer/Architect before permit is issued)
I certify that I am familiar with the design of the above- named project and, in accordance with section 1704
the International Building Code, hereby assume full responsibility for carrying out the required Special
Inspections. Inspection reports will be filed with the Building Official, as required by section 1704.1.2. The
individuals named below will be ICC-Certified Special Inspectors under my direct supervision and will be on
the job site to render competent inspections.
Seal, Sign and Date:
Name of Inspector
Name of Inspector
PROCESSED BY: DATE:
(ECS-Compliance)
CERTIFICATE OF COMPLIANCE
(To be filled out and sealed by registered Engineer/Architect before a Certificate of Occupancy is issued)
I certify that, to the best of my knowledge, the requirements of the International Building Code and the
approved plans and specifications have been complied with, insofar as the portion of the work requiring
special inspection under section 1704 is concerned, except for those deviations previously reported. A
guarantee that the contractor has necessarily constructed the building in full accord with the plans and
specifications is neither intended nor implied.
Seal, Sign and Date:
02/02/2012
