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ADDENDUM TO BUIhDING PERMIT NUMBER(S) —/ 6 5 1
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The undersigned applicant asse s that she or he is exempt from the contractor licensing requirement
of Arizona Revised Statutes Cha ter 10, Title 32 on the basis of:
nC ARS 32-1121.A.5. The a plicant owns the property and shall occupythe property,not intend the property t be for sale or rent, and shall have the work performed by the
applicant alone, or by the pplicant with employees of the applicant, and/or performed by duly
licensed contractor(s) all o 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 contractors) all of whom are identified below or on the attached.
Contractor/Company Name License Number
Classification
ARS 32-1121.A.7. The al licant is a registered architect or engineer, or employee of a
p
registered architect or engi er 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 pplication containing false or incorrect information with the intent
to avoid the licensing or tax requir ments of the State of Arizona is "unsworn falsification," a criminal
misdemeanor.
Cle/ CR6'07 P&re (01: 0/0
Printed name of Applicant Sig t e of pplicant
Date
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