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Minnesota Department of Labor and Industry Licensing and Certification Services <br /> Construction Codes and Licensing Division Phone: 651.284.5034 <br /> 443 Lafayette Road N Email: DLI.License@state.mn.us <br /> •Saint�Paul, MN 55155 Website: www.dli.mn.gov/ccld.asp <br /> NOTICES <br /> NOT TRANSFERABLE <br /> CHANGE YOUR BUSINESS STRUCTURE PELLA NORTHLA <br /> SUBMIT A NEW APPLICATION FOR NEW ENTITY <br /> 153010 -2 AVE STE 100 <br /> RENEW OR REPLACE INSURANCE POLICY PLY LITH, MN 55447 <br /> SUBMIT NEW CERTIFICATE OF INSURANCE <br /> PQ ll G S /112J � G� L <br /> NOTIFY THE DE13ARTMENT OF A CHANGE IN YOUR BUSINESS. <br /> Failure to do so,subjects you to administrative penalties of up to $10,00 <br /> 15-Day Notice Requirement—Forms available online at www.dii.m.q.ggv/CC&..Duf/LLLiicUuUpdada ov/CCLD/LicUpdat sp <br /> • <br /> Change in buslnr.�s'physical address,mailing address,phone number,or email address <br /> • Change in control, owners,officers,directors,members,partners <br /> • (Hauge n1 Nismoss' locial mune;and/or assumed name <br /> • Loss of or clt,nnptr nI QUALIFYING BUILDER <br /> • Change in dent+ral linbilily insurance or workers'compensalion insurance,coverag <br /> Immediate Notice Requirement—Notification to DLI in writing <br /> .ludglnent Dei-Mor. A licensed contractor has 15 days to provide written notice of tho. findinc lh al it is found to be a judgment <br /> debtor based upriri Conduct requiring IicenSUre. <br /> • Bankruptcy Politipn_F'iled. A licensed contractor has 15 days to provide wrillon notice that it filed a petition for bankruptcy. <br /> • Conviction Notice. A licensed contractor has 10 days to provide written notice that it has been found guilty of a felony,gross <br /> misdemeanod, misdr_+monnor or any comparable offense related to the license. including convictions of fraud, <br /> misrepre sonlation,misll se of funds. theft, criminal sexual conduct, assault, burglarv, conversion of funds, or theft of proceeds <br /> Ill this or any olhor state or any other United States jurisdiction. <br /> YOUR CERTIFICATE IS 13ELOW THE PERFORATION. SHOW CERTIFICATE WHEN OBTAINING PERMITS. <br /> �' vi30 <br /> C3r 11P.1"DrUst01-NRESIDENTIAL BLDG CONTRACTOR <br /> _ .. <br /> Cony;lrurllon;;odes anrd I Icnm,:rent Ihvieaon Licensing and Got fifiration Services -1,11 1 Afaye_lla 130ad N St.Paul,MN 55155 <br /> weh"11w w:aw r8i'loo 11�rv!rcJrl,a?SV 1=mnll: tali lice115gfr�gl�In n1n.lrs I'hnne: 651.284.5034 <br /> I In. to ccrtll:�•111:11 the crrlllicn(c holder is liccnsetl as a RFSIDIiNTIAI.. BUILDING CONTRACT()R in the:alit,of�4innesola and i%in <br /> r,nu+liance Mill Minncsola Stalulrs 326B.905. :Ind may build residonlial real esmte,contract or offer to conlincr :villi an owner to build <br /> It'Id(.1111.11 real vstatc,:1111 contract or off Cr to counsel with an owner to improve esisring residential re:11 estale; provided the <br /> q•,u1z1171r individual is al ;III Innes a OL1 I,IFY ING BUILDI R and the certificate holder maintains comphrince with ill(-required general <br /> '.r 11)1!11v !n+ur:lnrc. and wolt.cr;'rv7nrpcn.alirw laws. <br /> License RESIDENTIAL BLDG CONTRACTOR <br /> LIc Number t3106,15090 PELLA NORTHLAND <br /> L:Ifective Date 0'1127/201.' 15300 25TI-I AVE STE 100 f3 <br /> Expiration Date : 0.3/31/;'013 PLYMOUTH, MN 55447 C <br /> 1 <br /> VERIFY UP-TO-DATE STATUS, BOND, AND INSURANCE INFO ATwww.dli.mn.gov/ccid/LicVerifv_.ast� (ENTER NUMBER). <br />