HomeMy WebLinkAbout78418 if -/ P--og
riahirri City of Glendale
GI-ENP Development Service Center
_ _ SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance#2046
Please type or print:
Date g-2/-,�/3
Property Address 7S57 4.). tif1ac- '4
Name of Property Owner /p,f-� ofK,,"""v`-�--
I. p No children less than six years of age reside at this address.
II. 7 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.
' scoMmial, Agri>.
(Complete Reverse SId ,0 via , tV •,..:
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Page 1 of
NRIP
.4ei, City of Glendale
I- .F Development Service Center
❑ 1. The pool shall be protected by a motorized safety pool cover.
1 2. Doors and windows protected.
❑ 3. The pool shall be protected by an alarm maintained in or on the
swimming pool..
1 4. The above ground swirnniing pool shall have a ladder secured.
❑ 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 pprova y-the building official.
/24,0 Z. a„-,.....„A.,65.4___ Ale"Allitiomme.„,,, i
e74/ of Home Owner (Print) `o caner Sign. -. Date
• /1 ANN.
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Pool Contractor (Print) V o ;d'o it mature Date
SIGNATURE OF OWNER DUST BE NOTARIZED
State of Arizona
County of Maricopa
On this �.\ day of U v? , 20121, before me personally
�,appeared ' ..� u m , 1, 1 S (name of signer), whose
identity was proved to me on the basisd 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.
uMIZONViime
*t� A. '. : N tary P c
Page 2 of 2
S V Starling Madison Lofquist, Inc.
Consulting Structural and Forensic Engineers
5224 South 39th Street, Phoenix, Arizona 85040
tel: (602) 438-2500 fax: (602) 438-2505 www.smleng.com
Make Checks Payable to SML, Inc.
Home Owners Name A - 1 Ct} ✓Yt ^'t ' '1
/ GJ
Address Where Pool Will be Built 5S 1 tit) t 4-1 / j 1/
City_ (e1.0 O\ ek—Z-
Filing in
Pool Company -4—'NY j e c7 4 OO (� 0 �e Owner a
�
Starling Madison Lofquist, Inc. (SML) liability for this project is limited to the fees paid by the client.
In the event that a question or claim arises as to an error or omission in SML's work or plans, SML will
assume no liability for errors or omissions unless notified within 48 hours of the client's discovery of
such.
SML will not be responsible or liable for the following:
a. Any use of plans, surveys, specifications, etc., not signed by SML and approved by the
appropriate governmental agencies.
b. Inaccuracy of data, plans, legal descriptions or any other information supplied by the CLIENT.
c. Site soil and geological conditions.
d. Changes to the plans and specifications made by the CLIENT or others.
e. Jobsite conditions.
f. The performance of work on this project by any construction contractor or third party.
g. Legal fees that result from this project.
All documents furnished by SML are instruments of his service. They are not intended to be suitable for
reuse on extensions of this project or any other project. Any reuse without specific written approval by
SML will be at the sole ris f the user and without liability or legal exposure to SML
( ,6
I have read and n tand thes
Signat e Date ?S / / 7 / /
Starling Madison Lofquist,Inc. Consulting Structural and Forensic Engineers
Starling Madison Lofquist, Inc.
Consulting Structural and Forensic Engineers
5224 South 39th Street, Phoenix, Arizona 85040
• tel: (602)438-2500 fax: (602) 438-2505 www.smleng.com
Make Checks Payable to SML, Inc.
Home Owners Name .�Li A-►..I C'-' M i v t J
Address Where Pool Will be Built 1515-/ t,i j 4-7 / �t
City /eN airt .e t-Z--
Filing in
Pool Company --1--- j 2 t7&t ?p /. . ..
Owner ❑ -L NT)
Starling Madison Lofquist,Inc. (SML)liability for this project is limited to the fees paid by the client.
In the event that a question or claim arises as to an error or omission in SML's work or plans, SML will
assume no liability for errors or omissions unless notified within 48 hours of the client's discovery of
such.
SML will not be responsible or liable for the following:
a. Any use of plans, surveys, specifications, etc., not signed by SML and approved by the
appropriate governmental agencies.
b. Inaccuracy of data,plans, legal descriptions or any other information supplied by the CLIENT.
c. Site soil and geological conditions.
d. Changes to the plans and specifications made by the CLIENT or others.
e. Jobsite conditions.
f. The performance of work on this project by any construction contractor or third party.
g. Legal fees that result from this project.
All documents furnished by SML are instruments of his service. They are not intended to be suitable for
reuse on extensions of this project or any other project. Any reuse without specific written approval by
SML will be at the sole ris f the user and without liability or legal exposure to SML1.
I have read and tand thes . -..4 ...2‘Z,ok
Signa e Date k- / /47 / /5
Starling Madison Lofquist, Inc. Consulting Structural and Forensic Engineers