Application To Add New Personnel To Existing Corporate Or Limited Liability Company License

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Easy-Fill Application

IMPORTANT NOTICE REGARDING CONVICTIONS PLEASE READ CAREFULLY

Failure to accurately report a conviction (except as explained below) may result in an application being denied. In this notice and on the application, the term "conviction" includes pleading guilty or nolo contendere ("no contest") or being convicted by a court of any misdemeanor or felony in this state or elsewhere.

As part of the Contractors State License Board (CSLB) application process and as required by law, you must be fingerprinted if you have not been fingerprinted by CSLB before or if your previous fingerprint record was purged by CSLB due to a voided application; disassociated, revoked, or cancelled license or registration; or for some other reason. After an application is accepted by CSLB as complete (also known as "posted"), the applicant will be sent instructions on the process for obtaining and submitting fingerprints, usually via live scan electronic transmission.

Your fingerprints will be compared to the records of the California Department of Justice and the Federal Bureau of Investigation. If you have ever been convicted of a crime, your criminal record information will be reported to CSLB. This includes DUIs and other Vehicle Code violations resulting in a conviction. Even if you pled "no contest," had the conviction set aside, or judgment deferred pursuant to Penal Code sections 1000 or 1203.4 (commonly understood as "expunged"), the past conviction will still be reported to CSLB and must be disclosed on the application. However, some convictions or charges should NOT be disclosed, including the following:

  • Convictions that were adjudicated in the juvenile court;
  • Convictions under California Health and Safety Code sections 11357 (b), (c), (d), or (e) or section 11360 (b) that are two years old or older; and
  • Charges that were dismissed as the result of successful completion of a deferred entry of judgment program (diversion program) under California Penal Code section 1000.3.

If you have ever been convicted of a crime (except in the three circumstances outlined above), you should answer "Yes" to the criminal conviction question on the application and provide a detailed explanation of the circumstances resulting in your conviction. To help ensure that you provide the required information, you should complete and submit the Disclosure Statement Regarding Criminal Plea/Conviction form that is available on CSLB's website on the Forms and Applications page.

Applicants with criminal convictions are not automatically denied licensure - each application is reviewed individually based on the applicable sections of law. When reviewing criminal convictions, CSLB considers factors such as the nature and severity of the crimes, the amount of time that has passed since the convictions, and any evidence of rehabilitation submitted by the applicant.

For rehabilitation evaluation, pursuant to Title 16, California Code of Regulations section 869, CSLB is generally looking for three (3) years to have passed after a misdemeanor conviction and seven (7) years to have passed after a felony conviction, without further violations of law. These timeframes are calculated from the applicant's date of release from incarceration or from the end of probation if no time was served and are subject to reduction or extension based on several factors, including the nature of the applicant's conviction history as a whole. In addition, any type of conviction could be considered substantially related to the qualifications or duties of a contractor when evaluated in the context of the applicant's entire conviction record.

Failure to accurately report any and all disclosable convictions may be grounds for denial of your application. If your application is denied, you will be notified of the earliest date when you may re-apply, which will vary based upon the facts of each case, from one (1) to five (5) years from the effective date of the denial. (Business and Professions Code sections 486 and 7073)

This is an easy-fill form that will walk you through the process to fully and accurately complete this form. Upon completion, you will be required to print and submit the document to CSLB.

IMPORTANT NOTES:

Be sure to use the "Back" and "Next" buttons at the bottom of each page - do not use your browser's back arrow because all of your entered information will be erased and you will have to start over.

Please type your information directly into the fields of this form. If you copy text from another application or document and paste it into this easy-fill form and the text contains invalid (non-ASCII) characters, they will be removed from the final document.

Make sure you give yourself enough time to complete the entire form in one sitting. You will not be able to save a partially filled form to complete at a later time.


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Application Fees

Application fee....................................


