HomeMy WebLinkAbout164881 1 CITY OF GLENDALE &L` y
PLANNING&DEVELOPMENT SERVICES /
5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE,AZ 85301
Glendale 623.930.2800 SPECIAL INSPECTION CERTIFICATE
ARIZONA www.GlendaleAZ.com STRUCTURAL
OWNER'S 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 the 2018 International Building Code which requires that certain construction work be placed under inspection
of a registered design professional.I,as owner/legal agent,do hereby certify that I have retained VANN ENGINEERING, INC to be
responsible for the special inspections on this project. (Registered Design Professional/Firm-please print)
Owner's name: Owner's Signature: Date:
PROJECT NAME: REGISTERED DESIGN PROFESSIONAL/FIRM NAME:
Ninja_NationT..Giendale VANN ENGINEERING, INC,
Jeffry D.Vann, P.E.
PROJECT ADDRESS: REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS:
6750 W Deer Valley Road, 9013 N 24th Ave,Suite 7
Glendale,AZ 85310 Phoenix,AZ 85021
COG PROJECT NUMBER: 230726 COG PERMIT NUMBER: NOT ISSUED YET
CERTIFICATE OF RESPONSIBILITY CERTIFICATE OF COMPLIANCE
To be filled in and signed by the professional in charge o:Special Inspections To be filled in and signed by the professional in charge of S S.-cial Inspections
before a building permit is issued. before a certificate of occupancy is issued.
As registered design professional in I certify that,to the best of my
charge of special inspections of the knowledge,the requirements of the
above named project,I certify that I tgggA•�` En !na 2018 International Building Code s En
am familiar with the design of the /gyp f CAr e� and the approved plans and !'
project and hereby assume full 1 6'4, 0 specifications have been complied /037./-
ICArFeemsresponsibility for carrying out the , //" 15266 O with,insofar as the portion of the �9 m
required special inspections in I/r work requiring special inspection /J/� 15206
FFRY D. I _ �, FFRY D.
accordance with Sections 1704 and /'m under Section 1704 and 1705 is (fr m
1705 of the 2018 International a y� NN\29j ` concerned.A guarantee that the /1 a 9 NN ti�, m
Building Code. s, 950 contractor necessarily constructed 0�
o �.' the building in full accordance with s� D V.,
'%-4 0gP• the plans and specifications is
NA neither intended nor implied. Ifk,r i NpU S P
(Seal,Si:.: ure,and Date) (Seal,Signatur:,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
❑ CONCRETE CONSTRUCTION/REINFORCING STEEL/POST-TENSION(1705.3)
❑ MASONRY CONSTRUCTION(1705.4)
❑ WOOD CONSTRUCTION(1705.5)
❑ STEEL CONSTRUCTION(1705.2&AISC 360)
❑ SOILS(1705.6)
❑ FOUNDATIONS(1705.7,1705.8&1705.9)
❑ 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)
_
OOTHER: Welding Vann Engineering,Inc.
FORM EFFECTIVE 04/26/2019 POST AT JOB SITE WITH PERMIT