Workers Compensation Exemption -CSLB

Online Submission

You cannot be exempt from Workers' Compensation if: the qualifier is a Responsible Managing Employee (RME); if you hold a C-8 Concrete classification, C-20 Warm-Air Heating, Ventilating and Air-Conditioning classification, C-22 Asbestos Abatement classification, C-39 Roofing classification, and/or C-61/D-49 Tree Service classification ; or if you have employees (including Home Improvement Salespersons (HIS). Joint Venture entities are excluded from this provision.

If you are an out-of-state contractor licensed in California, but you have employees working in California from another state, you must also provide a certificate of insurance from your workers' compensation insurance carrier in your state in addition to submitting the exemption. You can fill out the Exemption form using this process, however, when prompted will need to print, email, or save the document to your own device. You cannot submit the document online, the exemption and the out of state certificate must be submitted by mail.

This Online Submission process walks you through the required fields for an Exemption from Workers' Compensation Insurance. This process was established to assist Licensees and Applicants with a way to submit an Exemption from Workers' Compensation Insurance with no exclusion errors. This information can only be added by an Owner, Partner, Officer, Director, Member, or Manager.

Upon submission, this data will automatically update CSLB's database and if provided, a confirmation email with a "For your Records" copy will be sent to that email address.

IMPORTANT INFORMATION:

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.

General Information and Instructions

This is an interactive process. You will not be permitted to continue if required fields are incomplete.

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.

You are not eligible for Exemption if:

You have employees, including Home Improvement Salespersons (HIS) or a qualifier who is a Responsible Managing Employee (RME).
You hold a C-8 Concrete classification, C-20 Warm-Air Heating, Ventilating and Air-Conditioning classification, C-22 Asbestos Abatement classification, C-39 Roofing classification, and/or C-61/D-49 Tree Service classification - all contractors with a C-8 Concrete classification, C-20 Warm-Air Heating, Ventilating and Air-Conditioning classification, C-22 Asbestos Abatement classification, C-39 Roofing classification, and/or C-61/D-49 Tree Service classification are required by B&P Section 7125 to have a Certificate of Workers' Compensation Insurance or a Certificate of Self-Insurance on file with CSLB. Joint Venture entities are excluded from this provision.

Do not continue this process if you cannot certify that you are an Owner, Partner, Officer, Director, Member, or Manager on the license or application.

You will have a chance to review the information entered in its entirety. Once you agree to the contents, you will be given the option to submit the information to CSLB or save/print the document to your own device.

IF you employ persons in connection with your California contractor's license in a manner that invokes the workers' compensation laws of a state other than California, the Exemption information will not be submitted online. However, you may print or save on your own device to mail at a later time. The form must be signed and the certificate of insurance for that state must be attached.

Should you decide to print and mail the form, rather than submit it directly to the CSLB, a signature will be required or the document will be returned as unprocessed by CSLB.

The form will no longer be available to edit or save once it has been submitted.

Submitting this document WILL update the license or application record. Please be sure that the information provided is true and accurate.

Once the information is submitted to the CSLB, do not mail, fax or email additional copies. Copies received with the same information will cause a delay in processing.

This information and final instructions will be provided upon completion of the Easy-Fill form.

Required Information

Select the appropriate response for each statement below:

1. The qualifier for this license is a Responsible Managing Employee (RME). Yes No

2. This license/application has a C-8 Concrete classification, C-20 Warm-Air Heating, Ventilating and Air-Conditioning classification, C-22 Asbestos Abatement classification, C-39 Roofing classification, and/or C-61/D-49 Tree Service Classification. Yes No

3. I have employees, (including any Home Improvement Salespersons (HIS)). Yes No

Disclaimer

Select the statement that is true:

I am an Owner, Partner, Officer, Director, Member, or Manager of this License or Application and I do NOT employ any person in any manner so as to become subject to the Workers' Compensation laws of California or I am not otherwise required to provide for workers' compensation insurance coverage under California law.

I am an Owner, Partner, Officer, Director , Member, or Manager of this License or Application and I do employ persons in connection with my California contractor's license in a manner that invokes the workers' compensation laws of a state other than California. I will print, email, or save this Exemption form to my own device, sign and submit by mail with the out of state certificate of insurance.

Review and Edit

Please Review the Following Information

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

Reminder: Do Not use the browser's back and forward arrows.

SET_IN_CODE

Penalty of Perjury

SET_IN_CODE

Agree To Complete

By checking this box and selecting the “Proceed to PDF” button, you understand the following:

You will no longer be able to make changes
The information entered on this form will NOT be added to the CSLB database
You will be directed to “Completion Instructions” where you will be able to review, print or save the PDF to your own device and mail at a later date

If you need to make any corrections to the provided information, please choose the Back or Edit buttons.
If you do not wish to continue this process, please select the Cancel button to return to CSLB’s Home Page.

Completion Instructions

Exemption has been Submitted

DO NOT SEND this data in a different format, either by mail, email or fax, as this may cause delays with information previously submitted.

Document (PDF) Link

Select the PDF link below to review your document. (If you choose, you may save or print the document to your own device.)

Be sure the information on the form is correct and signed before mailing it to CSLB.

Note: If you have a problem opening the PDF file, click this link for some PDF file troubleshooting steps.

Exemption from Workers' Compensation Insurance