HomeMy WebLinkAbout81515 (o P7( �" ftZ9r'1 ty Dove Dr,
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Development Group
ADDENDUM TO BUILDING PERMIT NUMBER(S) /S/ $
The undersigned applicant asserts that she or he is exempt from the contractor licensing requirement
of Arizo evised Statutes Chapter 10, Title 32 on the basis of:
ARS 32-1121.A.5. The applicant owns the property and shall occupy the property, and does not
intend the property to be for sale or rent, and shall have the work performed by the applicant
alone, or by the applicant with employees of the applicant, and/or performed by duly licensed
contractor(s) all of whom are identified below or on the attached.
ARS 32-1121.A.6. The applicant owns the property and shall have the work performed only by
duly licensed contractor(s) all of whom are identified below or on the attached.
Contractor/Company Name License Number Classification
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ARS 32-1121.A7. The applicant is a registered architect or engineer, or employee of a registered
architect or engineer engaged in professional practice, not as a contractor.
The undersigned swears and affirms that the information herein is true and accurate, and acknowledges
that the filing of an application containing false or incorrect information with the intent to avoid the
licensing or tax requirements of the State of Arizona is "unsworn falsification," a criminal misdemeanor.
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Printed name of Applicant Signature of Applicant ate
D SC001.0
City of Glendale * 5850 West Glendale Avenue* Glendale,Arizona 85301-2599 * (602)930-2800
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GLENDf Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date < ( (f 2a(
Property Address076, LU MoRo [ G D6Jr7 DP
Name of Property Owner (;/1'( A ()LT S
I. IA. No children less than six years of age reside at this address.
II. ❑ 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. ❑ The pool shall be protected by a motorized safety pool cover.
2. C] Doors and windows are protected
3. ❑ 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 approval by the Building Official
- 144P)/t)e—It5a c74
Name of Home Owner Home Owner Signature Date
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Pool Contractor Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this 1141 day of Aid/ , 20 /7 , before me, personally appeared
f am m au l Fj (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.
/ Hartman 14
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