Pest Control Dealer License Application, DPR PML 041 20180612 145141 PCDBL Packet

2018-06-12

: Pdf 20180612 145141 Pcdbl Packet 20180612_145141_PCDBL_Packet promotional s

Open the PDF directly: View PDF PDF.
Page Count: 11

STATE OF CALIFORNIA
PEST CONTROL DEALER BUSINESS LICENSE PACKET
PR-PML-041 (REV. 8/17)
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICENSING BRANCH
LICENSING AND CERTIFICATION PROGRAM
1001 I STREET
SACRAMENTO, CALIFORNIA 95814-2828
(916) 445-4038
Web site: http://www.cdpr.ca.gov
PEST CONTROL DEALER
BUSINESS LICENSE
PACKET
Contains the following documents:
Licensing Requirements and Fact Sheet
Application and Instructions
Visa/Mastercard Transaction Form
State of California
PEST CONTROL DEALER
LICENSING REQUIREMENTS
Rev. 8/17
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICENSING BRANCH
1001 I Street
P.O. Box 4015
Sacramento, California 95812-4015
Phone: (916) 445-4038 Fax: (916) 445-4033
Web site at <http://www.cdpr.ca.gov>
Do you need You must possess a pest control dealer license if you are a person, manufacturer, distributor,
this license? or retailer who does any of the following:
Sells agricultural use* pesticides, methods, or devices for the control of agricultural
pests
Solicits pest control sales through recommendations made by your field
representatives
Sells restricted use pesticides to users
Note: Registrants who sell their own pesticide products and licensed pesticide brokers are
excluded from this license requirement if they do not sell directly to the end user.
*California’s definition of agricultural use includes but is not limited to commercial
production of animals or plants, golf courses, parks, cemeteries, roadsides, power line
rights-of-way, and nurseries.
Basic licensing You can obtain a pest control dealer license by submitting the application, appropriate fee,
requirements and supporting business information and documents. The following criteria must be met
prior to the issuance of this license:
Qualified person
Documents required to verify your business name and type
Worker’s compensation insurance
Qualified
person According to the Food and Agricultural Code (FAC) section 12101.5, you must have at least
one person in a supervisory position at each principle and branch location who
Is actively responsible for the operation of the dealership, and
Holds a valid pest control dealer designated agent license, agricultural pest control
adviser license, pest control aircraft pilot certificate, or a qualified applicator license
Please state the name of the qualified person, their license or certificate number, and their
license or certificate category on the application form.
Continued on next page
Document Name
If you have a(n) …
Then you must …
Valid worker’s
compensation
insurance policy
State the carrier’s name, policy number, and expiration date
on the application
Write “not applicable” if your business has no employees
Sign your application
Expired worker’s
compensation
insurance policy
Choose one of the following:
Submit a certificate of insurance from your insurer stating
that the policy is valid, along with the expiration date
Complete the Worker’s Compensation Insurance Verification
form (PR-PML-120), which can be found on DPR’s Web site
at <http://www.cdpr.ca.gov/docs/license/lcforms.htm>
Page 2 Pest Control Dealer
Licensing Requirements (Rev. 8/17)
Verifying your According to FAC section 11702(a), you must have the following documents to verify your
business name business name and type. If you are the sole proprietor (i.e., owner) and use your surname as
and type part of your business name, then no documents are required.
Details
Fictitious Business
Name Statement
Obtainable from the County Clerk’s Office or County
Recorder’s Office
Applies to any business operating under a fictitious name
Certificate of Good
Standing
Obtainable from the California Secretary of State’s Office
Applies to any domestic or foreign corporation operating in
California
Must be registered with the California Secretary of State’s
Office
See the Secretary of State’s Web site at
<www.ss.ca.gov/business/business.htm> for registration
information
Worker’s
compensation
insurance
Each applicant, who is an employer as defined in Section 3300 of
the Labor Code, is required
to carry worker’s compensation insurance. The Department of Pesticide Regulation’s (DPR)
policy on the worker’s compensation insurance requirement is listed in the table below.
