SCHEDULE

ASSURANCE OF COMPLIANCE

To be submitted after completion of the Project, but prior to occupancy:
Separate form to be submitted by each Professional Designer.

Date:_

City of Port Coquitlam
Building Department
2580 Shaughnessy Street
Port Coquitlam, BC

V3C 2A8

ATTENTION: Director of Building Permits and Tnuspections

Dear Sirs:

RE: Address
Owner
Building Permit Application No.
(the "Project")

lt hereby certify that I have fulfilled my obligations for "€jeld review"
as outlined in the following previously submitted letters:

Schedule J: ASSURANCE OF “PROFESSIONAL DESIGN" AND
COMMILIMENT FOR "FIELD REVIEW"

Schedule K: SUMMARY OF PROFESSIONAL DESIGN AND FIELD
REVIEW REQUIREMENTS

Based on my “field reviews" the following aspects of the Project
substantially conform in all material respects with the plans = and
supporting documents including all amendments, prepared by the undersigned
Professional Designer and for which a building permit was issued.

Coordination of Design and Field Review
Architectural

Structural

Mechanical

Plumbing

Fire Suppression Systems

Electrical

Geotechnical - temporary

Geotechnical - permanent

Site Servicing

are
ed
ren eeerenenneeenes

t enclose the final design plans and supporting documents prepared by me
Cor the above referenced Project.