13L 50 PDF Template

The 13L 50 form is a document required by the Contractors State License Board (CSLB) in California for individuals seeking an exemption from workers' compensation insurance. This form certifies that the applicant does not employ anyone in a manner subject to California's workers' compensation laws. Completing this form is essential for those who qualify for exemption, ensuring compliance with state regulations.

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Article Guide

The 13L 50 form is an essential document for contractors in California seeking exemption from workers' compensation requirements. Before the Contractors State License Board (CSLB) can issue or renew a license, applicants must provide proof of workers' compensation insurance or file for an exemption using this form. To qualify for exemption, the contractor must certify, under penalty of perjury, that they do not employ anyone in a manner subject to California's workers' compensation laws. There are specific conditions under which this form should not be submitted, such as if the contractor has an inactive license or if they hold a C-39 Roofing classification, which mandates workers' compensation coverage. The form includes three main sections: the first requires the business name and address, the second involves selecting the appropriate exemption box, and the third necessitates the contractor's signature. It is crucial for applicants to complete the form accurately and legibly, as failure to comply with these requirements may lead to disciplinary action. Furthermore, the CSLB collects personal information on this form to assess applicants and ensure compliance with licensing standards. Understanding the nuances of the 13L 50 form is vital for contractors to navigate the licensing process effectively and remain compliant with state regulations.

13L 50 Preview

CONTRACTORS STATE LICENSE BOARD STATE OF CALIFORNIA

9821 Business Park Drive, Sacramento, California 95827

Mailing Address: P.O. Box 26000, Sacramento, CA 95826

800-321-CSLB (2752)

www.cslb.ca.gov ▪ CheckTheLicenseFirst.com

Exemption from Workers’ Compensation

Before the Cont

ractors State License Board (CSLB) can issue a new license or reinstate, reactivate, or renew an existing license, the applicant

or licensee must have on file a Certificate of Workers’ Compensation Insurance or a Certificate of Self-Insurance issued by the Director of

Industrial Relations, or must obtain an exemption by completing and submitting this form.

To be exempt from workers’ compensation, an applicant or lice

nsee must submit this form to CSLB, certifying under penalty of perjury that he

or she does not employ anyone in a manner that is subject to the workers’ compensation laws of California. (See Business and Professions

Code Section 7125.)

DO NOT SUBMIT THIS FORM IF:

 You have an inactive license.

 The license qualifier is a Responsible Managing Employee (RME).

 You hold a C-39 Roofing classification – all contractors with a C-39 Roofing classification are required by Section 7125 to have a

Certificate of Workers’ Compensation Insurance or a Certificate of Self-Insurance on file with the Board. Contractors with a C-39

Roofing classification are not eligible for exemption from workers’ compensation.

 You have employees.

For exemption from workers’ compensation, complete all of the requested information in S

ection 1, check only one of the boxes in Section 2, and

date and sign the form in Section 3.

Please type or print neatly and legibly in black or dark blue ink.

SECTION 1 – REQUIRED BUSINESS NAME AND ADDRESS

Business Name (as it currently appears on CSLB records) License or Application Fee Number

Business Mailing Address (number/street or P.O. box)

City State Zip Code

Business Street Address (number/street only – NO P.O. boxes) City State Zip Code

Business Phone Number Business Fax Number Business E-mail Address

( ) ( )

□ Check this box if the address shown above is new. CSLB will update your license / application business address of record.

SECTION 2 – REQUIRED CHECK BOX

YOU MUST CHECK ONLY ONE OF THE BOXES BELOW.

□ I do not employ anyone in the manner subject to the workers’ compensation laws of California. OR

□ I am an out-of-state contractor, and I do not hire employees who reside in California. (You must provide a certificate of insurance from your

workers’ compensation insurance carrier in your home state.)

SECTION 3 – REQUIRED SIGNATURE

I certify under penalty of perjury under the laws of the State of California that the information provided on this exemption statement is true and

accurate. I understand that, upon employing anyone in a manner that is subject to the workers’ compensation laws of the State of California, the

claim of exemption executed under this form will no longer be valid. I also understand that, as soon as I employ anyone subject to the

California’s workers’ compensation laws, I must obtain a Certificate of Workers’ Compensation Insurance, submit that certificate to CSLB within

90 days of its effective date, and continuously maintain the coverage provided by the certificate in accordance with the law. I further understand

that failure to comply with this requirement is grounds for disciplinary action. (The definition of “perjury” is telling a lie while under oath.)