Note: If you are interested in self-insurance to fulfill this requirement, please go to the
California Department of Industrial Relations’ Web site at
<http://www.dir.ca.gov/SIP/sip.html>.
Continued on next page
If your business name begins with …
Page 3 Pest Control Dealer
Licensing Requirements (Rev. 8/17)
Other
requirements Once you obtain your license, you must do all of the following:
Maintain records of all purchases, sales, and distributions of pesticides at main and
branch offices for four years. You must report the total dollars of sales and total
pounds or gallons of agricultural use pesticides sold into or within California to
DPR’s director on a quarterly basis.
Pay the quarterly mill assessment to the director if the registrant or pesticide broker
has not paid it (FAC section 12406[b]).
Report purchases from other licensed dealers or registrants to the director on an
annual basis.
Retain agricultural pest control adviser’s written recommendations for two years.
Retain restricted material permits and operator identification statements records for
two years.
Retain Qualified Applicator License, Qualified Applicator Certificate, and Private
Applicator Certificate numbers and pest control category(ies) received from
purchasers when the operator identification number certificate was not required.
Obtain a copy of the ship vessel registration for tributyltin purchases.
Application fee The application fees are $160 (main) and $80 (branch) per calendar year (Title 3 of
California Code of Regulations [3 CCR], Code section 6502), which are based on the
following 2-year cycles:
Then your license will …
A through L Expire on December 31 of even-numbered
years (e.g., 2018, 2020, 2022, etc.)
M through Z (including businesses
starting with “The”) Expire on December 31 of odd-numbered
years (e.g., 2017, 2019, 2021, etc.)
For example, if you applied for a license under the name “Pest Control Dealer Corporation”
in January 2017, then your license would expire on December 31, 2017 and the fee would
be $160. If you applied for a license under the name “Best Pest Control Dealers” in January
2017, then your license would expire on December 31, 2018 and the fee would be $320.
Renewal fee The renewal fee is $320 (main) and $160 (branch) for the 2-year cycle (3 CCR section 6502).
We do not prorate your renewal fee if you renew your license late.
Late renewal A late fee of 50 percent of the total renewal fee will be assessed for each license postmarked
fee after December 31 of the expiration year.
Continued on next page
Type Amount
Page 4 Pest Control Dealer
Licensing Requirements (Rev. 8/17)
Miscellaneous The following chart lists the miscellaneous fees for this license. We charge a maximum fee
fees of $20 for all changes/requests that are submitted on a single application form.
Details
Name
change $20 You must immediately notify the Licensing and
Certification Office in writing (3 CCR section 6508).
You must submit legal documents certifying the name
change.
A new license will be automatically issued for all name
changes.
The Address and/or Name Change Form is available on
our Web site at
<www.cdpr.ca.gov/docs/license/lcforms.htm>.
Address
change $20 You must immediately notify the Licensing and
Certification Office in writing (3 CCR section 6508).
This fee is only required if you request a new license.
The Address and/or Name Change Form is available on
our Web site at
<www.cdpr.ca.gov/docs/license/lcforms.htm>.
Duplicate $20
This fee applies to requests for a duplicate or replacement
license.
Timelines for
processing
applications
DPR may take up to a hundred days to complete the processing of your application.
License
duration A new license may be issued for up to two years, depending on when you apply and your
license cycle. Each renewed license is valid for two years unless you renew late.
Most common
mistakes and
how to avoid
them
The most common application errors made are
Incorrect fees
No insurance documents, or the insurance documents submitted do not meet our
requirements
No business type information provided
No qualified person listed
You can avoid these errors by reading the application instructions carefully and by mailing
your renewal application before your license expires.
