CONTRACTORS STATE LICENSE BOARD 9821 Business Park Drive, Sacramento, CA 95827-1703 Mailing Address: P.O. Box 26000, Sacramento, California 95826-0026
STATE OF CALIFORNIA 1-800-321-CSLB (2752) www.cslb.ca.gov
Request for Disclosure of Contractor’s License Information
Mail this form to the nearest Contractors State License Board Case Management Office shown below:
CSLB Northern Case Management P.O. Box 26888 Sacramento, CA 95827 (916) 255-4041 CSLB Southern Case Management 12501 East Imperial Highway, Suite 600 Norwalk, CA 90650 (562) 345-7656
This document is not admissible in court. For that purpose, submit a Request for Certified License History (Form 13L-2) with the $67 fee to CSLB Record Certification Unit, P.O. Box 26000, Sacramento, CA 95826. The form is available on CSLB’s Web site, www.cslb.ca.gov, or by calling 800-321-CSLB (2752).
REQUESTOR INFORMATION—PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK:
NAME OF PERSON REQUESTING INFORMATION ADDRESS (Number/Street or P.O. Box) HOME PHONE NUMBER ( ) City BUSINESS PHONE NUMBER ( ) DATE OF REQUEST State ZIP Code
E-MAIL ADDRESS
CONTRACTOR INFORMATION—YOU MUST PROVIDE THE CONTRACTOR’S NAME AND LICENSE NUMBER BELOW:
NAME OF CONTRACTOR NAME OF COMPANY ADDRESS (Number/Street or P.O. Box) City State ZIP Code LICENSE NUMBER
** FOR CSLB OFFICE USE ONLY ** THE FOLLOWING INFORMATION IS CURRENT AS OF __________________.
BUSINESS NAME LICENSE NUMBER LICENSE CLASSIFICATION(S)/DEFINITION ADDRESS OF RECORD LICENSE PERSONNEL (Number/Street or P.O. Box) City State ZIP Code DATE ISSUED DATE EXPIRES
PAST OR PENDING LEGAL ACTIONS: TYPE*
DATE
VIOLATIONS
COMPLAINTS: Any complaint listed is only an allegation of a probable violation. This does not affect the status of the license at this time. If referred to the Office of the Attorney General for
legal action, it may result in the suspension or revocation of the license. Pursuant to 7124.6 of the Business & Professions Code, the following complaints meet the criteria for disclosure.
COMPLAINT NO. DATE NATURE STATUS
* Please see page 2 for definitions and further information.
*disclo-req*
13I-94 (6/05)
California Contractors State License Board
Request for Disclosure of Contractor’s License Information, continued
DEFINITION OF LEGAL ACTION TERMS CITA Citation appealed; the licensee has contested all or part of the citation issued by the Board and has requested a hearing. CITP Citation pending; a citiation has been issued, but has not become a final order of the Registrar. CITC The licensee has complied with any order to correct violations of the Contractors License Law and has paid all civil penalties. CITS License is suspended due to noncompliance with citation. CITR License is revoked due to noncompliance with citation. CPVD Investigation has determined that a probable violation has occurred which will likely result in an accusation being recommended. L-1 Referred to legal action; a complaint has been closed alleging violations of the Contractors License Law but no legal action has been taken to date. Formal disciplinary action pending; the Board is seeking to revoke or suspend the license for alleged violations of the Contractors License Law. License suspended; see “Current License Status” section on page 1 to determine if licensee may operate. License revoked; see “Current License Status” section on page 1 to determine if licensee may operate.
DEFINITION OF LICENSE PERSONNEL TERMS O P QP Owner Partner Qualifying Partner
RMO Responsible Managing Officer RME Responsible Managing Employee PR VP T S President Vice President Treasurer Secretary
Notice Regarding Disclosed Information The information provided on this form is taken from the official records of the Contractors State License Board and in no way should be construed to be an endorsement or a criticism of the licensee referenced. License status can change daily. For the latest license and/or bond status information, check the CSLB Web site, www.cslb.ca.gov, or call 800-321-CSLB (2752). Notice on Collection of Personal Information CSLB collects the personal information requested on this form as authorized by B&P Code § 30 and CCR 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 for licensure or renewal unless you provide all of the requested information. You may review the records maintained by the CSLB that contain your personal information, as permitted by the Information Practices Act. We make 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 in response to a court or administrative order, a subpoena, or a search warrant. For questions about the Department of Consumer Affairs’ privacy policy or the Information Practices Act, contact the Office of Privacy Protection, 400 R Street, Sacramento, CA 95814, or email privacy@dca.ca.gov.
PA
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SSWC License was suspended, but the order of suspension is stayed, with the provision that the contractor meets certain conditions. DOES NOT BAR THE CONTRACTOR FROM OPERATING. RSWC License was revoked, but the order of revocation is stayed, with the provision that the contractor meets certain conditions. DOES NOT BAR THE CONTRACTOR FROM OPERATING. ARBS License suspended due to noncompliance of arbitration award. ARBR License revoked due to noncompliance of arbitration award. JBND License suspended for unsatisfied judgment.
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13I-94 (6/05)