HomeMy WebLinkAboutProperty Form -s+.m SCn;C"-"
handerstand that the Mate of tvli
that all residential buUdzng contractors, remodelers and roofers obtain a state licensees
unless they qualify for a specific ex
empti€hn 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 irnprovixzoseg this house for my own
use and =not building or improving this house for the
of
claim to be exempt.from the state licensing xequireznents becausE I am,not reselling It-I hereby
the business
of bLulding or remodeling on speculation or for resale and that the house for which I am.-
applying for this permit, located at 5 3'] � E t I e mW
is the onlyresidential � `" '�
structure I have built or unproved m the past 24 months acknowledge that because I do not have a state license, I forfeit any mechanic' Jaen
rights to whso
ich I may otherwise have been entitled under Mann.. stat. § 14.01.
Furthermore,I acknowledge that I May be hiring independent contractors to periarrn
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 Mate of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is a
misdemeanor under Minn... Stat. §326B.082,subs, 16 and can also result in a.fine of up to
S 10,000. I der state that I understand that the Ming of a false statement with
The tray also result in criminal prosecution and/or civil penalties
to applicable city ordinancesand/or state statutes.
I have also been informed and acknowledge that by listing myself as the contractor for
this pr jec-t,I alone will be responsible to The it
property. s ofEridle�for compliance will
all applicable building codes and city ordinances with the work being Preformed on this
Signature of Property Owner"
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 [ndustry, Construction
Codes and Licensing Division, at(651)254-5069,The web site is: lttlt2;/ KA-11, It .Inn- 3vAZC-14 sq