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�� CITY OF GLENDALE,ARIZONA
din BUILDING SAFETY DEPARTMENT-COMMUNITY DEVELOPMENT GROUP '
GLEN,E •
SPECIAL INSPECTION CERTIFICATE
Project Name Date
DI6C0cu 4T -11e — ' Elik-(DO I- ?= ( -o .
Project Address Permit Number DSC Number
70 to N N . 43z Avc /itit<43 - 02-1957
nCERTIFICATE OF SPECIAL INSPECTION BY OWNER
(To be filled in and signed by owner before permit is issued.)
In accordance with Section 306 of the Uniform Administrative Code of the City of Glendale, 1997 edition,which requires
that the execution of certain construction work be placed under the inspection of the architect,engineer,or special inspector
employed by me, I certify that the construction of the above-described building project will receive special inspection.
' Name of Architect Contractor
cuecrls HOWELL
Name
of�&�nmt f Engineer -Signature of Owne 1 Age
' [ •
I I SPECIAL INSPECTION RESPONSIBILITY CERTIFICATE
I I (To be filled in and sealed before building permit is issued.)
I certify that I am familiar with the structural design of the above-named project and,in accordance with
Section 306 of the Uniform Administrative Code of the City of Glendale, 1997 edition,I hereby assume full
responsibility for carrying out the required special inspection.Inspection reports will be filed with the Building
Safety Department,as required by Section 306.3.The following individual(s)will be special field inspector(s)
7' - . under my direct supervision and are to be on the job site to render full,complete and competent inspection.
/fielsrye1__,, rel - The special field inspector(s)are to be named below before work under their area of duty commences.
,�Ii11 /1 Architect or Engineer Responsible far Special Inspection (Type or Print)
•{ .T Dt' Vo
ieI"'STORER JOHN s. ( I1�iC 1260PFaR .iD h N SosNnos
ce - sosNowsia G Al me oflnspector(Structural Masonry) Name oflnspector(Steel) ; p��
1�' til WI(-@�5�'� �,S,tirru�a,
P`SjBned�'' Name Inspector(Concme Name of Inspector(Welding)\RfzoNA, 5'1'/ ' I'�C. a�ti. ,SBS t�U a,a f�t�Xlj 1'd( .(Specify �S�a�d
Pface ...��,_*fes Naaymre�oJnspermr(Specify Type) I Name of Inspector(Specify Type)
Signature Date t t�tZJ I U U . ( 1 c G4.P �i AI IISrvinktrAeigidfluOtna--(Y����• SPECIAL INSPECTOR QUALIFICATIONS [UAC SEC 302.5] ARE APPROVED9 L 7-c-OL
Building Offici ate
CERTIFIC: OF COMPLIANCE AND APPLICATION FOR CER1IFICATE OF OCCUPANCY
(To be fill d in and sealed before certificate of occupancy is issued.)
fr....-;,
r�•,i tag -.` The construction of the above-named project is substantially complete and request is hereby made for
4 4-.�b t;;l i,j Cry�('a- isissuance
ity nc Glf the
elcertiffi tee of occupancy.per Section 309 of the Uniform Administrative Code of the
, 1997
1q(ii, t� 31122& 9 ; certify that, my knowledge, requirements of the approved plans for which special inspection
li to the best of knowled a the
°' "r i SIOPHER JOHN required and Section 306 of the Uniform Administrative Code have been complied with.A guarantee that
CC 11,.. SO; ac^-.3 � - e contractor has necessarily fulfilled the obligations of his contract is neigher intended nor implied.
s 4 ...'I!'1'�/jr/// Architect or Engineer Responsible for Special Inspection (Type or Print)
Plat .. `tmtion Seal and' ,
is , eDal✓- l'
r,
a
• RETURN TO BUILDING SAFETY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING: •
u-BUILDING SAFETY DEPARTMENT
ij -BUILDING INSPECTOR '
0 -ARCHITECT OR ENGINEER .
. ❑ -JOB COPY(TO BE RETURNED TO THE BUILDING OFFICIAL WHEN YOUR INSPECTION IS COMPLETE AND BEFORE A CERTIFICATE OF OCCUPANCY IS REQUESTED.)
Aafgl-07/00