FALSIFICATION OF ANY DOCUMENT IS GROUNDS FOR DISCIPLINARY ACTION.

Date Signature of Contractor (Owner, Partner, or Officer) Printed Name of Contractor (Owner, Partner, or Officer)

NOTICE ON COLLECTION OF PERSONAL INFORMATION

CSLB collects the personal information requested on this form as authorized by Business and Professions Code Section 30. CSLB uses this information to identify

and evaluate applicants for licensure, issue and renew licenses, and enforce licensing standards set by law and egulation. Submission of the requested information

is mandatory. CSLB cannot consider this Exemption from Workers Compensation form unless you provide all of the requested information. You may review the

records maintained by CSLB that contain your personal information, as permitted by the Information Practices Act. 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 in response to a court or administrative order, a subpoena, or a search warrant. This application contains

an applicant authorization for the Franchise Tax Board to disclose to CSLB any outstanding final liabilities for the purpose of administering Business and

Professions Code Section 7145.5. For more information on the Information Practices Act, visit the Office of Privacy Protection’s website at www.privacy.ca.gov.

*WC-EXEMPT*

13L-50 (rev. 2/21)

FOR CSLB USE ONLY

↓ 13L 50

File Properties

Fact Name	Details
Purpose	The 13L 50 form is used to request an exemption from workers' compensation requirements in California.
Governing Law	Business and Professions Code Section 7125 governs the use of this form.
Eligibility	Only applicants or licensees who do not employ anyone subject to California's workers' compensation laws can use this form.
Submission Requirements	The form must be submitted to the Contractors State License Board (CSLB) to obtain the exemption.
Inactive License	If a license is inactive, the form should not be submitted.
C-39 Classification	Contractors with a C-39 Roofing classification must have workers' compensation insurance and cannot apply for an exemption.
Signature Requirement	The form must be signed under penalty of perjury, affirming the truthfulness of the information provided.
Address Updates	Checking a specific box on the form allows CSLB to update the business address on record.
Personal Information	CSLB collects personal information to process applications and ensure compliance with licensing standards.
Consequences of Falsification	Providing false information can lead to disciplinary action against the contractor.

Instructions on Utilizing 13L 50

Completing the 13L 50 form is a crucial step for those seeking exemption from workers' compensation in California. This form must be filled out accurately to ensure that the Contractors State License Board (CSLB) can process your request effectively. Once submitted, the CSLB will review the information provided and determine whether the exemption can be granted based on the eligibility criteria outlined.

Begin by entering your Business Name as it currently appears on CSLB records in Section 1.
Provide your Business Mailing Address including the number/street or P.O. box, city, state, and zip code.
Next, fill in your Business Street Address (number/street only, no P.O. boxes), followed by the city, state, and zip code.
Include your Business Phone Number, Business Fax Number, and Business E-mail Address.
If your address has changed, check the box indicating that the address shown is new.
Proceed to Section 2 and check only one of the boxes that apply to your situation:

I do not employ anyone in the manner subject to the workers’ compensation laws of California.
I am an out-of-state contractor, and I do not hire employees who reside in California.

In Section 3, certify under penalty of perjury that the information provided is true and accurate by signing and dating the form.
Print your name clearly as the Contractor (Owner, Partner, or Officer) beneath your signature.

Important Facts about 13L 50

What is the 13L 50 form?

The 13L 50 form is a document used by contractors in California to apply for an exemption from workers’ compensation insurance requirements. Before the Contractors State License Board (CSLB) can issue or renew a contractor's license, this form must be submitted if the contractor does not employ anyone subject to California's workers’ compensation laws.

Who needs to fill out the 13L 50 form?

This form is necessary for contractors who wish to certify that they do not have employees subject to workers’ compensation laws. It is important for those who are either applying for a new license or renewing an existing one. However, if a contractor has employees or holds a C-39 Roofing classification, they are not eligible for this exemption and should not submit the form.

What information is required on the 13L 50 form?

Applicants must provide their business name, mailing address, business phone number, and email address. Additionally, they must indicate whether they do not employ anyone subject to workers’ compensation laws or if they are an out-of-state contractor who does not hire California residents. The form also requires a signature certifying the truthfulness of the information provided.

Can I submit the 13L 50 form if I have an inactive license?