Continued on next page
Page 5 Pest Control Dealer
Licensing Requirements (Rev. 5/17)
Our physical Department of Pesticide Regulation
address Pest Management and Licensing Branch
Licensing and Certification Program
1001 I Street
Sacramento, CA 95814-2828
Our mailing Department of Pesticide Regulation
address Pest Management and Licensing Branch
Licensing and Certification Program
1001 I Street
P.O. Box 4015
Sacramento, CA 95812-4015
For more
information You can contact us between the hours of 8 a.m. to 5 p.m. at (916) 445-4038, or e-mail us
at <LicenseMail@cdpr.ca.gov>.
STATE OF CALIFORNIA
PEST CONTROL DEALER LICENSE APPLICATION
DPR-PML-041 (REV. 08/11)
Page 1 of 4
PLEASE READ INSTRUCTIONS ON PAGES 3 AND 4.
A. Application Type. Check the appropriate box(es).
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICENSING BRANCH
LICENSING AND CERTIFICATION PROGRAM
P.O. BOX 4015
SACRAMENTO, CALIFORNIA 95812-4015
(916) 445-4038
FAX - (916) 445-4033
Web site: http://www.cdpr.ca.gov/
B. Business Information (Main Location). Please print or type.
BUSINESS NAME
BUSINESS MAILING ADDRESS (Number and Street or P.O. Box Number) (City) (County) (State) (ZIP Code)
BUSINESS LOCATION ADDRESS (Number and Street) (City) (County) (State) (ZIP Code)
BUSINESS TYPE (Check only one box.) See instructions for documentation requirements.
CORPORATION INDIVIDUAL LIMITED LIABILITY COMPANY OTHER
C. Former Business Name. Enter former business name below.
FORMER BUSINESS NAME
D. Business Officers or Owners. Attach additional sheet if necessary.
MAILING ADDRESS (Number and Street or P.O. Box Number) (City) (State) (ZIP Code)
MAILING ADDRESS (Number and Street or P.O. Box Number) (City) (State) (ZIP Code)
E. Branch Locations. Attach additional sheet if necessary.
1) LOCATION ADDRESS (Number and Street or P.O. Box Number) (City) (County) (State) (ZIP Code)
2) LOCATION ADDRESS (Number and Street or P.O. Box Number) (City) (County) (State) (ZIP Code)
3) LOCATION ADDRESS (Number and Street or P.O. Box Number) (City) (County) (State) (ZIP Code)
F. Qualified Person. Each business location must have a qualified person, who possesses a valid license or certification in the
following: Pest Control Dealer Designated Agent License, Agricultural Pest Control Adviser License, Qualified Applicator License,
or Pest Control Aircraft Certificate. The qualified person is responsible for the operations of the pest control dealer business.
Attach additional sheet if necessary.
1) QUALIFIED PERSON'S NAME TYPE OF LICENSE/PILOT CERTIFICATE LICENSE/PILOT CERT. NUMBER EXPIRATION DATE
BUSINESS LOCATION ADDRESS (Number and Street) (City) (State) (ZIP Code)
2) QUALIFIED PERSON'S NAME TYPE OF LICENSE/PILOT CERTIFICATE LICENSE/PILOT CERT. NUMBER EXPIRATION DATE
BUSINESS LOCATION ADDRESS (Number and Street) (City) (State) (ZIP Code)
3) QUALIFIED PERSON'S NAME TYPE OF LICENSE/PILOT CERTIFICATE LICENSE/PILOT CERT. NUMBER EXPIRATION DATE
BUSINESS LOCATION ADDRESS (Number and Street) (City) (State) (ZIP Code)
Application Continued on Reverse Side
2) NAME
TITLE
1) NAME
TITLE
PARTNERSHIP
LIMITED LIABILITY PARTNERSHIP
NEW APPLICATION
NAME / ADDRESS CHANGE
OTHER (Specify)
ADD BRANCH LOCATION
DUPLICATE / REPLACEMENT LICENSE
BUSINESS LICENSE #
EMAIL ADDRESS
FAX NUMBER
TELEPHONE NUMBER
(
(
)
STATE OF CALIFORNIA
PEST CONTROL DEALER LICENSE APPLICATION
DPR-PML-041 (REV. 08/11)
Page 2 of 4
G. Pest Control Dealer Type.
Indicate the type(s) of pest control methods/devices or pesticides your business will be selling by checking the appropriate box(es) below.
