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IMPORTANT NOTICE REGARDING CONVICTIONS PLEASE …

CONTRACTORS STATE LICENSE BOARD STATE OF CALIFORNIA9821 Business Park Drive, Sacramento, CA 95827 Governor Edmund G. Brown Jr. Mailing Address: Box 26000, Sacramento, CA 95826 (2752) | | 13A-2a (rev. 06/17) 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.

Please detach this General Information and Instructions portion before submitting the completed application package to CSLB. 13A-2a (rev. 06/17) General Information and Instructions – Page 2 of 7 APPLICATION FOR REPLACING THE QUALIFYING INDIVIDUAL

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