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LICENSE DETAIL INFORMATION Form Page 1 of 2
STATE OF WASHINGTON
DEPARTMENT OF LABOR AND INDUSTRIES
Specialty Compliance Services Division
P. O. Box 44000 Olympia,WA 985044000
THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS:
LICENSE DETAIL INFORMATION
Current Filter: None
Registration#or License CASCACB980LJ
Name CASCADE CUSTOM BUILDERS
Address 5940 BUCKTHORN CT NW
Address
City OLYMPIA
State WA
Zip 98502
Phone Number 3608674116
Effective Date 6/11/2002
Expiration Date 6/11/2004
Registration Status SUSPENDED
Type CONSTRUCTION CONTRACTOR
Entity INDIVIDUAL
Specialty Code GENERAL
Other Specialties UNUSED
UBI Number 602127675
* *VIEW CROSS REFERENCE FILE FOR THIS LICENSE*
* *__*VIEW PRINCIPAL OWNERS) FOR THIS LICENSE* *
* * *VIEW CONTRACTOR BOND/SAVINGS INFORMATION
* * *CHECK INQUIRY FOR SUMMONS AND COMPLAINTS*
* * * VIEW CONTRACTOR INSURANCE INFORMATION
E
.... ._.. ..............._ ........... ...._...._.... ....__.. .._......._.. .....__._..... ...._.__...... ___._.......... .. ........ .............. ................... ._. ......... ....... ....... `
i
New inquiry by CITY, NAME , PRINCIPAL OWNER NAME , LICENSE , UBI
NUMBER, check the
L&I Contractor Industrial Insurance Premium Status or return to the L&I Construction
https://wws2.wa.gov/lni/bbip/TF2Forrn.asp?License=CASCACB980LJ 1/29/2004
i8Od38 83311
INFRACTION
❑TRAFFIC
NON-TRAFFIC j
IN THE (STRICT❑MUNICIPAL COURT OF _TAT OF WASHINGTON ,PLAINTIFF VS.NAMED DEFENDANT
COUNTY OF ASHINGTON
m CITY/TOWN OF
L.E.A.ORl r: WA
THE UNDERSIG ED CER I ouRr oeI r: WA O
DRIVER'S LICENSE NO. IES AND SAYS THAT IN THE STATE OF WASHINGTON
STATE EXPIRES ID I (SSN N CV)
NAM T A
� FIRST
�- • •MIDDLE
ADDRESS
Cal El O
� IF NEW ADDRESS
(J �� STATE ZIP CODE EM ❑ PASSENGER
OYER
RACE SEX DATE OF BIRTH
HEIGHT' h O.WE� �zh� EYES v
MONTH
VIOLATI TE RESIDENTIAL PHONE N/ )
ON OR ABOUT DAY YEAR TIME
AT LOCATION 24 HOUR ❑INTERPRETER
M.P. LANG:
CITY/COUNTY OF ----
OPERATE E FOLLOWING VEHICLE/MOTOR VEHICLE ON A PUBLIC HIGHWAY AND
VEHICLE LICEN
STATE EXPIRES
VEH.YR. MAKE MODEL
TRAILER N1 LICENSE NO. STATESTYLE
EXPIRES
TR.YR. TRAILER N2 LICENS
OWNERICOMPANY IF OTHER THAN DRIVER ATE EXPIRES TR.yq
ADD
CITY STATE
21P CODE
COMMERCIAL YES HAZARD
NO NR R I F VEHICLE El
EXEMPT FARM FIRE
NO PLACARD 0 NO VEH(
DID THEN AND THERE COMMIT EACH OF THE FOLLOWING INFRA❑R V OTHER
I.VIOLATION/STATUTE CODE
y' VE ICLE SPEED S IN A 20NE
• • ❑SMD
T PACE
IRCRAFr �
2.VIOLATION/STATUTE CODE
yi o
f�btf AV .dill
3.VI OLATION/STATUTE CODE
i ./a
PENALTY
RELATED
U.S.FUNDS$
ar DATE ISSUED
WITHOUT ADMITTING HAVING COMMITTED EACH I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF W
OF THE ABOVE OFFENSE(S),I PROMISE TO I HAVE ISSUED THIS ON THE DATE AND AT THE LOCATION _
RESPOND AS DIRECTED ON THIS NOTICE. WASHINGTON THAT
TO BELIEVE THE ABOVE NAMED PERSON COMMRTED THE ABOVE E,THAT I HAVE PROS WR CAUSE
ITTEN ON THE BACK OF THIS DOCUMENT IS TRUE AND CORRE�FENSE(S),AND MY REPORT
OFFICER
X
DEFENDAVSIGNATURE OFFICER ~y
F
INFRACTION
c INF RESPONSE DISPOSITION
PENALTY SUSPENDED F
C. 1 C NC C NC D P $ SUB-TOTAL DADE JDGT
2 $ $
C NC C INC D P $ $ ABSTRACT MILD O
3 C NC C NC D P $ $ TO OLYMPIA N
COSTS$
WASHINGTON UNIFORM COURT DOCKET-COURT COPY
- WASHINGTON UNIFORM COURT DOCKET-DOL COPY
