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HomeMy WebLinkAbout97978 � 16 j (.4 q (c3,_.3 lk GLENEV OWNER/BUILDER ADDENDUM OWNER/BUILDER ADDENDUM TO BUILDING PERMIT NUMBER(S) 0\---7 Cl - ADDRESS ( d© N -f'e The undersigned applicant asserts that she or he is exempt from the original contractor licensing requirement of Arizona Revised Statues 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 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. X1-1(6 Printed Name of Owner Signature of Owner Date City of Glendale Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599• Phone(623)930-2800 www.glendaleaz.corn INSTALLATION CARD WESTERN lI C C t) Western 1 Kote Exterior Stucco System 1 COMPANY Western Products nc. KOTE Stucco Co.,, IAPM0 ER-382 Job Address: .� I-� IAPMO Evaluation Services OD . Evaluation Report 382 • hh % ,��-111�GL� A Z a :�,� Date of Job Completion / V/7 Plastering Contractor Name: + us+G�4 �� ;/ Address: i(4 1 t'lJ F Telephone Number: `i y Approved Contractor License Number as / Issued by Western Stucco Products This is to certify that the plastering system on the building exterior at the above address has been installed in accordance with the evaluation report specified above and the manufacturer's instructions. Signature of authorized representative or plastering contractor Date Installation card must be presented to the building inspector after completion of work and before final inspection.