General Information

Listed below is general information to assist you as you complete the attached application. Do not submit this General Information portion with your completed application - the actual application begins immediately following this section on Application - Page 1 of 2. Before you submit your application, please review it and be sure that you have completed all requested information. Your application may be returned to you if it is insufficient or incomplete. You must provide any missing information, make corrections, and resubmit your completed application to CSLB within 90 days after the date that it was returned to you or your application will be deemed abandoned and will become void. You cannot reinstate an abandoned application - you must submit a new application and application fee if you wish to reapply.

Complete the application legibly in black or dark blue ink, with a typewriter, or on CSLB's website using the form-fill feature. Forms completed in pencil will be returned to you. Please make sure that you and other authorized individuals sign and date the application. Leave no space blank. If a particular question or request for information does not apply to you, write "N/A" in the blank space to indicate that the question has received your attention but that it is not applicable. The "#" symbol is used interchangeably with the word "number" where space is limited on the application.

Limited Liability Company (LLC) Personnel and Liability Insurance Requirement

If the existing license is an LLC, you will be aware that all LLC licenses are required to have liability insurance in an amount that is not less than one million dollars ($1,000,000) or more than five million dollars ($5,000,000), based on the number of personnel of record on the license. For five (5) or fewer personnel, the amount is not less than $1 million. For each additional member of the personnel, the amount increases $100,000, up to $5 million maximum. For example, an LLC that has eight (8) members of personnel would be required to carry a $1,300,000 liability insurance policy. Therefore, the additional personnel being added with this application may result in the need to increase the amount of the liability insurance. (Business and Professions Code [BPC] section 7071.19)

LLCs can have managers or members that are corporations or other LLCs, as opposed to individual people. When an LLC has corporate or LLC managers or members, complete Section 2 for those companies, omitting the fields that do not apply (e.g., date of birth, SSN/ITIN, and driver license number). Since corporations and LLCs are incapable of signing documents (e.g., applications, renewals, etc.), you must also report at least one individual person who will be an authorized responsible signer for that company. To do this, you must make a copy of Page 1 of the application after Section 1 has been completed and fill in portions of Section 2 using this individual person's personal information. Identify that person as the "Authorized Signer for ______" (inserting the name of the corporation or LLC on behalf of which the individual person will sign). This individual person will not be part of the official license personnel of record (unless they are also an actual responsible manager, member, or officer of the LLC), but their information will be maintained by CSLB for signing purposes only.

Conviction Question and Fingerprint Requirement (Question 11 on the application)

Please be sure to read the Important Notice Regarding Convictions on the front of this application packet. All applicants for licensure are required to submit a full set of fingerprints for the purpose of conducting a criminal background check. Even though you may have been fingerprinted previously for an employer or another regulatory body, you will need to undergo the fingerprinting and criminal history check process again specifically for CSLB, unless you have previously fingerprinted for CSLB and the results are still available and active on record with CSLB. California Penal Code section 11142 prohibits criminal history information from being released to any entity other than the requesting agency that you have authorized to receive it. Individuals in California are required to fingerprint by electronic live scan; individuals outside of California can fingerprint either by electronic live scan in California or by submitting hard card fingerprints that are completed in the applicant's location, as explained in the instructions that are sent after the application has been accepted (also known as "posted"). For more information, please visit CSLB's website and view information on the Applicants page.

Collection of Social Security Numbers and Individual Taxpayer Identification Numbers

With the exception of the driver license number, all information requested on the application is mandatory, including disclosure of U.S. Social Security numbers (SSN) and individual taxpayer identification numbers (ITIN). Collection of the SSN and ITIN is authorized by BPC sections 30, 31, and 7145.5. SSNs and ITINs are used exclusively for the purpose of tax enforcement, compliance with any judgment or order for family support in accordance with Family Code section 17520, measurement of employment outcomes of students who participate in career technical education programs offered by the California Community Colleges as required by BPC section 30, and investigation of tax evasion and violations of cash-pay reporting laws as set forth in Section 329 of the Unemployment Insurance Code. If you fail to disclose your SSN or ITIN, your application will not be processed and you will be reported to the Franchise Tax Board; they may assess a $100 penalty against you.

