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PART IV G NTit&CTaR ST�TEtl�IENT QF RF-SPONW111LITlf <br /> 1 Ji*D+escdption: Interior Remodel <br /> "� . 450 East 11th Street,Tracy,CA Permit#: <br /> ProJtat Address: <br /> � <br /> r <br /> riitb� ..�. n(— License#i: <br /> R Phone#?��'15-Cage <br /> Res Person: t.._. <br /> In a=rdance with the CaiPfomia Building Code, Section 1704.4, and the City of Tracy Special <br /> Inspections Policy each contractor responsible for the construction of a main wind- or saismio-force- <br /> resisting system, designated seismic system or a wind- or seismic-resisting component, or other <br /> required system listed in the statement of special inspections shall submit a written statement of <br /> responsibility to the building official and the owner prior to the commencement of work on the system <br /> or component. <br /> CONTRACTOR STATEMENT OF RESPONSIBILITY: <br /> InIlIal adjacent to each statement to acknowledge, <br /> gP44??:rELJ✓ ...Yiz:::::.:i.... <br /> ..,.: 1 aim awwo and knowledgeable of the special requirements contained In the <br /> " Clty of Tracy Special Inspection Agreement form; <br /> I acknowledge that project controls will be exercised to obtain conformance <br /> with the current building code and construction documents approved by the <br /> Building Official; <br /> I acknowledge that i must coordinate with the special Inspection agency to <br /> "-ensure all required inspections are conducted at the appropriate intervals <br /> during construction; <br /> I acknowledge that I have been in contact with the special inspection agency <br /> {' chosen for this project and am aware of their notification requirements for <br /> I acknowledge that failure to comply with special inspection requirements <br /> may lead to additional project expenses and project delays due to issuance <br /> of stop work orders, destructive inspections & testing, In-situ load testing, <br /> and possible redesign. <br /> Signature <br /> 6—ItWiredQl�Oli WJWAdmW8Fv IALINBM'E10"P*ciet1naRocuanAurowmentFomtRevised4„20zadocs <br /> E •' <br />