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Swimming Pool <br />0 Spa Jet / Booster <br />Existing Pump(s): Maket`4ocil lee,-p41---)//_.5 <br />Spa Recirculation <br />0 Wadingftoddier pool <br />H.P ; Flow (gpm) 97/1 <br />Make/Model J/e?..S-2) H.P ; Flow (gpm) <br />FIE USE ONLY <br />Fee Paid $ <br />FA: <br />PR: <br />Forthe property named '-'7.- <br />/V <br />tAZet.' 7 <br />located at 2 '. <br />State Health & Safety Code Sec. 114.4.1 and 1160642, that an Anti-entrapment cover meeting the current standards of the American <br />NOTE: Use one fy, for each pump or rriult.m pa und the same cover. <br />t.1 ?kg/ ' . h <br /> <br />,-, eP., nti-X--,e,res<-- , California, I hereby certify that pursuant to California <br />SR: <br />Date: <br />Society of Mechanical Engineers ASME/ANSI standard A112.19.8-2007 and where required, a secondary safety device meeting the current <br />ACME/ANSI or ASTM standards will be installed per the manufacturer's instructions on the: <br />4)4)6)e9 /2 _ <br />Main Drarn(s): <br />Manufacturer of approved cover: Gleiec7/ <br />Cover bears the following markings: <br /> GP M rating: Froor.bt} : Installed on o Waroor <br />„DI< "ASMEIANSI standard A 112.19.3-2007 or later", "Life": .) <br />"VGB 2008 or later, <br />-- <br />Main drain/Jet Suction pipe size is inches. Manufacturer's main drain(s) sump depth requirement in inches is: <br />Single drain — Not unblockable (one of the following secondary devices required: SVRS / Suction Miffing ve <br />auto pump shut-off other approved by enforcement agency) <br />Type of secondary device installed: <br />Manufacturer of approved device: Model/Part Number: <br />SVRS bears the following markings: <br />"ATSM F2387", <br />“ASMEIANSI standard A 112.19.17", <br />NOTE: if Installing a variable speed SVRS pump a RPM/Time Data sheet shall be faxed to MD at 875-8513 following <br />the installation. (A sample form is available from the Environmental Health Flan Review office) <br />Single drain — Unblockable (size and shape that a human body cannot sufficiently block to create a sucUon entrapment) <br />Dual main drain(s) <br />Equetizer <br />L X, Manufacturer of approved cover: A/ <br />Model/Part Number. GPM rating: Fioor .V\fail Installed on o Wail o Fioor <br />"VGB 2008 or later", <br />"ACME/ANSI standard A 112.19.8-2007 or later", <br />Skimmer equalizer line(s) pipe size were found to be inches # of Skimmers: <br />Manufacturer's skimmer skimmer equalizer line(s) sump depth requirement in inches is: <br />Single equalizer line <br />Dual Skimmer equalizer tine(s) sump depth inches <br />Skimmers are connected with single line to pump. <br />Skimmers are separately valved before pump and can be isolated. <br />I declare that I hold an active California State Contractor license ft / q,4 or California State Professional Engineer license # <br /> , with qualified experience working on public swimming pools and that the information provided above is true to the best <br />of my knowledge. I'm aware that improper certification of the above information shall be subject to potential disciplinary action at the <br />!oration e licensing authority. <br />A-61 <br />Contact Name: .4, <br />PAYMENT DUE PRIOR TO APPROVAL CALL PLAN REVIEW AT (S1E} 874-3010 <br />Fer a complete te>1 of the law, visit: • <br /> 1001-1050/ab 1020 bill 20091011 t <br /> <br />AFFRONTED BY <br /> <br />INSTALLATION CERTIFICATION <br /> <br />DATE: <br /> <br />VGB DRAIN COVER & SECONDARY DEVICE <br /> <br />Model/Part Number. <br />l'/( <br />/ gravity drainage I <br />Sidnature Print name <br />p <br />, Date <br />Phone 9/6 —it/ y- 7e00 emit ietvr,•e e: rem 1 Cir <br />'LA -