Collection of Personal Information

CSLB collects the personal information requested on the following form as authorized by BPC sections 30, 31, 141, 480, 7068.2, 7069, 7071, 7073, and 7145.5 and Title16 of the California Code of Regulations section 816. CSLB uses this information to identify and evaluate applicants for licensure, issue and renew licenses, and enforce licensing standards set by law and regulation. Submission of the requested information is mandatory. CSLB cannot consider your application unless you provide all of the requested information. You may review the records maintained by CSLB that contain your personal information, unless the records are identified as confidential information and exempted from disclosure by the Information Practices Act, including Civil Code section 1798.40. CSLB makes every effort to protect the personal information you provide us; however, it may be disclosed in response to a Public Records Act request as allowed by the Information Practices Act; to another government agency as required by state or federal law or as provided in Civil Code section 1798.24; or in response to a court or administrative order, a subpoena, or a search warrant. The Custodian of Records is responsible for maintaining the information on this form and may be contacted at the address and telephone number listed in the letterhead at the top of this General Information portion for questions about this notice or access to records.

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Use this application only to add NEW personnel of record to an existing corporate license (officer only) or to an existing limited liability company (LLC) (officer, manager, or member) license.

Use one application for each new officer, manager, or member. Each additional personnel must use a separate application.

If you have additional licenses with the same corporate or LLC registration number (as issued by the California Secretary of State and listed in box 3 in Section 1), you must submit a copy of this form for each license. All licenses using the same corporate or LLC registration number must show the same officers, managers, and/or members.

To report a change of title for current personnel of record on an existing license, use form 13A-7a - Application to Report Change of Title for Current Officer or Personnel of an Existing Corporation or Limited Liability Company.

To disassociate personnel from an existing license, including a responsible managing officer (RMO), responsible managing manager, responsible managing member, or responsible managing employee (RME), use form 13M-5 - Disassociation Request.

To replace a current qualifying individual (RMO, responsible managing manager, responsible managing member, or RME) on an existing license, use form 13A-2a - Application for Replacing the Qualifying Individual.

SECTION 1 - BUSINESS NAME AND ADDRESS

Business Name

Please provide the full legal business name as it appears on the CSLB license. P.O. Boxes and private mail boxes (PMB) are not acceptable for the street address. Also include the license number as issued by CSLB and the registration number as issued by the California Secretary of State.

*BUSINESS MAILING ADDRESS
*BUSINESS STREET ADDRESS

* Required Entry

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SECTION 2 - NEW PERSONNEL'S FULL LEGAL NAME AND ADDRESS

NEW PERSONNEL'S FULL LEGAL NAME

Please provide the full legal name of the new personnel (individual or company) that will be added to the license. If the individual does not have a middle name, write "None" or "No Middle Name" in the space provided. If the individual has only an initial for their first or middle name, write "(Initial Only)" after the initial. When adding a company to the personnel of an LLC license, see the General Information page for LLC personnel information.

  Must be hand written on form
*RESIDENCE ADDRESS
*BUSINESS ENTITY:

*TITLE OR POSITION Officer titles - president, secretary, and treasurer for California corporations and for LLCs that have officers; president only for foreign corporations. All LLCs must have at least one (1) manager or member.


* Required Entry

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SECTION 3 - REQUIRED APPLICATION QUESTIONS

All questions in this section must be answered. If you checked "Yes" in response to any question, the person involved must attach a separate sheet with a detailed explanation for each situation.

* Required Entry

*Question 10

To the best of your knowledge, are you (or any company that you are or were a part of) named in or responsible for any unsatisfied final judgments, liens, and/or claims against any bond or cash deposit pertaining to a construction project?

If you checked "Yes" for this question, you are required to attach a statement identifying all judgments (pending or on record), liens, past due unpaid bills, claims, or suits and a detailed explanation of the situation. Include the names and addresses of the parties involved. If the obligation was or is being discharged in bankruptcy, attach a copy of the bankruptcy filing and a copy of the creditors list.

