SWIMMING POOL OWNER'S CERTIFICATION Date: _____/_____/_____ Miami-Dade County Department of Planning and Zoning 111 NW First Street, Suite 1210 Miami, Florida 33128 Re: Building Permit Application #: ___________________________________ Property Address: _____________________________________________ Ladies and Gentlemen: I certify that I am the legal owner of the above referenced property. In accordance with Section 33-12(e) and (f), Code of Miami-Dade County, Florida, I hereby certify that I understand and agree that the swimming pool to be constructed at the above address will not be used or filled with water until a separate permit has been pulled for, and a final inspection obtained, for the installation of an approved safety barrier. The barrier shall include a spring-lock self-closing gate equipped with a safe lock. The gate shall remain in a closed and locked position when the pool is not in use. I further understand that this certification does not eliminate the need for obtaining a permit and erecting an approved barrier prior to final inspection of the pool, and prior to use of the pool. I have read and understand the safety barrier requirement. Sincerely, Property Owner Signature __________________________________ Property Owner (print name): __________________________________ NOTE: IF, AT THE TIME OF FINAL INSPECTION OF THE POOL, THE REQUIRED SAFETY BARRIER HAS NOT BEEN INSTALLED AND INSPECTED, THE PROPERTY OWNER WILL BE CITED WITH A VIOLATION. 18 Apr 2000 dgm American LegalNet, Inc. www.FormsWorkflow.com