Loading...
HomeMy WebLinkAbout122266 '��,, GLENDf I NEW SWIMMING POOL BARRIER AFFIDAVIT Ordinance#2046 Please type or print: Date f - 'Q„ - 1°I Property Address $1-1 C YR w. cc A,clot 6, iak ,r . c3o$ Name of Property Owner Dowl.cat I. ❑ No children less than six years of age reside at this address. II. Si( 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. (Complete Reverse Side) City of Glendale Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599•Phone(623)930-2800 www.glendaleaz.com PI Ilk GLEND4? ❑ 1. The pool shall be protected by a motorized safety pool cover. ❑ 2. Doors and windows protected. 'V 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 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 approval by the building official. Delved / /2,- 2_-r4 Name of Home Owner(Print) ome Owner Signature Date A (:)Ccvi'of 1''oC4-- a,- 2.—Ict Pool Contractor(Print) Contractor Signature Date SIGNATURE OF OWNER MUST BE NOTARIZED State of Arizona County of Maricopa On this 7 day of1ke2(_ , 20 Pa, before me personally appeared v`.ci r"A1eci (name of signer),g ), whose identity was proved 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. rjP+,�»4� AIMEE NAYES u Notary Public Arizona MaricoPa County �'�� Commission p Feb237 `__ ��+•+�� My Comm.Expires eb 23,2023 (Seal Notary Public City of Glendale Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599•Phone(623)930-2800 www.glendaleaz.com i CITY OF GLENDALE PLANNING&DEVELOPMENT SERVICES 5850 W.GLENDALE AVE.,2ND FLOOR GLENDALE,AZ Glendale 623.93 .2800 5301 OWNER/BUILDER ADDENDUr 623.930.2800 ARIZONA www.GlendaleAZ.com RESIDENTIAL PROJECTS ONL' DATE: COG PERMIT NUMBER: r2 - 3 r9 ozoz C.e (v PROJECT NAME: /� PROJECT ADDRESS: U v ICC-¢-CAA- aP5(��. © 9 _ fN 5Cu4c 1,CA S 3 ce The undersigned applicant asserts that she or he is exempt from the original contractor licensing requirement of Arizona Revised Statutes Title 32,Chapter 10, on the .asi .f: 0 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: AZ ROC NUMBER: LICENSE CLASSIFICATION: ❑ ARS 32-1121.A.7 The applicant is registered architect or engineer,or employee of 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 licensing or tax requirements of the State of Arizona is'unsworn falsification",a criminal misdemeanor. PRINTED NAME OF THE OWNER: SIGNA RE OF HE/OWNER• DATE: