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I' r v , understand that the State of Minnesota requires
that all residential building contractors, rennodelers and roofers obtain a state license
LMIess 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 docuunzent, I attest to tfre fact that.I am improving this house fbr my owra
use and an-r not building or improving th�i.s house for the purpose of reselling it. I hereby i
claim to be exel-npt from the state lice-tusing requirements because I am not in the business
of building or remiodelinET ' i
b on specu[at,on or for resale and that the hour _for �uhicn I axe I
applyu�.g for this permit, located at G � � is
is the only residential structure I have built ow improved in the past 24 zx�ezath- I also 7
ac sinutivledgc that because I do not have a state license, I forfeit any rrtecharzc's lien
tights to which I may otljerwise have been, entitled under NIirua. Stat. §514.01.
Furthermore, I aekriowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I under-stand 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. 1.6 and can also.result in a fine of up to
$10,000. I further state that I understand that the filing of a false statement with
"'!'he Cats of Fr_idiev 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 being preformed on this
Property.
Ulacture f proper € caner E
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FOr C[lastioris or i
d i1I():CililtiOtl 0:1 COflti'ictOi'liCems,in , or to�lILC[i'he licensirR�:,taus a�.cl err'fc�rcrn�[ tt
hisi:ory o: �;rti.:ular contractor•, cal! the Minriesota Departrucnt of Labor an(1 lndilsti- rv')
COties MCI i..icer•,siiiKT 'f ti ) 7f'r:_ � E f f LfzSL t1Cii0i
r, I�IVI:iiGii, L7l':Jti�.f .t 1 _1r,(��. �',lC 4Vtb 5rt i5: �ltk'3L,'� 4utiyu,.clll.[�1.1�..�7vJ>~cl[f,�asp
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