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0- understand that the State of Minnesota requires
that all residential bUf&m-g contr,actors,remodelers and roofers obtain a state license
unless they qualify for a specific", emPtion from the licensing requireme c e
requirement applies to Owners of residential requirements.This license
real estate who build or improve such
Property for Purposes of speculation or resale.
By signing this document
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 resell-mg it. I hereby
claim to be exempt
from the state licensing requirements because I am not in the business
of building or remodeling on speculation or for resale and that the house for which r am
applying for this Permit, located at.-5-0c-, 6;( 04-r.
is the only residential structure I have built or improved in the past 24 inonthsl�also
acknowledge- that because I do not have a state license, I forfeit any mechanic's lien
ghts to which I may othen7rise have been entitled under-Nirinn Stat. §514.0 1.
Furthermore, I acknowledge that I may be hiring independent contractors to p 0
certain aspects Of the construction or improvement Of this house and I u erf rm
the 0 inn
some of these contractors may be required to be licensed by nderstand that
e State f M esota. 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 of up to
10,000. 1 further state that I Understand that the filing of a false statement with
Tie.City of l r>ic�lev 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 my,elf the contractor f r
this project, I alone will be responsible to s as e o
14LQIY-��fbr compliance will
all applicable building codes and city ordinances ,,york bet reformed on this
Signlactuye of Property Owner
7- 7 2-3
Da
For questions or information on contractor Licensing,or to check the licensing status and enforcement
history of,,,.particular contractor,call the Minnesota Department of Labor and Industry,Corstruction
Codes and Licensing Division,at(65 284-5069.The web site is: