HomeMy WebLinkAbout126720 C. CITY OF GLENDALE
PLANNING&DEVELOPMENT SERVICES
5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE,AZ85301 OWNER/BUILDER ADDENDUM
Glendale 623.930.2800
AR i z 0 N A www.GlendaleAZ.com RESIDENTIAL PROJECTS ONLY
DATE: COG PERMIT NUMBER: / 27 - o
zazo
PROJECT NAME: PROJECT ADDRESS:
n WV �o/llebe,(/v Avg
Go✓1z14 &$►DWC Pool 6✓dna ,f7 0. 303
/ The undersi d applicant asserts that she or he is exempt from the original contractor licensing requirement of Arizona Revised Statutes Title 32,Chapter 10,
i.
/ on the as' 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 safe 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 contractors)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.
i
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"unworn falsification',a criminal misdemeanor.
PRINTED NAME OF THE OWNER: SIGNATURE OF THE OWNER: DATE:
✓/1241 'M?/0544,
6/-2o2D
•
•
06) 11— °
GLENDf.,E
NEW SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance#2046
Please type or print:
Date 55 -21- 20
Property Address 8151 Mono idle A ve 644 p97. 65'303
Name of Property Owner 1i G oh zs�5
I. gsz 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. ,Q . 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
oral
GLENDr
O 1. The pool shall be protected by a motorized safety pool cover.
❑ 2. Doors and windows protected.
O 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.
O 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.
&o4;:f1 s -3/-20
Name of Home Owner(Print) Horn Owner Signature Date
Pool Contractor(Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this day of , 20 cb before me personally
appeared (name of signer), whose
identity was prov 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.
( I
DNA JE$SICA
G N7 L ` L
(,
h • CI AmM
ARicOA COUNTY // _)
(Se *,3g
(Notary Pubic
City of Glendale
Development Services•5850 West Glendale Avenue• Glendale,Arizona 85301-2599• Phone(623)930-2800
www.glendaleaz.com