CONTRACTORS STATE LICENSE BOARD 9821 Business Park Drive, Sacramento, CA 95827 Mailing Address: P.O. Box 26000, Sacramento, CA 95826 800.321.CSLB (2752) | ZZZFVOEFDJRY | &KHFN7KH/LFHQVH)LUVWFRP STATE OF CALIFORNIA Governor Edmund G. Brown Jr. Licensed Sole Owner Applying for Corporate License This form must be completed by sole owners applying for a corporate license and must be submitted in conjunction with a completed Application for Original Contractor License ­ Examination Waiver (7065). Sole owners applying for a corporate license MUST complete this form if they fall in one or both of the following categories: The licensee maintains ownership of at least 51%* of the voting power of the corporation. Regardless of whether or not the licensee wants his or her sole ownership license number reissued to the corporation, this form is required. If you fall in this category, you must complete and sign the form below, checking the Yes box and providing the requested information if you do want the license number reissued OR checking the No box if you do not want the license number reissued. The licensee wants his or her sole ownership license number reissued to the corporation. Regardless of the percentage of ownership, if the licensee wants the sole ownership license number reissued to the corporation, this form is required. If you fall in this category, you must complete and sign the form below, checking the Yes box and providing the requested information. If you are applying for a corporate license and you do not complete this form, your sole ownership license number cannot be reissued to your corporation ­ a new license number will be issued. California law allows a sole ownership license number to be reissued to a corporation if: The sole ownership license is in good standing; The corporation was formed by the same licensee as the sole ownership license; and The licensee maintains ownership directly or indirectly of shares evidencing at least 51%* of the voting power of the corporation. Please be aware that once the number is reissued, it belongs to the corporation and cannot be reissued to an individual at a later date. Please type or print neatly and legibly in black or dark blue ink. Incomplete forms are not accepted. 1. NAME OF CORPORATION (as shown on the Application for Original Contractor License ­ Examination Waiver) 2. SOLE OWNERSHIP CSLB LICENSE NUMBER 3. NAME OF SOLE OWNER (as shown on CSLB records) 4. PLEASE CHECK ONLY ONE BOX BELOW: YES ­ Reissue my sole ownership license number, #______________________________, to the corporation named above. I certify that I own ________% of this corporation. I understand that the license number cannot be reissued back to me as a sole owner in the future. NO ­ DO NOT reissue my sole ownership license number to this corporation. Please issue a new license number to the corporation. 5. Date Signature Printed Name Notice About Reissued License Numbers and Joint Venture Licenses When a sole ownership license number that was previously associated with a joint venture license is reissued to a corporation, the joint venture license is cancelled. The remaining entities may request a continuance of the joint venture license to complete projects already contracted for or in progress before the cancellation date. The continuance may be granted for a period of up to one year. The written request must be received by CSLB headquarters within 90 days after the cancellation date (date of reissue). * CSLB interprets the phrase "more than 50%" as meaning at least 51%. % 3 &RGH 6HFWLRQ  FOR CSLB USE ONLY *REISSUE-CONF* 13A-1h (rev. 06/11) Licensed Sole Owner Applying for Corporate License American LegalNet, Inc. www.FormsWorkFlow.com