Exemption from Workers' Compensation Insurance

    Pane 0

    Online Submission

    You cannot be exempt from Workers' Compensation if: the qualifier is a Responsible Managing Employee (RME); if you hold a C-39 Roofing classification; or if you have employees (including Home Improvement Salespersons (HIS).

    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, 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.

    * Required Field

    Pane 1

    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-39 Roofing classification - all contractors with a C-39 Roofing 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

    Do not continue this process if you cannot certify that you are an Owner, Partner, Officer, 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.


    Pane 2

    Required Information

    Select the appropriate response for each statement below:

    1. The qualifier for this license is a Responsible Managing Employee (RME).
    2. This license/application has a C-39 Roofing Classification.
    3. I have employees, (including any Home Improvement Salespersons (HIS)).

    * Required Field

    Pane 3

    Disclaimer

    Select the statement that is true:




    * Required Field

    Pane 4

    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.

    Penalty of Purjury

    Agree To Complete


    • 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.

    Pane 5

    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.

    About Us Popular Pages

    Online Services

    Image of Online Services