August
WASHINGTON UNIFORM COURT DOCKET-DEFENDANT COPY August 1997
1997
WASHINGTON UNIFORM COURT DOCKET_LEA COPY August 1997
August 1997
Department of
Labor&Industries NON-COMPLIANCE INFRACTION
Specialty Compliance
PO Box 44450 •Circle One
Olympia WA 98504-4450 {N ) Fj' p 37136
Infraction Issued to:
Last name(if Infraction issued to individual) First name Middle SSN or Certificate N
Busines a of'Infraction issued to business) WI#or License N
Z c cL �L
Address p �
PO, 13ox /Z-/,-),051407F - fry
City.---- State ZIP+4 Driven License number
I t-+ M WA 9 fV l-Y20
Sex Race Date of Birth Height Weight aclEyes Hair Lic exp date
Additional Information:
Name of: ❑Employer Business T inee O Q Witness
r Other
..4
Address ZZA I p��
x City
04 Z�
w m o Non-compliance 1 ation:
►� c7 ,� , (,,� t �j
Ey d ep n°; ,,7 W Address g ! 0 1 -3V
z a t+ne�9it0�
C i oD ry O --
0 /r 3 m m o :+ City t ,Sf�to ZIP County
0.4R'4
W Ea m w a�a Property owner `^_ �--,r Phone
P-D
;1"X M M p Violation month day year Violation
p
C4 a H 0 W�z PAS Date: ( /Z // 0 Time: //.Oo& PM
a f Violation: ❑ 18.27.100 RCW
❑ 18.106.020(4)(a)RCW(worker)
F s
❑ 19-27.114 RCW ❑ 43.22 RCW ❑ 18.106.020(4)(b)RCW(contractor)
18.27.200 RCW ❑ 19.106.020(4)(c)RCW(dispatcher)
CG Description. _
z Pe r L"o r +h a U rr a S 0,7 r JZ o vh
o
,, Q o r'e s e a,.5' r u r e
a s �1
x w
W �4
1 n
f ants S
0 M dJ
Date Infraction issued Insp.ID k in
1-act-0` l02-9 , n, /43
Penalty amount Telephone N ctor(signatu
$ 1010610A (38a) 2 5A Z0
This Infraction may be contested at a hearing conducted pursuant to te 34.05, if requested in writing within
twenty (20) days of service of the Infraction. Unless contested, the rmination of violation shall be final.
Appeals are to be mailed to the Department of Labor and Industries at the address listed above.
You may pay the full amount of the penalty to the Department indicated above. The amount of the penalty has been
set by RCW 43.22, RCW 18.27.100, RCW 18.27.340, RCW 18.106.270, WAC 296-400A-400, WAC
296-200A-400,WAC 296-150M-0860,as amended. Payment will close the case.
If the unregistered contractor becomes registered within ten days of service of the Infraction and the Infraction is the
contractoes first offense,the Director may reduce the penalty. In no case can the Director reduce the penalty below
five hundred dollars($500). Applies only for 18.27.200 RCW.
Your signature on this infraction is not an admission of guilt. Your signature is a promise that you will respond to
the Infraction as provided in RCW 18.27.270, 18.106.200, and 43.22. Failure to sign the Infraction is a
misdemeanor and may be punishable by a fine or imprisonment in jail. Failure to respond after s�' h'ing this
Infraction is a misdemeanor punishable by fine or imprisonment in jail. See RCW 18.27.290,and 18.106.230.
At any hearing held to contest the Infraction, the state has the burden of proving, by a preponderance of the
evidence that the infraction was committed. You may subpoena the witness, including the compliance inspector
who issued the Infraction.This Infraction is a non-criminal offense for which imprisonment shall not be imposed.
{ F625-067-000 non-compliance infraction 8-02
White-L&I Oly Green-Defendant Canary-Defendant mail Pink-Hearing officer Goldenrod-Inspector