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535 Chapel Lane - Specific Exemption from Licensing Form BUILDING PERMIT APPLICANT: PROPERTY OWNER I, J , l 0 (,(., , understand 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 residential building contractor licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, located at j3 54-G. W , Eagan is the only residential structure I have built or improved in the past 24 months. 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 of up to $10,000. I further state that I understand that the filing of a false statement with the City of Eagan may also result in criminal prosecution and/or civil penalties pursuant 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 Eagan for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. I also understand that if I hire an unlicensed contractor, my only recourse in the event I have a dispute with my contractor will be to pursue private civil action (lawsuit) against the contractor, and that even if I am successful in a lawsuit, I will not be able to make a claim for compensation from the Contractor Recovery Fund, the state's consumer protection program for licensed contractors. ; ld. Name / /9 -� d /" 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 (651) 284-5069 or 1- 800-657-3944, or visit their website at: www.dli.mn.gov/CCLD/RBC