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Initial Application Form 10-17-08

Initial Application Form 10-17-08 2025

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4.8 out of 5

80 votes

The document is an application form for asbestos contractor registration in California, issued by the Department of Industrial Relations, Division of Occupational Safety & Health. It requires detailed information about the contractor's business, including licensing, employee details, previous asbestos activities, and compliance with safety regulations. The application includes sections on medical surveillance, workers' compensation insurance, personnel training, and assurances from management regarding adherence to safety standards. Additionally, it outlines the submission process and necessary fees.

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Click ‘Get Form’ to open the Initial Application Form 10-17-08 in the editor.
Begin with Part I: General Information. Fill in your Contractor License Number, Entity Name, and DBA if applicable. Provide your main office address, including city, state, and zip code.
Complete the contact information section by entering your telephone number, fax number, email address, and website address.
In Part II: Contractor Information, specify your licensing details and primary business type. Ensure you indicate whether your CSLB license includes asbestos certification.
Proceed to Part III: Medical Surveillance & Workers’ Compensation Insurance Coverage. Indicate your insurance status and attach necessary documentation.
For Parts IV and V, attach the required personnel roster and safety program documents as specified.
Finally, review Part VI: Assurances and Declarations. Ensure all statements are initialed by the appropriate management representative before signing.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (80 Votes)
2011	4.5 Satisfied (53 Votes)

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