Agricultural Use Pesticides Only
Restricted Use Pesticides Only (Either California or Federal)
Both Agricultural Use and Restricted Use Pesticides
Tributyltin Other
Livestock/Poultry Pesticides
Biological Control Agents
H. Worker's Compensation Insurance. Each applicant who is an employer, as defined in Section 3300 of the Labor Code, is
required to carry worker's compensation insurance. If your business has no employees, write "Not Applicable" below.
WORKER'S COMPENSATION INSURANCE CARRIER NAME
POLICY NUMBER
EXPIRATION DATE
I. Fees. All fees are non-transferable and non-refundable.
1-Year 2-Year #Branches Total Fees
Main Location
Branch Location
Name/Address Change, Duplicate/Replacement Fee
Total Fee(s) Due/Enclosed $
Enclose a check, money order or credit card payment for the total amount due payable to: Cashier, Department of Pesticide
Regulation. Mail your completed application, required documentation, and fees to: Cashier, Department of Pesticide Regulation,
P.O. Box 4015, Sacramento, California 95812-4015.
J. Read Before Signing. During the last three years, have you had any administrative, civil, or criminal action taken against you
for violation of any State or federal laws or regulations relating to the application or use of pesticides that resulted in disciplinary
actions or in which any disciplinary action is pending?
YES (State explanation below or attach separate page.) NO
K. I declare under penalty of perjury, under laws of the State of California, that the above information is true and correct.
APPLICANT SIGNATURE
DATE SIGNED
FOR OFFICIAL
USE ONLY
BUSINESS LICENSE NUMBER PROBLEM COMPUTER ENTRY DATE
$160 or
$320 -- = $
$80 or $160 x = $
$20 x = $
STATE OF CALIFORNIA
PEST CONTROL DEALER LICENSE APPLICATION INSTRUCTIONS
DPR-PML-041 (REV. 08/11)
Page 3 of 4
A. Application Type.
New Application: If you are applying for the Pest Control Dealer License for the first time.
Add Branch Location: Adding a pest control dealer branch location to your license.
Duplicate/Replacement License: Requesting a duplicate or replacement license.
Name/Address Change: Requesting name/address changes. Submit a copy of the legal document
substantiating the name change. Address changes may be made directly on the application form with a $20
fee.
Other: Any other change, please specify the change.
B. Business Information (Main Location). Complete the information requested in this section. If you are changing
your business name, enter your former business name in Section “C”. If there is a change in business name or
address you must immediately notify the Director in writing. If your business is a:
Corporation, submit a current copy of the “Certificate of Good Standing” which may be obtained from the
Secretary of State, Certificate Department, 1500 11th Street, Sacramento, California 95814.
Limited Liability Company or Limited Liability Partnership, submit a current copy of the “Certificate of
Good Standing” which may be obtained from the Secretary of State, Certificate Department,
1500 11th Street, Sacramento, California 95814.
Partnership, submit a “Fictitious Business Name Statement” which may be obtained from the county clerk’s
office.
Individual, if the business name is different than your surname (last name), submit a “Fictitious Business
Name Statement” which may be obtained from the county clerk’s office.
Non-Profit Association, if the business is a corporation, submit a current copy of the “Certificate of Good
Standing” which may be obtained from the Secretary of State, Certificate Department, 1500 11th Street,
Sacramento, California 95814. If the business name is different than your surname (last name), submit a
“Fictitious Business Name Statement” which may be obtained from the county clerk’s office.
C. Former Business Name. If your business name has changed, enter the former name in this section of the
application.
D. Business Officers or Owners. List the name, title, and mailing address of the business officers and/or owners. If
necessary, use an additional sheet of paper. If there is a change in the business ownership or organization, notify
the Director immediately in writing. A new application and fee must be submitted for this change.
