The GFCI Compliance letter, printed as the Ground-Fault Circuit Interrupter (GFCI) Compliance Form for Public Swimming Pools/Spas, is issued by the Sacramento County Environmental Management Department (EMD). The owner or operator of a public pool or spa and the contractor who repaired the GFCI each complete one half of the form. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original is published by EMD in its Pools Forms and Documents list.
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What is GFCI Compliance letter – Sacramento County, CA?
The GFCI Compliance letter, titled Ground-Fault Circuit Interrupter (GFCI) Compliance Form for Public Swimming Pools/Spas, is the Sacramento County Environmental Management Department form on which a pool or spa owner or operator and a licensed contractor certify that a GFCI was repaired in compliance with Section 116049.1 of the California Health and Safety Code.
The form has two halves. The first is completed by the pool/spa owner or operator, who gives the facility name, address and city and verifies being the person responsible for the pool or spa and that the GFCI was repaired by a qualified contractor. The second is completed by the licensed electrician or contractor, who certifies holding a qualified California license (A-1, C-10, C-53, or C-61/D-35), having repaired and inspected the pool or spa, and that it complies with Section 116049.1.
The form carries a note that any work conducted afterward is the responsibility of the facility permit holder. A footnote says all work must comply with local City or County Building Department codes and that the local Building Department should be contacted for any required permits. An "Office use only" box at the top is for EMD.
EMD lists the document among its Pools Forms and Documents, alongside other recreational health materials. It is a compliance certification and does not itself grant a permit or a license.
Who needs to file GFCI Compliance letter – Sacramento County, CA?
The form is completed by two people, each in their own section.
- The pool/spa owner or operator completes the first section for a public swimming pool or spa. This person verifies being responsible for the named pool or spa and that the GFCI has been repaired by a qualified contractor.
- The licensed electrician or contractor completes the second section. The contractor must hold a California A-1, C-10, C-53, or C-61/D-35 license and must have repaired and inspected the pool or spa.
The form is written for public swimming pools and spas. It does not address private residential pools, and it does not say who may sign on behalf of an owner or operator beyond the person responsible for the facility. Because the form says any later work is the responsibility of the facility permit holder, the facility's permit holder should know who signed for the facility. Contact EMD at (916) 875-8440 if you are unsure whether the form applies to your pool or spa.
When to file GFCI Compliance letter – Sacramento County, CA
The form is completed after the GFCI at a public pool or spa has been repaired and inspected by a qualified contractor, because both signers certify work that is already done. The contractor certifies having repaired and inspected the pool or spa, and the owner or operator verifies that the repair was made by a qualified contractor.
No due date is printed on the form, and it gives no validity or renewal period. The form says any work conducted after the certification is the responsibility of the facility permit holder. For any deadline connected to your facility permit or a corrective notice, contact EMD at (916) 875-8440.
How to fill out GFCI Compliance letter – Sacramento County, CA
Enter the facility details
In the first section, write the Facility Name, the Address and the City of the public pool or spa. Leave the 'Office use only' box at the top blank.
Read the owner's verification
The owner or operator confirms being the person responsible for the named pool/spa and that the GFCI was repaired by a qualified contractor under Section 116049.1 of the California Health and Safety Code.
Print the owner's name and title
The owner or operator enters their Print Name and Title in the first section.
Sign and date as owner or operator
The owner or operator adds the Signature and Date for the verification statement.
Enter the contractor's license details
In the contractor section, enter the Print Name, License # and Type. The license must be A-1, C-10, C-53, or C-61/D-35 in California.
Add the contractor's company name
Write the Company Name of the licensed electrician or contractor who repaired and inspected the pool or spa.
Sign and date as contractor
The contractor signs and dates the certification that the pool/spa complies with Section 116049.1.
Review and download the completed PDF
Check that both sections are complete and signed, then download or print the completed PDF from FillingPDF. Confirm with EMD how to deliver it, as described under How to submit.
How to submit GFCI Compliance letter – Sacramento County, CA
The form itself names no submission channel, portal or deadline. The letterhead gives the contact details of the Sacramento County Environmental Management Department:
- Address: 11080 White Rock Road, Suite 200, Rancho Cordova, CA 95670
- Phone: (916) 875-8440
- Website: EMD.saccounty.gov
EMD publishes the document on its Pools Forms and Documents page at https://emd.saccounty.gov/content/emd/us/en/forms/pools-forms---documents.html. Call EMD before sending the completed form to confirm how it wants to receive it. Both sections must be signed and dated first. The form also says to contact the local City or County Building Department for any permits the repair work requires; that is separate from this form. FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Having the owner or operator sign the verification before a qualified contractor has repaired the GFCI, when the statement says the repair has already been made.
- Using a contractor whose license is not A-1, C-10, C-53, or C-61/D-35; those are the only license types named in the certification.
- Leaving the contractor's License # or Type blank, so the license cannot be matched to the certification.
- Submitting the form with only one half signed; the owner/operator and the contractor each sign and date their own section.
- Treating the form as a substitute for a building permit; the footnote says to contact the local Building Department for any required permits.
- Writing in the shaded 'Office use only' box at the top, which is reserved for EMD.
- Assuming the contractor is responsible for later work; the form says any work conducted afterward is the responsibility of the facility permit holder.
Frequently asked questions
What is the GFCI Compliance letter?
It is a Sacramento County Environmental Management Department form for public swimming pools and spas. The owner or operator and a licensed contractor certify that the GFCI was repaired in compliance with Section 116049.1 of the California Health and Safety Code.
Is the GFCI Compliance letter a Sacramento County business license?
No. It is a compliance certification for a GFCI repair at a public pool or spa, issued as an EMD form. The form does not grant a license or a permit, and it tells you to contact the local Building Department about any permits the work requires.
Who has to sign the GFCI compliance form?
Two people sign. The pool or spa owner or operator signs the first section, and the licensed electrician or contractor signs the second. Each prints a name and dates their signature; the owner also enters a title, and the contractor a license number, type and company.
Which contractor licenses are accepted on the form?
The contractor certifies holding a California license of type A-1, C-10, C-53, or C-61/D-35. The form has a License # line and a Type line where the contractor enters those details.
Where do I send the completed GFCI compliance form?
The form prints no submission channel. Its letterhead gives the Environmental Management Department at 11080 White Rock Road, Suite 200, Rancho Cordova, CA 95670, phone (916) 875-8440. Call EMD to confirm how it accepts the completed form.
Do I need a building permit for the GFCI repair?
The form says all work must comply with local City or County Building Department codes and to contact the local Building Department for any required permits. Ask that department whether your repair needs one.
Can I fill out the GFCI compliance form online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not file the form with EMD; delivery follows EMD's own channels.
Who is responsible for work done after the contractor signs?
The facility permit holder. The contractor's section carries a note that any work conducted afterward is the responsibility of the facility permit holder.
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