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Owner's Authorization: <br /> The undersigned owner or the owner's authorized agent assumes the responsibility of ensuring coordination with the special <br /> inspection agency during construction to ensure performance of the marked inspections. Further the undersigned owner or <br /> owners' authorized agent acknowledges aware that they are responsible for hiring and employing the special inspection <br /> agency in order to maintain the independence from the contractor as required by CBC 1703.1.1. The undersigned also <br /> states that he/she understands the duties and responsibilities of the special inspector. All fees/costs related to the <br /> performance of Special inspections shall be the responsibility of the owner. <br /> Spink SiY* AZO[ <br /> Owner or Owner's Authorized Agent(Print name) Signature Date <br /> (204) g55 -1149 c +0 nolil.cin <br /> Telephone Number Email'Address <br /> The following statement has been reviewed and accepted by the undersiianed: <br /> Primary RDP in Responsible Charge: Building Official or Designee: <br /> Richard L. Flower, P. E. <br /> Print name Print name <br /> GI cs3a9-Zy <br /> Signature Date Signature Date <br /> (Additional special inspections may be required at the <br /> discretion of the Building Official prior to acceptance of <br /> the statement in accordance with CBC 1705.1.1) <br /> RDP Responsible for Structural Design: Special Inspection Agency Representative: <br /> Richard L. Flower, P. E. <br /> Print name I�// Print name -y ^} <br /> 4— <br /> 03-01 <br /> Signature Date Signature Date <br /> INSTRUCTION TO THE SPECIAL INSPECTION AGI=NCY <br /> 1. Provide Interim/daily field reports to the building Inspector on site as construction progresses.Daily <br /> field reports shall be numbered sequentially for later reference. <br /> 2. A copy of all special inspection test laboratory reports shall be sent to the City's Building Official <br /> and the RDP in responsible charge. <br /> 3. The special Inspection agency shall notify the Building Official and the RDP in responsible charge of <br /> any conflict of interest between the agency and the OwnerlOwner's authorized agent or any other <br /> entity involved in this agreement. <br /> 4. Upon completion of special inspections and testing woi k, provide to the City the completed final <br /> special inspections report(Part V attached),wet stamped and signed by the responsible professional <br /> engineer of the special Inspection agency—such report shall also be sent to the registered design <br /> professional in responsible charge(designer of record for the structure. <br /> Pg 2_Rwlsed 600020 W:113ultdingISPECIAL iNDPECTIMSprtetail Inspection Agraamentft►m Revised 4 2020.docx <br />