HomeMy WebLinkAbout129167 CITY OF GLENDALE 4 12 l 1 LIB -i
04.4.i PLANNING&DEVELOPMENT SERVICES
5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE,AZ 85301 SPECIAL INSPECTION CERTIFICATE
Glendale 623.930.2800
A R I 7 o N n www.GlendaleAZ.com STRUCTURAL
OWNERS NOTIFICATION OF SPECIAL INSPECTION
To be completed and signed by the Owner before a building permit is issued
In accordance with Sections 1704 and 1705 of national Building Code which req u. - .in constr c n work e c under inspection
of a registered design professional.I,as owne/legal agent, hereby certify that I have reta'., ; , ` to be
responsible for the special inspections on this �rstered Design Professional/Firm-please print)
Owner's name: be Th. __ L-000 d Owner's Signature: 4 C/[,t_A- Date: //1
PROJECT NAME: REGISTERED DESIGN PROFESSIONAL/FIRM NAME:
-,- .4.d-4
PROJECT ADDRESS: REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS:
6 ii i-i IL) . ( nAbc1J[ -e
COG PROJECT NUMBER: COG PERMIT NUMBER:
CERTIFICATE OF RESPONSIBILITY CERTIFICATE OF COMPLIANCE
To 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 Inspections
before a building permit is issued. before a certificate of occupancy is issued.
As registered design professional in (:::6(of
otegsieind °^ I certify that,to the best of my g�p�
charge of special inspections of theICAT( J, knowledge,the requirements of the �o�es ��e,
above named project,I certify that I N� 2018 International Building Code0aQ `����FICATf� s�
am familiar with the design of the a22969 - and the approved plans and ,
project and hereby assume full PAUL M. . specifications have been complied o, PAUL M.
responsibility for carrying out the KUKLA with,insofar as the portion of the KUKLA
required special inspections in Oo 9/1/2020 work requiring special inspection •
accordance with Sections 1704 and l° Si nea-" under Section 1704 and 1705 is ovr 10/2 /z
1705 of the 2018 International 4#/ �� g,P• concerned.A guarantee that the ° Si ne�'.
Building Code. DNA' �' contractor necessarily constructed 44i/ZONp U5•1"
I / the building in full accordance with
the plans and specifications is
neither intended nor implied.
(Seal i t r d Date) (Seal, at
ilt
SPECIAL INSPECTOR QUALIFICATIONS APPRO L BY BUILDING OFFICIAL/PLANS EXAMINER(1704.2.1): DATE:
WORK WHICH REQUIRES SPECIAL INSPECTION QUALIFIED SPECIAL INSPECTOR INDIVIDUAL OR FIRM
❑ CONCRETE CONSTRUCTION/REINFORCING STEEL(1705.3)
❑ MASONRY CONSTRUCTION(1705.4)
❑ WOOD CONSTRUCTION(1705.5)
❑ STEEL CONSTRUCTION(1705.2&AISC 360)
❑ SOILS(1705.6)
IN FOUNDATIONS(1705.7,1705.8&1705.9) Helical Piers Paul M.Kukla PE,SE
❑ SPECIAL CASES:POST-INSTALLED(EPDXY/EXPANSION)ANCHORS(1705.1.1)
❑ SEISMIC RESISTANCE(1705.12)
❑ SPRAYED FIRE-RESISTANT MATERIALS(1705.14)
❑ EXTERIOR INSULATION AND FINISH SYSTEMS(EIFS)(1705.16)
❑ STORAGE RACKS(1705.12.7)
❑ OTHER:
FORM EFFECTIVE 04/26/2019 POST AT JOB SITE WITH PERMIT