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�f!�JJJ CITY OF GLENDALE,ARIZONA
P D BUILDING SAFETY DEPARTMENT-COMMUNITY DEVELOPMENT GROUP
G�111 SPECIAL INSPECTION CERTIFICATE
Project Name Date
(*Min..'n. ELEMaNWA y scihXZ—//-,s
Project Address Permit Number DSC Number
•
8520 P. y7'^'AI6. Oil- /%77
- CERTIFICATE 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 '
Cowco,to
Name of.9free(_..4 Engineer Signature of Owner or Legal Agent
Ri - 41:kIr 5 , - r 'kcY3_e.. ad t ,61fro ri - 'Suez •
-
0 SPECIAL INSPECTION RESPONSIBILITY CERTIFICATE �/ • .
(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 inspections. Inspection reports will be bled with the Building
Safety Department,es required by Section 306(c). The following individual(s)will be special field inspectors(s)
under my direct supervision and are to be on the job site to render full,complete and competent inspection.
t The special field inspector(s)are to be named below before work under their area of duty commences.
/n� , 740 a Architect or Engineer Responsible for Special Inspection(type or print)
C427
O0 t
21852 O Name of Inspector Masora Name of Inspector(Steel)
tr CHARLES H. a
\ ATKINSONp
`rT Name of Inspector(Concrete) Name of Inspector(Welding) •
l9/2ONA YY.' Name of Inspector(Specify Type) C� A e I Name of Inspector(Specify Type)
f� N ESCA PIMA •
— .. D.:{r•!i. .—.r:_.:-.Fl1.ut M if _ '. T 9 is ...
SPECIAL INSPECTOR QUALIFICATIONS [UAC SEC 306(B)]ARE APPROVED. Y. /,'( JZ-it/a>
taromg umctal Date
I I CERTIFICATE OF"COMPLIANCE AND APPLICATION FOR CERTIFICATE OF OCCUPANC
f ' (To be rfi�lled in and sealed before certificate of occupancy is issued.)
,0004/701„ie . The construction of the above named project is substantially complete and request is hereby made for
� � `i 4gi i •uance of the certificate of occupancy per Section 309 of the Uniform Administrative Code of the
„/ ? O ^ City of Glendale 1997 edition. ,
21852 • e'
�
CHARLES H. — I certify that,to the best of my knowldege.the requirements of the approved plans for which special inspection
\QQQ ATKINSON[ is required and Section 306 of the Uniform Administrative Code have been complied with. A guarantee that •
° ,: 411yf the contractor has necessarily fulfilled the obligations of his contract is neither intended of implied.
9/ZONA U s Architect of Engineer Responsible for Special Inspection(Type or Print)
RETURN TO THE BUILDING SAFETY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
0 BUILDING SAFETY DEPT. 0 BUILDING INSPECTOR 0 ARCHITECT OR ENGINEER 0 JOB COPY