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BUILDLLK PERMIT APPLICANT: PROPERTY OWNER
4-2. Gci unders
tand that the State of Minnesota requires
that all residential building contractors, remodelers and roofers obtain a state license
unless they qualify for a specific exemption from the licensing requirements.This license
requirement applies to owners of residential real estate who build or improve such
Property for purposes of speculation or resale.
By signing this document, I attest to the fact that i am improving this house for my own
use and am not building or improving this house for the Purpose of reselling it_I hereby
claim to be exempt from the state licensing requirements because I am not in the business
of building or remodeling on specul tion or for resale and that the house for which i ain
aPplYing for this permit, located at 6q_ 51 IRSCe Cie
is the only residential structure I have built or improved in the past 24 months. I also
acknowledge that because I do not have a state license, I forfeit any mechanic's lien
rights to which I may otherwise have been entitled under Minn. Stat. §5 i 4.0I.
Furthermore,I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is a
misdemeanor under Minn. Stat. §326B.082,subd. 16 and can also result in a fine i up to
$10,000. I further state that I understand that the filing of a false statement with of
The Q of Fri4Le may also result in criminal prosecution and/or civil penalties
to applicable city ordinances and/or state statutes.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to The City of Fridley for compliance will
all applicable building codes and city ordinances with the work bei reformed on this property.
ignature of Proper Owner
-S - Z02,
Date
For questions or intortnation on contractor licensing, or to cheek the[icenstng status and ertCorcement
history of a.pa rticular conU,:actor,call the N innesota Department of Labor and Industry Construction
Codes and Licensin,, Div!sion,at(651)234-5069 ''he web site is lit
t�).�3www,dli.ino. ovJC:cld.asl?