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CITY OF GLENDALE
PLANNING&DEVELOPMENT SERVICES
5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE,AZ 85301
523.930.2800 SPECIAL I\SPECTION CERTIFICATE
www.GlendaleAZ.coM STRUCTURAL
OWNER'S NOTIFICATION OF SPECIAL INSPECTION
To be completed anti signed by the Owner before a building permit is Issued
In accordance with Sections 1704 and 1705 of the 2018 International Building Code which je uir s net certain construction work be placed under inspection
of a registered design professional.I,as owner/legal agent,do hereby certify that I have r;ealned to be
responsible for the special inspections on this project. (Ilegistved Design Flofessoonato -please tunnti
Owner's name: F•C't?,>) S_O) Owner's Signature: Dale: 41. 2
PROJECT NAME: REG ERED DESIGN PROFESSIONAL/FIRM NAME:
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PROJECT ADDRESS: REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS:
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COG PROJECT NUMBER: 2.8.1.100 COG PERMIT NUMB R: c7
CERTIFICATE OF RESPONSIBILITY CERTIFICATE OF CoMPUANCE
ro be filled In and signed by the professional in charge of Special Inspections To be filled in and signed by the professional in charge of Special In sections
before a budding permit is issued. before a certificate of occupancy Is issued. ""•!"7*"1--
As registered design professional in I certify that,to the best of my • A r
charge of special inspections of the knowledge,the requirements of the
/ •
above named project I certify that I 2018 International Building Code
FREDERICK J.
29371 PI am familiar with the design of the :4
specificationsandthe approvedav have been complied project arid hereby assume full
responsibility for carrying out the • 29371 54 with,insofar as the portion of the NUEVA
required special inspections in FREDERICK J E3 work requiring special inspection 1r).4.p w 2. , ' 5 accordance with Sections 1704 and NoaKE under Section 1704 and 1705 Is
1705 of the 2018 International Al I P £ concerned.A guarantee that the •/
s
Building Code. "T'l; um' contractor necessarily constructed . `1•
vy the building in full accordance with
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the plans anti specifications Is
neither Intended nor Implied.
(Seal Sigikdure.and Date) (Seal,Signature.and Date)
SPECIAL INSPECTOR QUALIFICATIONS APPROVAL BY BUILDING OFFICIAL/PLANS EXAMINER(1704.2.1): DATE:
WORK WHICH REQUIRES SPECIAL INSPECTION QUALIFIED SPECIAL INSPECTOR INDIVIDUAL OR FIRM
IR CONCRETE CONSTRUCTION/REINFORCING STEEL/POST-TENSION(1705.3) -'VUL.u L...„”v
0 MASONRY CONSTRUCTION(1705.4)
0 WOOD CONSTRUCTION(1705.5)
0 STEEL CONSTRUCTION(1705.2&AISC 36D)
0 SOILS(1705.6)
ci FOUNDATIONS(1705.7,1705.13&1705.9) U L_i .tAsiD •
SPECIAL CASES:POST.INSTALLED(EPDXY/EXPANSION)ANCHORS(1705.1.1) r24,4u, Lo,
O SEISMIC RESISTANCE(1705.12)
0 SPRAYED FIRE-RESISTANT MATERIALS(1705.14)
0 EXTERIOR INSULATION AND FINISH SYSTEMS(EIFS)(1705.16)
0 STORAGE RACKS(1705.12.7)
0 OTHER:
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Phoenix,Arizona 85016 pooxet
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COnsulting Phone 602.955.9200 p-o af, ,.-.,-3 (72-
structural engineers Fax 602.955.9201 Lottion .
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www. bakkomnoe11ca , corn CC•4701/*STOR 0414031
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Phoenix,Arizona 85016 PRO•rct
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structural engineers Fax 602.955.9201 tOCAREPI
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PRESENT AT SITE
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