E. Branch Locations. Complete this section to add a branch location to your business. Enter the business location
address for each branch location added. If the branch name is different from the main business name, indicate the
branch name and submit a “Fictitious Business Name Statement” which may be obtained from the county clerk’s
office.
F. Qualified Person. Each principal and branch office must have a qualified person who possesses a valid Pest
Control Dealer Designated Agent License, Agricultural Pest Control Adviser License, Qualified Applicator License, or
Pest Control Aircraft Certificate. The qualified person is responsible for the operations of the pest control business.
Use an additional sheet of paper if necessary. If there is a change in the qualified person for the business, notify the
Director immediately. There is no fee required for this change.
G. Pest Control Dealer Type. Indicate the type of pesticides the business will be selling. Check all that apply.
H. Worker’s Compensation Insurance. Each applicant who is an employer as defined in Section 3300 of the Labor
Code is required to carry worker’s compensation insurance. If applicable, enter the name of the worker’s
compensation insurance carrier, the policy number, and the policy expiration date.
STATE OF CALIFORNIA
PEST CONTROL DEALER LICENSE APPLICATION INSTRUCTIONS
DPR-PML-041 (REV. 08/11)
Page 4 of 4
I. Fees.All fees are non-transferable and non-refundable.
One-Year* Two-Year*
Main Location: $160 $320
Branch Location: $ 80 $160
Name/Address Change Fee: $20 (See Note)
Duplicate/Replacement Fee: $20 (See Note)
NOTE: A fee for an address change is only required when the licensee requests a new license be issued (printed
and mailed). A maximum fee of $20 is due for all name/address changes and requests for a duplicate/replacement
licenses submitted on a single application.
* The following information and table will assist you in determining the appropriate application fee.
New Application Fee Schedule Example: Main License Branch License
Year Submitting License License Application Application
Application Name Expiration Year Fee Fee
2010 A-L 2010 $160 $80
M-Z 2011 $320 $160
2011 A-L 2012 $320 $160
M-Z 2011 $160 $80
2012 A-L 2012 $160 $80
M-Z 2013 $320 $160
If your business name begins with A - L, the expiration date of the business license is on even-numbered years.
If your business name begins with M - Z, the expiration date of the business license is on odd-numbered years.
J. Read Before Signing. Check appropriate box.
K. Declaration/Signature Block. Sign and date your application. Enclose a check, money order or credit card payable
to “Cashier, DPR” and mail to: Cashier, Department of Pesticide Regulation, P.O. Box 4015, Sacramento, California
95812-4015.
Failure to complete or provide the requested information may delay the processing of your application.
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
1001 I STREET
SACRAMENTO, CA 95814-2828
Web site: http://www.cdpr.ca.gov
DPR-105 (Rev. 08/17)
Page 1 of 1
VISA/
M
ASTE
RC
A
RD
T
R
A
N
SA
C
TIO
N
Mail completed application with this payment form
to:
For Licensees: For Continuing Education Sponsors:
ATTN: Cashier Cashier
Department of Pesticide Regulation ATTN: CE
P.O. Box 4015 Department of Pesticide Regulation
Sacramento, CA 95812 P.O. Box 1379
Sacramento, CA 95812
ALL SECTIONS MUST BE COMPLETED. DO NOT E-MAIL OR FAX this form.
FAILURE TO COMPLETE ALL SECTIONS WILL RESULT IN YOUR APPLICATION BEING DELAYED OR REJECTED.
NAME OF CARDHOLDER (NAME APPEARING ON THE CARD)
VISA or MASTERCARD ONLY. No other cards are accepted.
VISA MASTERCARD
CHECK ONE:
CARD NUMBER
(16 DIGITS)
Expiration Date
Total Amount of Payment
SIGNATURE OF CARDHOLDER (NAME APPEARING ON THE CARD)
PAYMENT FOR:
MAILING ADDRESS (Street or P.O. Box Number)
City, State, and ZIP Code TELEPHONE NUMBER (include area code)
(DEPARTMENT USE ONLY) - ENTERED ON POS BY:
TODAY'S DATE
BY:

Navigation menu