No, individuals with an inactive license should not submit the 13L 50 form. The exemption applies only to active contractors who meet the specified criteria. If your license is inactive, you will need to reactivate it and fulfill the necessary insurance requirements.

What happens if I employ someone after submitting the 13L 50 form?

If you begin employing individuals in a manner subject to California's workers’ compensation laws after submitting the form, your claim for exemption becomes invalid. You must then obtain a Certificate of Workers’ Compensation Insurance and submit it to the CSLB within 90 days of its effective date. Continuous coverage is required to comply with the law.

Is it necessary to provide a signature on the 13L 50 form?

Yes, a signature is required on the form. By signing, the contractor certifies under penalty of perjury that the information provided is accurate. This signature is a crucial part of the application process and indicates the seriousness of the claims made in the form.

What should I do if my business address changes?

If your business address has changed, you can indicate this on the 13L 50 form. There is a checkbox to mark if the address provided is new. The CSLB will then update your license or application records accordingly.

What are the consequences of falsifying information on the 13L 50 form?

Providing false information on the 13L 50 form is a serious offense and can lead to disciplinary action by the CSLB. It is essential to ensure that all information is accurate and truthful to avoid any legal repercussions.

How can I contact the CSLB for more information about the 13L 50 form?

For additional questions or clarification regarding the 13L 50 form, you can contact the Contractors State License Board at 800-321-CSLB (2752) or visit their website at www.cslb.ca.gov. They provide resources and assistance for contractors navigating the licensing process.

Common mistakes

When filling out the 13L 50 form for exemption from workers' compensation, many people make common mistakes that can delay their application or even lead to rejection. One frequent error is failing to provide complete and accurate information in Section 1. This section requires specific details about the business name and address. If any of this information does not match what is on file with the Contractors State License Board (CSLB), it can cause issues. Always double-check that the business name and address are correct and formatted as required.

Another mistake involves the selection in Section 2. Applicants must check only one of the boxes indicating their employment status. Some individuals mistakenly check both boxes or leave the section blank. This can lead to confusion and may result in the application being returned for correction. It is crucial to read the instructions carefully and ensure that only one box is checked, reflecting the accurate employment situation.

In Section 3, the signature is often overlooked or improperly completed. Applicants must sign and date the form, certifying the truthfulness of the information provided. A common oversight is forgetting to include the date or using a signature that does not match the printed name. This can be seen as a lack of attention to detail, which may raise red flags during the review process.

Lastly, many applicants do not keep a copy of the submitted form. This can be problematic if there are questions or issues later on. Keeping a copy ensures that you have a reference point for any follow-up communication with CSLB. Remember, thoroughness is key. By avoiding these mistakes, you can help ensure a smoother application process.

Documents used along the form

The 13L 50 form is essential for contractors in California seeking exemption from workers' compensation requirements. It serves as a declaration that the applicant does not employ anyone subject to these laws. Alongside this form, several other documents are commonly utilized to ensure compliance and facilitate the licensing process. Below is a list of these related forms and documents.

Certificate of Workers' Compensation Insurance: This document proves that a contractor has valid workers' compensation insurance coverage. It is required for those who employ workers in California and cannot use the 13L 50 form for exemption.
Certificate of Self-Insurance: Contractors may opt for self-insurance instead of traditional workers' compensation insurance. This certificate, issued by the Director of Industrial Relations, confirms that a contractor has the financial capability to cover potential workers' compensation claims.
Application for Contractor License: This is the initial application form that contractors submit to obtain a state license. It includes details about the business, ownership, and qualifications, and must be completed before any licensing can occur.
Change of Address Form: If a contractor changes their business address, this form must be submitted to the Contractors State License Board. Keeping address records current is crucial for maintaining communication and compliance with state regulations.

Understanding these documents can help streamline the licensing process for contractors. Each form plays a vital role in ensuring compliance with California's laws and regulations regarding workers' compensation and business operations.

