HomeMy WebLinkAbout20221020_114531 'IT: PROPERTY 0,
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understand that the State of M:inuesotaa,requires
that all residential building contractors,temodelers and roofers obtain a state license
unless-(hey qualify fcxr a specific exemPti:on from the licensing requirements.This license
regtureznent applies Co 0—omers of residential real estate who build or improve sucl,
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 artd am not building or improving this house for the
t-I hereby
claim to be exempt from the state licensing requirements because I pose of ram o�inzthe business
of biulding or remodeling on speculation or for r1 e�d^thatte use for wlZich I a�xiapplying for this pearmit, located a:t'7 �tl't',lK � 3is the only msidentlal structure I have built or improved in the p��rnon4t h'81 Mls
acknowledge that because I do not have a state license, I forfeit any mechanic's lien
rigkats to
j�v'hich I may otherwise have been entitled under Minn. Stat. §514.01.
Furthermore,rthermore, I acknowledge-Chat I inay be hiring independent contractors to perforn,,
certain aspects of the constriction or improvement of this house and I understand that
some of these contractors.may be tecltured Co be licensed by the State ofM:izuaesota. I
understand that fixz icensed residential conlract•ing, reInodeling, and/or goofing activity is a
zzxisdez xcanc r under Minn. Stat. §326B.082, subd. 16 and can also result in a furs of up to
113,(10 I further state that I understand thciC the filing ofa false statement withfhe +C t of T'r�i e May also result in criminal prosecudon'nd/or civil penalties
to applicable city or i ieirzances aaw r state statutes.
I have also been inforined and acknowledge that by listing myself as the contractor for
this project;, I &lone will be responsible to Thy o dl�for camplivace will
all applicable built ng codes Wd city ordinaa,ces with the worts:being preformed on this
property.
Signature of Property Owner
6 �
Date
For questions or information on contractor licensing,or to check the licensing status and enforcement
history of a particular contractor, call the Minnesota Department of Labor and Industry,Construction
Codes and Licensing Division, at(65I)284-5069.The web site is: I,tt� ;/lwww.cll