*Question 11

Have you EVER been convicted of or entered a plea of guilty or nolo contendere to ANY misdemeanor or felony in the United States or a foreign country? NOTE: Convictions that were later expunged from the records of the court or set aside pursuant to California Penal Code sections 1203.4, 1203.4a, or 1203.41 or an equivalent non-California law MUST be disclosed. However, some convictions should NOT be disclosed, including the following:
  • Convictions that were adjudicated in the juvenile court;
  • Convictions under California Health and Safety Code sections 11357 (b), (c), (d), or (e) or section 11360 (b) that are two years old or older; and
  • Charges that were dismissed as the result of successful completion of a deferred entry of judgment program (diversion program) under California Penal Code section 1000.3.

If you checked "Yes" for this question, please attach a statement disclosing all pleas/convictions, including violated law sections, and thoroughly explain the acts or circumstances that resulted in the plea/conviction. In addition, the following information must be included for each plea/conviction: date of the plea/conviction, level of the plea/conviction (i.e., misdemeanor or felony), county and state where the violation took place, name of the court, court case number, sentence imposed, jail/prison term served, terms and conditions of parole or probation, parole or probation completion dates, and parole agent/probation officer names and phone numbers. If you have obtained a dismissal of your conviction(s) pursuant to Penal Code sections 1203.4, 1203.4a, or 1203.41, please submit a certified copy of the court order dismissing the conviction(s) with your application. You may submit the required information using the Disclosure Statement Regarding Criminal Plea/Conviction form that is available on the Forms and Applications page on CSLB's website.

The information provided will be verified through CSLB's fingerprinting requirement. Failure to report a disclosable plea/conviction may be grounds for denial of your application.

*Question 12

Have you (or any company that you are or were a part of) ever received a citation from CSLB or had a contractor license or other professional or vocational license or registration denied, suspended, revoked, or otherwise disciplined by this state or elsewhere (i.e., other U.S. state, U.S. territory, agency of the federal government, or other country)?

For the purposes of responding to this question, "disciplined" is an administrative action that resulted in a restriction or penalty being placed on any license you have or have possessed, such as a revocation, suspension, probation, or reprimand.

(Check "No" if the license or registration was suspended due to lack of a bond, workers' compensation or other required insurance, a qualifier, or family support.)

If you checked "Yes" for this question, you are required to attach a statement detailing the events leading to the CSLB citation or the license or registration being denied, suspended, revoked, or otherwise disciplined.

*Question 13

To the best of your knowledge, have you failed to resolve any outstanding final liabilities, which include taxes, additions to tax, penalties, interest, and any fees that may be assessed by CSLB, the Department of Industrial Relations, the Employment Development Department, the Franchise Tax Board, or the State Board of Equalization (BOE)?

If you checked "Yes" for this question, you are required to attach a statement regarding the outstanding liabilities. In relation to BOE liabilities, you must indicate if you have entered into an installment payment agreement for that liability with the BOE and provide verification that you are in compliance with the terms of that agreement, if applicable.

STATE TAX AND OTHER OBLIGATIONS NOTICE

The State Board of Equalization and Franchise Tax Board may share taxpayer information with CSLB. You are obligated to pay your state tax obligation. CSLB may suspend or refuse to issue, reactivate, reinstate, or renew a license if your state tax obligation, child support obligation, or any outstanding final liability to CSLB, the Department of Industrial Relations, or the Employment Development Department is not paid. (BPC sections 30, 31, and 7145.5)

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Review and Edit

Please Review the Following Information

This is a summary of the information that will print on your form. If there are any corrections that need to be made, please choose the Edit button or Back button below to make the change now, as you will not have the opportunity to do so after you submit this page.

MAILING ADDRESS

STREET ADDRESS

RESIDENCE ADDRESS


Agree To Complete


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Completion Instructions

NOTICE: This document is not submitted to or saved by CSLB. You must either print it now, save it to your computer, or email it to your email address to print and mail at a later time.



Mail your document(s) along with the application to:


Contractors State License Board
P. O. Box 26000
Sacramento, CA 95826

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