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IP@ CITY OF GLENDALE,ARIZONA
BUILDING SAFETY DEPARTMENT•COMMUNITY DEVELOPMENT GROUP
SPECIAL INSPECTION CERTIFICATE.
Project Name Date
?UMPKIIJ ?-Alck\ T.I. • 8124101-
• Project Address Permit Number DSC Number
1700 AKcowD TOWN aes-if11 070899
❑ 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 or Glendale 1997 edition,which requires that the execution or 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
coWI1r1ikg) NIOIZ P43 011cICT01.8 Oz)LSTIPJuc77{OJ
Name of Structural Engineer1v � �y�1 / Signature of Owner
►1 'eIGC Va'JtkA)�CrllL 45. DeSpk")
FSPECIAL INSPECTION RESPONSIBILITY CERTIFICATE
(To be filled in and sealed before building permit is Issued.)
•
I certify that t am familiar with the structural design of the above-named project and,In accordance with
Section 306 or the Uniform Administrative Code of the City of Glendale 1997 edition,I hereby assume full
responsibility for carrying Out the required spacial inspections. Inspection reports will be filed with the Building
Safety Department,as required by Section 306(c). The following individuals)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.
rft0
aR \ The special field inspectors)are to be named below before work under their area of duty commences to Archers or Engineer Re e��sible for Special Inspection(type or print)
755 pRTWO/ 1 N171 A14.4
1� r�RTLAND Name of inspector Structural Mason, Name of Ins
MORGAN w ( Inspector(Sleet)
:, ti�
,/ yd4aed r� Name of Inspector(Concrete) Name of Inspector(Welding)
ZONA u s' 1W f INICENl311.X Z
t.. Name of Inspector(Specify Type) Name of Inspector(Sped&Type)E,p[t)(�rE(rkfi41Q.:
SPECIAL INSPECTOR QUALIFICATIONS[UAC SEC 306(8)1 ARE APPROVED. /.p�/
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nCERTIFICATE OF COMPLIANCE AND APPLICATION FOR CERTIFICA PANCY
I 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 or 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 305 of the Uniform Administrative Code have been complied with. A guarantee that
the contractor has necessarily fulfilled the onligations of his contract is neither intended or implied.
Architect of Engineer Responsible for Special Inspection(Type or Print)
RETURN TO THE BUILDING SAFETY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
❑ BUILDING SAFETY DEPT. 0 BUILDING INSPECTOR 0 ARCHITECT OR ENGINEER 0 JOB COPY