CONTRACTORS STATE LICENSE BOARD
STATE OF CALIFORNIA
9821 Business Park Drive, Sacramento, CA 95827-1703
Mailing Address: P.O. Box 26000, Sacramento, California 95826-0026
STATEMENT OF OWNERSHIP
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK
_______________________________________________________________________ has owned __________________ %
NAME OF RESPONSIBLE MANAGING OFFICER OR QUALIFYING PARTNER
of the voting stock/equity of ________________________________________________________________________________
BUSINESS NAME AS IT CURRENTLY APPEARS ON THE RECORDS OF CSLB
_______________________________________________________________________ since _______________________ .
LICENSE NUMBER OR PENDING APPLICATION FEE NUMBER
On _________________________ at ____________________________________________________________________________________________________________,
I/we certify under penalty of perjury under the laws of the State of California that all statements, answers and representations in
this application, including all supplementary statements attached hereto, are true and accurate, and that I/we have reviewed the
entire contents of this application.
I further certify that the Contractors State License Board will be notifi ed within 90 days of any change in the percentage of voting
stock/equity owned by me.
Signature of RMO or Qualifying Partner _______________________________________________________________________
Print name ______________________________________________________________________________________________
If you own less than 20% of each fi rm for which you are the Responsible Managing Offi cer (RMO)
or Qualifying Partner (QP), you must inactivate your individual license.
If you own less than 10% of the voting stock of the corporation for which you are the RMO,
you must fi le a Bond of Qualifying Individual in the amount of $12,500.
All Responsible Managing Employees (RMEs) must fi le a B