Mailing Address:
P.O. Box 4008, MS 406
Chandler, Arizona 85244-4008
Transportation and Development Department
Development Services Division
215 E. Buffalo St., Chandler Arizona 85225
Telephone: (480) 782-3000
Fax: (480) 782-3055
www.chandleraz.gov
Form No: UDM-075/Building
Rev: 6-17-11
Building Permit
Application
City Permit No.
Date
Applicant/Applicant’s Representative (contact for questions, plan pickup, etc.)
Phone Number
Trust Account:
Yes
No
Trust Account Number
Permit Type:
Commercial:
Site Plan
Tenant Improvement
Residential:
Custom
Remodel
Standard Plan
:
No.:_________ Elevation:_______
Other:
Pool/Spa
Gas/Elect
Water Meter
Project Address
City, State, Zip
Project Name
Description of work to be performed
Construction Area S.F.
Pool S.F. (pool permit)
Type of Construction (e.g. I, II, III, IV, V)
No. of Stories
Occupancy Class
Assessor's Parcel No.
Subdivision/Shopping Center Name
Lot No.
Property Owner Name
Phone # Fax #
Mailing Address
City, State, Zip Code
Contractor Name (Please Sign Below)
City Sales Tax No.
Phone # Fax #
Mailing Address
City, State, Zip Code
Water Meter is:
New
Existing
Inside City Limits
Outside City Limits
Domestic Meter Size
Landscape Meter Size
Service Line Size
Name
Phone Number
Billing Address
City, State, Zip Code
Applicant/Applicant’s Representative/Owner’s Signature
Date
Total Construction Valuation (bid price, if applicable):
I am Currently a Licensed Contractor: (This section must be filled out by contractor or have a qualifying exemption)
Name: ________________________
Signature: __________________________
Date: ___________________________
Falsification of information on this
document for the purpose of evading
State Licensing laws is a Class II
misdemeanor pursuant to A.R.S. State
Statutes 13-2704. See back of this form
for state statue regarding contractor
licensure and exemptions.
ROC License #:____________________
License Class: ___________________
I am claiming an Exemption
(See back)
Transportation and Development Department
Form No: UDM-075/Building
Rev: 6-17-11
Page No. 2
EXEMPTION FROM LICENSING
I am exempt from Arizona contractors’ license laws on the basis of the license exemptions contained in Arizona Revised
Statutes 32-1121A., as marked below.
A.R.S. State Statute 32-1121; Persons not required to be licensed; Penalties.
32-1121A.5 Owners of property who improve such property or who build or improve structures or appurtenances
on such property and who do the work themselves, with their own employees or with duly licensed contractors, if
the structure, group of structures of appurtenances, including the improvements thereto, are intended for
occupancy solely by the owner and are not intended for occupancy by members of the public as the owner’s
employees of business visitors and the structures of appurtenances are not intended for sale or for rent. In all
actions brought under this chapter, proof of the sale or rent or the offering for sale or rent of any such structure by
the owner-builder within one year after completion or issuance of a certificate of occupancy is prima facie
evidence that such project was undertaken for the purpose of sale or rent. For the purposes of this paragraph,
“sale” or ‘rent’ includes any arrangement by which the owner receives compensation in money, provisions,
chattels or labor from the occupancy of the transfer or the property or the structures on the property.
32-1121A.6 Owners of the property who are acting as developers and who build structures of appurtenances to
structure on their property for the purpose of sale or rent and who contract for such a project with a general
contractor licensed pursuant to this chapter and owners of property who are acting as developers, who improve
structures or appurtenances to structures on their property for the purpose of sale or rent and who contract for
such a project with a general contractor or specialty contractors licensed pursuant to this chapter. To qualify for
the exemption under this paragraph, the licensed contractors’ names and license numbers shall be included in all
sales documents.
32-1121A.14 Any person other that a licensed contractor engaging in any work or operation on one undertaking
or project by one or more contracts, for which the aggregate contract price, including labor, materials and all other
items, but excluding any electrical fixture or appliance that was designed by the manufacturer, that is unaltered,
unchanged or unmodified by any person, that can be plugged into a common household electrical outlet utilizing a
two pronged or three pronged electrical connector and that does not use any other form of energy, including
natural gas, propane or other petroleum or gaseous fuel, to operate or is attached by a nail, screw or other
fastening device to the frame or foundation of any residential structure, is less than one thousand dollars. The
work or operations which are exempt under this paragraph shall be of a casual or minor nature.
This exemption does not apply:
(a) In any case in which the performance of the work requires a local building permit.
(b) In any case in which the work or construction is only a part of a larger or major operation, whether undertaken by
the same or a different contractor, or in which a division of the operation is made in contracts of amounts less
than one thousand dollars, excluding any electrical fixture or appliance that was designed by the manufacturer,
that is unaltered, unchanged or unmodified by any person, that can be plugged into a common household
electrical outlet utilizing a two pronged or three pronged electrical connector and that does not use any other form
of energy, including natural gas, propane or other petroleum or gaseous fuel, to operate or is attached by a nail,
screw or other fastening device to the frame or foundation of any residential structure, for the purpose of evasion
of this chapter or otherwise.
(c) To a person who utilizes any form of advertising to the public in which the person’s unlicensed status is not
disclosed by including the words “not a licensed contractor” in the advertisement.
I I will be using the following licensed contractors on this project:
General Contractor License No. ROC Class______________
Mechanical Contractor License No. ROC Class______________
Electrical Contractor License No. ROC Class______________
Plumbing Contractor License No. ROC Class______________
Other Contractor License No. ROC Class______________
Applicant/Owner Signature______________________________________Date_____________________________
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