Design Professional Cement Limit Pathway compliance form

Use this form for compliance with the cement limit pathway. The structural engineer or responsible applicant on the design team must complete and submit this form to the building department for plan check to review.

Form instructions

1. Complete the form by providing the date, company information, and signature.
2. Make sure you provide information for all unique concrete mix designs used on the project.
3. If Ready-Mix Design Number has been pre-qualified with the County, you must provide the County issued pre-qualified reference number. See pre-qualified mixes.
4. Place or print this compliance form within the structural plans.
   1. If a licensed professional is present, that person must stamp the mix design to ensure that it complies OR
   2. a signature of the responsible applicant will suffice.

How to submit this form

Submit this form with your building permit application via the online building permit portal. If you have any questions about submittal, please call the Building & Safety hotline at 415-473-6550.