HomeMy WebLinkAbout1044361 TIN Community
GLENDf,E Development Group
ADDENDUM TO BUILDING PERMIT NUMBER(S) (C44 3 2
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 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
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.
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Printed name of Applicant Signature Applicant Date
DSC001.0
City of Glendale* 5850 West Glendale Avenue* Glendale,Arizona 85301-2599* (602)930-2800
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G Development Group
NEW SWIMMING POOL
PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
Please type or print
Date I I— 13.0 u
Property Address f S -2. N . I A-tic_ •
Name of Property Owner C-URcleS 4 A lene j\1 1 e 1.1e_S
I. No children less than six years of age reside at this house.
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II. A child under the age of six years of age resides at this house.
(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 page two of
this affidavit per the Glendale Pool Barrier Ordinance.
Page 1 of 2
�41,
., Community
GLENI1E Development Group
1 . The pool shall be protected by a motorized safety pool cover.
2. Doors and windows 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 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.
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Owner Name (printed) Owner Signature Date
Pool Contractor(printed) Pool Contractor Signature Date
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Page 2 of 2
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THIS APPROVAL SHALL NOT PREVENT THE-3UI!_DING i
OFFICIAL FROM TItE ,EAFTER REIsUiIi!'vG THE It
CORRECTION OF E; HORS IN SAIL PLANS, !d rM--- - ,. ______
SPECIFICATIONS, DATA !J CONSTRUCTION WHEN IN I CovE. -r" PA'?"•UI
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BY BUILDING SAFETY
DEPARTMENT OF THE CITY OF i
GLENDALE, AR ZON,A I max,: I _ : _� ,T�C:..,� 1.�
DATE: 11 —UL� I
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