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• P7% CITY OF GLENDALE,ARIZONA •
d�h BUILDING SAFETY DEPARTMENT-COMMUNITY DEVELOPMENT GROUP
�, SPECIAL INSPECTION CERTIFICATE
Project Name • Date '
Y S s z Ln o... 'Fit /-23—0 7
Project Address - Permit Number DSC Number
net/ /✓. 79- 1'6: alp''
4-1--e2149-07-4- 492. $S3o /
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 ofArc/bract Contractor -
Name of Structural Engineer Signature of Owner or Legal Agent
— 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 filed with the Building '
Safety Department,as 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. '
SONE The special field inspector(s)are to be named below before work under their area of duty commences.
r Architect or Engine Responsible for Special Inspection(type or print)
� i�rICATFy E ? rE da- SdLTIdef Sit Were
1LcT46
.OName of Inspector(Structural Mason, Name oclnspector(Steel)
7fa ais/ " eName ollnspecbr(Concrete) Name ofInspector(Welding) /
ra-ea an/ Per
o'!•.k Nameof Inspector(Specify Type) Name of Inspector(Spacily Type)- �✓'�'�
#4-441/4745)
/ •-��+ 7 'fl7 G)4ftt f 7E,
SP CIAL INSPECTOR QUALIFICATIONS [UAC SEC 306(8)1 ARE APPROVED. i 9 dime rL/� 42 .07
dm g dime Date
7I CERTIFICATE OF COMPLIANCE AND APPLICATION FOR CERTIFICATE OF OCCUPA
I (To be filled in and sealed before certificate of occupancy is issued.)
The construction of the above named project is substantially complete and request is hereby made for -
• issuance of the certificate of occupancy per Section 309 of the Uniform Administrative Code of the
•
City of Glendale 1997 edition. - •
' I certify that,to the best of my knowidege,the requirements of the approved plans for which special inspection •
is required and Section 306 of the Uniform Administrative Code have been complied with. A guarantee that
the contractor has necessarily fulfilled the obligations of his contract is neither intended or implied.
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Architect of Engineer Responsible for Special Inspection(Type or Print) •
RETURN TO THE BUILDING SAFETY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
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0 BUILDING SAFETY DEPT. 0 BUILDING INSPECTOR 0 ARCHITECT OR ENGINEER 0 JOB COPY