Similar forms

The 13L 50 form, which is used to apply for an exemption from workers' compensation in California, shares similarities with several other legal documents. Each of these forms serves a specific purpose in the realm of business licensing and compliance. Below is a list of documents that are comparable to the 13L 50 form:

Certificate of Workers’ Compensation Insurance: This document proves that a contractor has active workers' compensation coverage, which is required for most contractors in California. Unlike the 13L 50 form, it does not provide an exemption but rather confirms compliance with the law.
Certificate of Self-Insurance: Similar to the workers’ compensation insurance certificate, this document indicates that a contractor is self-insured for workers' compensation. It is an alternative to obtaining insurance from a provider, but it requires approval from the Director of Industrial Relations.
Application for Contractor License (Form 13L): This form is used to apply for a contractor's license in California. While it includes a broader range of information for licensing, it also requires proof of workers' compensation coverage, making it similar in purpose to the 13L 50 form.
Request for Reinstatement of License: This document is submitted by contractors seeking to reinstate a previously revoked or expired license. It often requires proof of compliance with workers' compensation laws, linking it to the exemption process outlined in the 13L 50 form.
Business License Application: This form is necessary for obtaining a general business license in California. It may include questions about workers' compensation coverage, similar to those found in the 13L 50 form.
Out-of-State Contractor Registration Form: This form is for contractors from other states who wish to work in California. It requires information about workers' compensation coverage, aligning it with the exemption purposes of the 13L 50 form.
Employer's Report of Occupational Injury or Illness: This document is used to report injuries or illnesses that occur in the workplace. While it serves a different function, it is related to the workers' compensation system, just as the 13L 50 form addresses exemptions from it.
Workers' Compensation Claim Form (DWC 1): This form is used by employees to file a claim for workers' compensation benefits. It highlights the importance of workers' compensation coverage, contrasting with the exemption focus of the 13L 50 form.

Understanding these related documents can help clarify the requirements and responsibilities of contractors in California regarding workers' compensation and licensing. Each form plays a role in ensuring compliance with state laws, safeguarding both contractors and their employees.

Dos and Don'ts

When filling out the 13L 50 form, it is essential to follow specific guidelines to ensure a smooth process. Here are nine important do's and don'ts to consider:

Do complete all requested information in Section 1 accurately.
Do check only one box in Section 2 to indicate your exemption status.
Do sign and date the form in Section 3 to validate your submission.
Do use black or dark blue ink, and ensure your handwriting is neat and legible.
Do keep a copy of the completed form for your records.
Don't submit the form if you have an inactive license.
Don't check a box in Section 2 if you have employees.
Don't submit the form if you hold a C-39 Roofing classification.
Don't forget to provide accurate contact information, including phone and email addresses.

Misconceptions

Misconception 1: The 13L 50 form is only for new applicants.

This form is also required for those looking to reinstate, reactivate, or renew an existing license. It is not limited to new applicants.

Misconception 2: Anyone can use the exemption form regardless of their employment status.

Only individuals who do not employ anyone in a manner subject to California's workers' compensation laws can use this form. If you have employees, you cannot claim this exemption.

Misconception 3: The form can be submitted without a signature.

A signature is mandatory. The applicant must certify under penalty of perjury that the information provided is true and accurate. Without a signature, the form is incomplete.

Misconception 4: All contractors can use the exemption regardless of their license classification.

Contractors with a C-39 Roofing classification cannot use this exemption. They are required to maintain a Certificate of Workers' Compensation Insurance or a Certificate of Self-Insurance.

Misconception 5: Submitting the form guarantees an exemption from workers' compensation.

Submitting the form does not automatically guarantee an exemption. The Contractors State License Board (CSLB) must review and approve the application before the exemption is granted.

Misconception 6: The exemption is permanent once granted.

The exemption is not permanent. If you hire anyone in a manner subject to the workers' compensation laws, the exemption becomes invalid. You must then obtain the appropriate insurance and submit the certificate to CSLB.

Key takeaways

When filling out and using the 13L 50 form for exemption from workers’ compensation in California, keep these key points in mind:

The form is required to certify that you do not employ anyone subject to California's workers’ compensation laws.
Before submitting, ensure that you do not have an inactive license or hold a C-39 Roofing classification, as these categories are not eligible for exemption.
Complete all requested information in Section 1, including your business name and address, and ensure it matches CSLB records.
In Section 2, check only one box to indicate your employment status regarding California’s workers’ compensation laws.
Sign and date the form in Section 3 to certify the accuracy of the information provided.
Use black or dark blue ink when filling out the form to ensure clarity and legibility.
Understand that falsifying any information on this form can lead to disciplinary action.
If you later employ anyone subject to these laws, you must obtain and submit a Certificate of Workers’ Compensation Insurance within 90 days.
CSLB collects personal information for licensing purposes, and this information may be disclosed under certain legal circumstances.