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CITY OF GLENDALE,A1 .ONA
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BUILDING SAFETY DEPARTMENT-COMMUNITY DEVELOPMENT GROUP
GLEN E SPECIAL INSPECTION CERTIFICATE
Project Name • Date •
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Project Address rjiAumher DSC Number
]S59 N, 59 t
A &cu�— �3') 2
8 0 - 9
CERIIFICATE OF SPECIAL INSPECTION BY OWNER
(To be filled in and signed by owner before permit is issued.)
In accordance with Section 306 of the Unifoi-tn Administrative Code of the City of Glendale,_edition, which requires
that the execution of 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 f (.,012) A/)AL -e.g._ Contractor ' ad•ri_-YX,02_&11).4--
-- _____- '-!�PR-G'-tom$- !-C1 l.- ._ A. -of Structural Engineer�e.,R � DAL�t� 792 ' Lj7
w ► e I en 1-
Name
p L It o .,Lam. 7�
SPECIAL INSPECTION RESPONSIBILITY CERTIFICATE
(To be filled in and sealed before building permit is issued.)
I certify that I am familiar with the structural design of the above-named project and,in accordance with
// Section 306 of the Uniform Administrative Code of the City of Glendale,_edition,I hereby assume full
responsibility for carrying out the required special inspection.Inspection reports will be filed with the Building
„t/ Safety Department,as required by Section 306(c).The following individual(s)will be special field inspector(s)
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y ' t► ,• under my direct supervision and are to be on the job site to render full,complete and competent inspection.
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', `.I �,c-ICA f`6� The special field inspector(s)are to be named below before work under their area of duty commences.
V44.1 C 4'O J� A e i'trc•-Engineer Responsible for Special Inspection (Type or Print)
/m 35977
JEREMY F. -3--*612.eJ`- 14 ,Ark-a :ALL.
o RANDALL ,
t- c ,. T`, Name of Inspector(Structural Masonry) Naa of Inspector(Steel)
/ a4'174,, �� ' AV �joi 2.DPI -d Pc` T ,4(L.DFI .-0
"/l� , ' Name of Inspector(Concrete) Name of Inspector(Welding)
.• ..::' AC... I�oA-( I FtI3- L. EXAR.OFi�
Name of Inspector(Specify Type) Efidx`i 4. ' Pk si{atj_ Name of Inspector(Specify Type)
Place Registration Seal and A 5 �� O p`�f ?Matt
Signature Date J`1(1..� Q"TI`- _
SPECIAL INSPECTOR QUALIFICATIONS [UAC SEC 306(B)] ARE APPROVED1i1/,(� /Z rY- Z -
- - - ---- - - _ — Dui' ing- j;cial —-'_Date- -
CERTIFICATE OF COMPLIANCE AND APPLICATION FOR CERTIFICATE OF OCCUPANCY
(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 308 of the Uniform Administrative Code of the
City of Glendale,_edition.
I certify that,to the best of my knowledge,the requirements of the approved plans for which special inspection
is required and Section 306 of the Uniform Administrative Code have been complied with.A guarantee that
the contractor has necessarily fulfilled the obligations of his contract is neigher intended nor implied.
Architect or Engineer Responsible for Special Inspection (Type or Print)
Place Registration Seal-and
Signature Date
RETURNTO.BUILDING'SAFEfY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
ID -BUILDING SAFETY DEPARTMENT
CI -BUILDING INSPECTOR
0 -ARCHITECT OR ENGINEER •
El -JOB COPY(TO BE RETURNED TO THE BUILDING OFFICIAL WHEN YOUR INSPECTION IS COMPLETE AND BEFORE A CERTIFICATE OF OCCUPANCY IS REQUESTED.)
111-07/96