Chicago, IL · Cook County
Self-Certification Professional Statement (Form 410)
Self-Certification Professionals complete this statement for each permit application submitted under Chicago’s Self-Certification Permit Program.
What this form is
This statement records the Self-Certification Professional’s certifications about eligibility, code compliance, approvals, and the accuracy of the permit application. The form must be completed for each permit application submitted under the Self-Certification Permit Program. It asks for project and permit details, professional information, a signature and date, and whether a structural peer review report is required and included.
Who needs it
A registered Self-Certification Professional completes this statement for each permit application submitted under Chicago’s Self-Certification Permit Program.
How to submit it
Complete the form and upload it to the ‘Documents’ folder in ProjectDox for each permit application submitted under the Self-Certification Permit Program.
About notarization
This statement is signed and sealed without a notary; it mentions no notarized attachment or sworn step, so the professional signs and dates it.
How to submit this form
- 1
Download Form 410
Download the fillable Self-Certification Professional Statement.
- 2
Complete the Form
Enter the project and permit details, complete the required sections, and provide the professional information.
- 3
Gather Any Peer Review Report
If a structural peer review report is required, include it with the application as indicated on the form.
- 4
Upload to ProjectDox
Upload the completed statement to the ‘Documents’ folder in ProjectDox for the permit application.
Frequently asked questions
- What is the Self-Certification Professional Statement?
- Form 410 records the professional’s certifications about the permit application, including eligibility for the program and conformity with Chicago Construction Codes.
- Who completes Form 410?
- A registered Self-Certification Professional completes the statement for each permit application submitted under the Self-Certification Permit Program.
- How do I submit Form 410?
- Upload the completed form to the ‘Documents’ folder in ProjectDox for each permit application submitted under the Self-Certification Permit Program.
- Do I need a notary for Form 410?
- No. This statement is signed and sealed without a notary. The professional signs and dates it; the document mentions no notarized attachment or sworn step.
Need something notarized?
This Self-Certification Professional Statement (Form 410) doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.