13A-20a (rev. 12/14) Application – Page 2 of 2
Applicant’s Business Name (as listed in Section 1 of this application): ____________________________________________________
SECTION 3 – REQUIRED LLC APPLICATION QUESTIONS
All questions in this section must be answered. Questions 10, 11, and 12 pertain to all individuals listed on this application (qualifying
individual and additional person who signed Section 2 of the application, if applicable). If you checked “Yes” in response to any question, the person involved must
attach a separate sheet with a detailed explanation for each situation.
10. To the best of your knowledge, is anyone listed on this application (or any company the person is or was a part of,
or any immediate family member of the applicant) named in or responsible for any entered and unsatisfied
judgments, liens, and/or claims against any bond or cash deposit pertaining to a construction project? (Immediate
family member is defined by BPC Section 7075.1 as a spouse, father, mother, brother, sister, son, daughter, stepson,
stepdaughter, grandson, granddaughter, son-in-law, or daughter-in-law.)
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.
□ Yes □ No
11. Has any individual listed on this application ever been convicted of or plead 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 Section 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 a 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;
Under certain circumstances, some arrests/convictions relating to specified marijuana offenses that occurred prior to
January 1, 1976, as provided in Health and Safety Code Section 11361.5 (b); and
Under certain circumstances, some arrests/convictions relating to specified drug offenses as provided in Penal Code
Section 1000.
□ Yes □ No
If you checked “Yes” fo
r this question, you are required to attach a statement disclosing all pleas/convictions, including
violated law sections, and thoroughly explain the acts or circumstances which 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. 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 is considered falsification of your application and is grounds for denial of your application.
12. To the best of your knowledge, has anyone on this application (or any company the person was a part of, or any
immediate family member of the applicant) ever received a citation from the Contractors State License Board or had
a contractor license or other professional or vocational license or registration denied, suspended, or revoked by
this state or elsewhere? (Check “No” if the license was suspended due to lack of a bond, workers’ compensation
insurance, a qualifying individual, or family support.)
□ Yes □ No
If you checked “Yes” fo
r this question, you are required to attach a statement detailing the events leading to this action.
13. (This question must be answered by the qualifying individual.) The Registrar of Contractors has determined that direct
supervision and control includes any one or a combination of the following activities: supervising construction, managing
construction activities by making technical and administrative decisions, checking jobs for proper workmanship, or direct
supervision on construction job sites. Will you, as the qualifying individual, perform one or more of these duties?
□ Yes □ No
14. (This question must be answered only if the qualifying individual is a Responsible Managing Employee [RME].) CCR Section
823 states that an RME must work at least 32 hours per week or 80% of the total operating hours per week for the entity for
which he or she acts as the qualifier. Will you, as the Responsible Managing Employee, meet the requirement of CCR
Section 823 cited above?
□ Yes □ No
SECTION 4 – LLC QUALIFIER EDUCATION, APPRENTICESHIP, LICENSURE, AND MILITARY
15. HAVE YOU COMPLETED AN EDUCATIONAL OR APPRENTICESHIP PROGRAM?
□ Yes □ No
If you checked “Yes,” you may be granted credit for completed education in a business, technical, or construction-related field if you submit sealed official
transcripts from your college/university. If you received your degree outside of the United States, your transcripts must be translated and evaluated by an
accredited evaluation service that does business within the United States.
For apprenticeship programs, you may be granted credit if you submit a copy of your apprenticeship certificate,
AND enter the beginning and ending dates of your completed apprenticeship program:
(The apprenticeship period cannot overlap the journey-level experience period being certified.)
From ____________________ to ____________________
Month/Day/Year Month/Day/Year
RECIPROCITY – If you are seeking a waiver of the trade exam because you are licensed in one of the specified classifications in
Arizona, Nevada, and/or Utah, please check this box. For more information, refer to page 3 of 4 in the General Information section.
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MILITARY – If you are currently serving in the military (California National Guard or United States Armed Forces) or previously served,
please check this box. For information about the services that CSLB offers military personnel, their families, and veterans, including
expedited application processing and experience credit for military duties, refer to CSLB’s website.
□
FOR CSLB USE ONLY
