Escalon, CA · San Joaquin County
Statement of Special Inspection Form
This form documents required special inspections and testing for a construction project and is completed by the owner or representative and other project parties.
What this form is
The form records the project details, special inspection and testing agencies, required inspections, and acknowledgments from the owner, contractor, design professional, and agency. The city requires two completed copies for review and approval before a permit can be issued. The package also includes a contractor statement of responsibility and a summary of inspections to complete for the project.
Who needs it
An owner or representative, with the registered design professional’s advice, completes and submits this package with the project’s required signatures.
How to submit it
Submit two completed copies to the Development Services Division for review and approval before a permit can be issued. The form lists 2060 McHenry Avenue, Escalon, CA 95320.
About notarization
This document is signed without a notary; the listed parties sign and date the form, and it does not specify a notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the Statement of Special Inspection Form.
- 2
Complete The Project Details
Enter the project title, plan check number, and project address, and complete the applicable inspection summary.
- 3
Gather The Required Materials
Attach the City-approved matrix list of special inspectors and complete the required party acknowledgments.
- 4
Submit Copies To The City
Submit two completed copies to the Development Services Division for review and approval before a permit can be issued.
Frequently asked questions
- What does the Statement of Special Inspection Form do?
- It records project details, required special inspections and testing, the agencies involved, and acknowledgments by project parties.
- Do I need a notary for the Statement of Special Inspection Form?
- No. The document has signature and date lines but no notary block; it does not specify a notarized or sworn attachment.
- How do I submit the Statement of Special Inspection Form?
- Submit two completed copies to the Development Services Division for review and approval before a permit can be issued. The form lists its street address.