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PLANNING&DEWt-OPMEMTSERVICES
�T c 5850 W.GLENALCC,RNBDA A1VE,2ND FLODR
r;:eta—E.c sz3.s3D.2aon SPECIAL INSPECTION/VERIFICATION CERTIFICATE
P t . u to n wmr.GlertdaltAlcom ARCHITECTURAL ENERGY CODE COMPLIANCE
OWNER'S NOTIFICATION OF SPECIAL INSPECTION
To be completed and signed by the Owner before a(wilding permit Is Imuad
In accordance with theGlendele city Code,G`tapter 9,I,as tiwner/legal agent do hereby certify that the construction of the below described building project
receive Special Inspection or Third Pert/Verification for compliance with the City of Gkndele's current adopted Energy Code.
The Archttect may also cerr1{tlfythls project for Energy Code compliance.
Owners(tam t..514.— Owner's Signature: . Dale /fl
PROJECT NAME: REGISTERED DESIGN PROFESSIONAL/FIRM NAME:
Cadence at Westgate VillageL Energy Inspectors -JC
PRO'E RE Z'Z h 1 V r�` �Q f(1 ( REGISTERED DMZ PROFESSIONAL/FIRM ADDRESS:
0 v C7 V l� 2570-S Miller Lane
g/q—' � - Las Vegas, NV 89117
COa PROJECT NUMBER: 1 l I 1 7 a COD PERMIT NUMBER:
SPECIAL INSPECi1CN/VERIFIcAT1ON RESPONSIBILITY CERTIFICATE CERTIFICATE OF COMPLIANCE&APPLICATION FOR CERTIFICATE OF occtIPANCt
To be lifted In and signed by the Architect,Special Inspector,Contractor or Third Te be filled in end signed by the ATchfect,Special Inspector,Contractor Cr Thin.?
Party Responsible for ver1ti Uon• Party Reoponsible for vmrirrcatlon.
I certify that I am familiar Oh the The construction of the above 4€ /
/
ilio-,
energy codacompllanca namedpioJewtIscompleteand
requirements of the above named meets or excrPr+s the requirements
project and energy conservation.I of the City of Gtendale`s currently
hereby assume hullresponsibiyto adopted Ener r Code.Request is
carrying out the required special hereby rode far Issuance of the
Inspections and verifications. certificate of occupancy.
I certify that.to the best of my
knowledge,the requirements of the 4:-//4' -y�
approved plans for Which Special
Inspection or Third Party Verification
Is required have been met.
l achlteaUSeal,Signature,aret oats ` (ArchttecEsSeal,sigtetarq and Date•V
anonoabta) !I appllaelt ai
r.
SPEciALINSPECTOR QUALIFICATIONS APPROVAL BY BUILDING OFICtAL/PLANS E(AMINER,., ; �'+� I DATZ;t!%I24114
1r:strucun !information about fins form:
I. A Special Inspection is not'Required'.
2. The person'tigning in the area that states that project will confirm to the currently adopted Energy Code does not have to be the sane Gorr that water'
those requirements,
3. The City of Glendale,Amon,nitiy needs this fate catnpteted and whit net we do not need any supporting documentation hi order to issue a Certificate of
Occupancy.
JOB SITE COPY
THESE PLANS SHALL BE KEPT AT THE
JOBSITE AND BE AVAILABLE TO CITY
OF GLENDALE INSPECTORS DURING
WORKING HOURS. PLANS SHALL NOT
BE ALTERED WITHOUT BUILDING
OFFICIALS APPROVAL
FORM EFFECTIVE 04/26/201.9 POST AT 2CR SITE WITH PERMIT