Form Cscl Lbl 021 PDF Details

Engaging with the complexities of maintaining up-to-date licensing and regulatory compliance is a task many businesses must navigate, especially within the construction and building sector. The CSCL/LBL-021 form, issued by the Michigan Department of Licensing and Regulatory Affairs (LARA), is a critical document for companies operating in this field. This form is specifically designed for the application process involved in changing a qualifying officer within a company. Mandated by the authority of the 1980 PA 299 under Michigan Compiled Laws 338.3434(a) and supported by federal law 42 USC 654, it underscores the significance the state places on maintaining accurate records of those responsible for the operational oversight of licensed building entities. The application requires detailed information about the company and the new qualifying officer, including but not limited to names, addresses, and whether the new officer has any felony convictions not previously reported. This process is not only a legal obligation but serves as a safeguard to ensure that individuals in positions of authority within these companies adhere to a standard that promotes trust and security in the building industry. Additionally, the form outlines the necessary fee for processing the change, emphasizing the non-refundable nature of this charge, as authorized by the State License Fee Act of 1979 (PA 152). Through this, LARA demonstrates its commitment to equal opportunity, ensuring accessibility and accommodation for all individuals throughout the application process.

QuestionAnswer
Form NameForm Cscl Lbl 021
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names1980, refundable, 1979, LARA

Form Preview Example

CSCL/LBL-021 (9/14)

Michigan Department of Licensing and Regulatory Affairs

Corporations, Securities & Commercial Licensing Bureau - Licensing Division P.O. Box 30245, Lansing, MI 48909

517-241-9288 www.michigan.gov/builders

FOR OFFICE USE ONLY

Approved By:

Date Approved:

License Number

QUALIFYING OFFICER CHANGE APPLICATION

AUTHORITY: 1980 PA 299, MCL 338.3434(A), AND 42 USC 654

 

 

 

PENALTY: FAILURE TO PROVIDE THIS INFORMATION MAY RESULT IN DENIAL OF THE APPLICATION

 

 

AND/OR DISCIPLINARY ACTION.

 

 

 

 

 

 

 

Name of Company

 

Permanent ID #

 

 

 

 

 

Business Address (NO PO BOX)

City

State

Zip Code

 

 

 

 

Mailing Address (if different)

City

State

Zip Code

 

 

 

 

Telephone Number

E-mail Address

 

 

 

 

 

 

NEW QUALIFYING OFFICER INFORMATION

Name (First, Middle, Last)

Permanent ID # or last 4 digits of Social Security Number

 

 

 

Have you ever been convicted of a felony not previously reported to the Department for this license type or occupation?

Yes

No

 

 

 

 

CERTIFICATION

I certify that the statements in this document are true and complete. I understand that any omitted statement, misrepresentation, or fraud may be cause for denial of my application, disciplinary action, or may be punishable by law.

Qualifying Officer Signature

 

Date

 

 

 

FEE PAYMENT INFORMATION (Check One Box)

FOR OFFICE USE ONLY

FOR OFFICE USE ONLY - VALIDATION

Residential Builder Qualifying Officer Change

$10.00

2102-33

 

Residential Maintenance & Alteration

$10.00

2104-33

 

Contractor Qualifying Officer Change

 

 

 

 

 

 

 

Make your check or money order in U.S. Currency payable to:

STATE OF MICHIGAN

FEES ARE AUTHORIZED BY THE STATE LICENSE FEE ACT, 1979 PA 152, AND ARE

NOT REFUNDABLE.

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

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This PDF will require particular info to be entered, so make sure to take some time to fill in what's required:

1. To begin with, once filling in the REFUNDED, start with the page that features the subsequent blanks:

1979 completion process explained (part 1)

2. Once your current task is complete, take the next step – fill out all of these fields - Qualifying Officer Signature, Date, FEE PAYMENT INFORMATION Check One, FOR OFFICE USE ONLY, FOR OFFICE USE ONLY VALIDATION, Residential Builder Qualifying, Residential Maintenance, Make your check or money order in, STATE OF MICHIGAN, FEES ARE AUTHORIZED BY THE STATE, and LARA is an equal opportunity with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

The way to prepare 1979 portion 2

Be extremely attentive when completing LARA is an equal opportunity and Make your check or money order in, as this is where many people make a few mistakes.

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