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CITY OF TRACY <br /> DEVELOPMENTERVICE <br /> S S DEPARTMENT Z�tw <br /> BUILDING SAFETY DIVISION TRACY <br /> 333 CIVIC CENTER PLAZA, TRACY, CA 95376 <br /> P: (209)831-6400 • F: (209) 831-6439 <br /> www.cihm racv.ercl <br /> V,W tn.Hk t 7rin � <br /> PART V <br /> FINAL REPORT OF SPECIAL INSPECTIONS <br /> PERMIT# <br /> PROJECT CONTRACTOR <br /> Nam: Name: <br /> Address' Address: <br /> RDP IN RESPONSIBLE CHARGE RDP RESPONSIBLE FOR <br /> STRUCTURAL DESIGN <br /> Name: Name: <br /> Address: Address: <br /> To the best of my information, knowledge, and belief, the Special Inspections and tests required for <br /> this project, and Itemized in the Statement of Special Inspections submitted for permit, have been <br /> completed, and any discrepancies noted in the inspections or tests have been corrected.Attached to <br /> this final report are the Certificates of Compliance for shop fabricated load bearing members and <br /> assemblies. (Include If applicable) <br /> Interim/daily reports submitted prior to this final report,and numbered to , form a <br /> basis for, and are to be considered an integral pari of this final report. <br /> Respectfully submitted, <br /> (Signature) <br /> (Date) l <br /> (Type or Print Name) i <br /> (Place Seal Here) <br /> Pg 7—Revised OU6►2020 W.WuildinglSPECIAL WSPECTMASpecial inspection Agreement Form Revised< 2020.docx <br />