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GLENDfE Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date
Property Address LI 0 41 W . CO S'riz,EET
Name of P operty Owner po 2vq 4 I RA►VDEE pas7Re%v-t
I. No children less than six years of age reside at this address.
II. El A child under the age of six years of age resides at this address.
(If this box is checked, identify method of secondary pool protection)
A. ❑ We will provide an interior fence and enclosure around the pool as
required by the Glendale Pool Barrier Ordinance.
B. ❑ We will provide exterior fence and enclosure protection with
secondary protection as checked on reverse side of this affidavit per the
Glendale Pool Barrier Ordinance.
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IF YOU CHECKED BOX II B, PLEASE COMPLETE REVERSE SIDE
WHICH IS THE NEXT PAGE IN THIS DOCUMENT
THIS IS THE REVERSE SIDE OF THE PREVIOUS PAGE
1. El The pool shall be protected by a motorized safety pool cover.
2. El Doors and windows are protected
3. El The pool shall be protected by an alarm maintained in or on the
swimming pool.
4. ❑ The above ground swimming pool shall have a secured ladder.
5. ❑ Locking hard safety cover on the spa or hot tub.
6. ❑ Alternative protection not specified above which is attached to the
plan submittal and submitted for ap ro al y the Building Official
g/tlA
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c��S�REcc�-f
Name of Home Owner Home Owner Signature Date
Pool Contractor Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this /2 day of YI 1 , 20 1 , before me, personally appeared
1$14-0. ) grar f OeSinia_i (name of signer), whose identity was
proven to me on the basis of satisfactory evidence to be the person whose name is
subscribed to in this document, and who acknowledged that he/she signed the
above/attached document.
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(?
(Seal) , _ Notary Public
ANGELA FARLING
�; ,, ,, Notary Public,Sta te of Arizona
`y, Maricopa County
L" My Commission Expires
January 25, 2016
VIRGINIA GRAEME BAKER
POOL & SPA SAFETY ACT
CPSC STAFF'S GUIDE TO
COMPLYING WITH THE LA W
By December 19, 2008, ALL public pool owners/operators must:
• Install drain covers that meet the ANSI/ASME A 112.19.8-2007 standard on
EVERY drain/grate. A list of cover manufacturers can be found at
www.cpsc.gov/whatsnew.html#pool
• Install an automatic shut-off system, gravity drainage system, Safety Vacuum
Release System
(SVRS), suction-limiting vent system or disable the drain, if the pool operates off
of a
SINGLE main drain. Pools and spas with unblock able drains are exempt from this
requirement. A list of SVRS manufacturers can be found at
www.cpsc.gov/whatsnew.html#pool.
• Ensure that dual or multiple main drains are at least 3 feet apart.
* * *
Pools And Spas Not Open On December 19, 2008 Are Not Required To Be
In Compliance
Until The Day The Pool Or Spa Is Re-opened!
* * *
The new Consumer Product Safety Improvement Act requires all new drain
and grate covers
be certified to all applicable standards starting on November 12, 2008.
* * *
CPSC staff recommends that to ELIMINATE and not just MITIGATE the drain
entrapment hazard
in pools and spas, pool owners should disable old drains or build new pools
without any drains and
use gutters, overflows and/or skimmers to provide water to the pump.
* * *
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