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HomeMy WebLinkAbout1 (2) . , 'V. Community dill Development GroupG NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT Ordinance#2046 Please type or print Date ///2/1 Property Address 7 ( -i----41 cfs---"7"* U --.8 .. Name of Property Owner ' ` ( (/` P4ektiiiu-a----e— I.. ❑ No children less than six years of age reside at this address. H. ❑ A child under the age of six years of age resides at this address. (Tf this box is check&r�, identify method of secondary pool protection.) __ . _ rntQrtion. A. �We will provide an interior fence and enclosure around the ool as P requiredby 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) Community GLIENDfE Development Group 1. ❑ The pool shall be protected by a motorized safety pool cover. 2. D--- Doors and windows protected. 3. 0 The pool shall be protected by an alarm maintained in or on the swimming pool. 4. 0 The above ground swimming pool shall have ladder secured. 5. 0 Locking hard safety cover on the spa or hot tub. 6. 0 Alternative protection not specified above which is attached to the plan submittal and submitte• f►r approv41 .tthe . +ing official. NOS7019-10-(21 0-aril Name of Home Owner (Print) Ho - 41 *r S'g- . � re Date -- AA i Pool Contractor (Print) o ractor :ignature Date SIGNATURE OF OWNFR MUST BF, NOTARIZED State of Arizona County of Maricopa On this l day of ©C3-t !V , 20 CAS , before me personally appeared '('As `2- f nctfs- iY�Z (name of signer), 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. (seal) — . ROBIN J.ABNER Notary Public Notary Public-Arizona Maricopa County. My Commission Expires • 1" November 11,2006 • Communityi Development Group ADDENDUM TO BUILDING PERMIT NUMBER(S) The undersigned applicant asserts that she or he is exempt from the contractor licensing requirement of Arizona Revised Statutes Chapter 10, Title 32 on the basis of: ARS 32-1121.A.5. The applicant owns the property and shall occupythe 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 applicont, and/cr 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 ARS 32-1121.A.7. 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. 1 )(()Ilierriniliieelei 4-1/71/‘ - nted name of Ap licant ignatur of Appli t ' ate DSC001.0 City of Glendale * 5850 West Glendale Avenue * Glendale,Arizona 85301-2599 * (602)930-2800 r {Q� w • • • • • • • • Win:. • _ - 'itr..,...i.-. ^,- '''' '..-..1'-...... ' , . . ., ' '.'... . . o__ x l R 'F'Y X^"MCA* • tow -x t�- - _ - F x.'. • `� - is , • • • • • 'ai �� -•..9�'Cnriir.'fri, ' ..". t..SY, _r e ,. a .,c =r-- •1 ',',,, aiiiilliiiiiiiii A