HomeMy WebLinkAbout105504 (2) _ - - - _GL11
p__
OWNER/BUILDER ADDENDUM Pec •
\O556I
OWNER/BUILDER ADDENDUM TO BUILDING PERMIT NUMBER(S) `i 114 QIUD f y-
ADDRESS 5801 M. 4i' 7A J %\• C� Q)(1016.121
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 "unworn falsification," a criminal misdemeanor.
rrN
arr
k-riclet{ 6- 6' 42
ame uPrinted Nr Owner c___J Signature I wner Date
City of Glendale
Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599• Phone(623)930-2800
www.glendaleaz.com
jD55°�
pr 8 f t.j. . INSTALLATION CARD
t �,� v�ESTERN
'�°�� Western 1 Kote Exterior Stucco System 1
-.. COM Nr 4 Western Stucco Products Co., Inc. KOTE
'','oo ;�
� IAPMO ER-382
Job Address: IAPMO Evaluation Services
„.6-8a/ 47 km. (Evaluation Report 382
�\ erz. Z-- Date of Job Completion
Plastering Contractor e
Name: d\ / 604 c'2
Address:
Telephone Number:
y-Approved Contractor License-Number as--__�. . ti_ _ _—__�_ f_ _ _
Issued byWestern Stucco Products A//4 o\, ,vim p —
This is to certify that the plastering system on the building exterior at the above address has been installed in
)/26r accordance • the evaluatio ort s ecified above and the manufacturer's instructions
l(74 67/
5 yr,--0 gg Si at o authorized representati� or plastering contractor Date
/ " n6tallation card bust be presented to the building inspector
after completion of work and before final inspection.