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t CITY OF GLENDALE, ARIZONA
BUILDILNG SAFETY DEPARTMENT- COMMUNITY DEVELOPMENT GROUP
- SPECIAL INSPECTION CERTIFICATE
Project Name Date
V [►)S MEW icA-L/ P - 6 ( 87
Project Address Permit No. DSC No.
5f;2 o c,k3, 7140 N) Co 1 PO poP $qo t 3 2—
CERTIFICATE OF SPECIAL INSPECTION BY OWNER
(To be filled in and signed by owner before permit is issued.)
In accordance with Section 306 of the Uniform Administrative Code of the City of Glendale, R(-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 inspectio
Name of Architect Contractor
Ma So I) Ku r tc is ftfJL14irct S E S (- SUGI /US'
Name of Structural Engineer Signa wn r al t l
St
G1�UC0 2CEO Sc-6`T (, /
r
SPECIAL INSPECTION RESPONSIBILITY CER IFICATE
(To be filled in and sealed before building permit is issued.)
I certify that I am familiar with the structural design of the above-nam)project and,in accordance with Section
306 of the Uniform Administrative Code of the City of Glendale, ei edition,I hereby assume full responsi-
bility for carrying out the required special inspection. Inspection reports will be filed with the Building Safety
Department,as required by Section 306(c). The following individual(s)will be special field inspector(s)under
®Qet :; •� my direct supervision and are to be on the job site to render full,complete and competent inspection.
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ca, • '0 The special field inspector(s)are to be named below before work under their area of duty commences.
(iz Ir`• t / '• Architect or Engineer Responsible for Special Inspection(Type or Print)
i TURiEY 0 d
. yA . . RIC-4fileb , �u,ei- Y
gq,,d Si.nee. Name of Inspector(specify type) Name of Inspector(specify type)
-0NA. u.S.A Ea )COG5rOPT — Co,VGL1T#
r Place Registr. and Name of Inspector(specify type) � Name of Inspector(specify type)
ISignature Above. )i D. S 7, -Dr - �,Sa4/�i/
SPECIAL INSPECTOR QUALIFICATIONS [UAC SEC 306(B)] ARE APPROVED. j
: .I DING FFICIAL DATE
II CERTIFICATE OF COMPLIANCE AND APPLICATION FOR CERTIFICATE OF OCCUPANCY
J (To be filled in and sealed before certificate of occupancy is issued.)
2totossEon164 The construction of the above-named project is substantially complete and request is hereby made for issuance
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o,te 11�„•t'�1 of the certificate of occupancy per Section 308 of the Uniform Administrative Code of the City of Glendale,
'� 0 N dition.
t y RICHARD T : certify that,to the best of my knowledge,the requirements of the approved plans for which special inspection
+0 ,� s required and Section 306 of the Uniform Administrative Code have been complied with. A guarantee that the
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l4 •ne•!••' contractor has necessarily fulfilled the obligations of his contract is neither intended nor implied.
tl.S.A Architect or Enginee Responsible for Special Inspection(Type or Print)
Place Registration Seal and P. �
Signature Above. / 'c j map u L e y
WI III -BUILDING SAFETY DEPARTMENT
YELLOW-ARCHITECT OR ENGINEER
PINK-HOB COPY(TO BE RETURNED TO TILE BUILDLNG OFFICIAL WI[EN YOUR INSPECTION IS COMPLETE AND BEFORE A CERTIFICATE OF OCCUPANCY IS REQUESTED.)