Form 13L-50 at a glance
What it is: Form 13L-50 is the Exemption from Workers' Compensation form of the Contractors State License Board (CSLB), State of California.
Who signs: Complete all of the requested information in Section 1, check only one of the boxes in Section 2, and date and sign the form in Section 3.
A filled-in Form 13L-50 example: a sole contractor claims the exemption
How to fill out Form 13L-50, box by box
Section 1 - required business name and address
In Section 1, enter the Business Name (as it currently appears on CSLB records) and the License or Application Fee Number.
Enter the Business Mailing Address (number/street or P.O. box), City, State and Zip Code.
Enter the Business Street Address (number/street only, NO P.O. boxes), City, State and Zip Code.
Enter the Business Phone Number, Business Fax Number and Business E-mail Address.
Check this box if the address shown above is new
Check this box if the address shown is new; CSLB will update your license / application business address of record.
Section 2 - required check box
In Section 2, check only one of the boxes: 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
Enter the Date, sign as the Contractor (Owner, Partner, Officer, Manager, Member, or Director) and enter the Printed Name of the Contractor (Owner, Partner, Officer, Manager, Member, or Director).
In Section 3, you 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. Upon employing anyone in a manner that is subject to the workers' compensation laws of the State of California or upon obtaining a C-8, C-20, C-22, C-39, or C-61/D-49 license, the claim of exemption executed under this form will no longer be valid. As soon as you employ anyone subject to the California's workers' compensation laws, you 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. Failure to comply with this requirement is grounds for disciplinary action. Falsification of any document is grounds for disciplinary action.
More rules for Form 13L-50
To be exempt from workers' compensation, an applicant or licensee 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.) This exemption is not available to contractors applying for or holding a license in any of the following classifications: C-8 Concrete, C-20 Warm-Air Heating, Ventilating, and Air-Conditioning, C-22 Asbestos Abatement, C-39 Roofing and C-61/D-49 Tree Service. Joint Venture entities are excluded from this provision.
Before 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.
Type or print neatly and legibly in black or dark blue ink.
Common questions about Form 13L-50
When is this form not the right one?
Do not submit this form if you have an inactive license, the license qualifier is a Responsible Managing Employee (RME), you hold or are applying for a license in any of the classifications C-8, C-20, C-22, C-39, or C-61/D-49, or you have employees.
Sources
[1] Form 13L-50 (rev. 11/2022), Exemption from Workers' Compensation, Contractors State License Board (the Official source link on this page).
