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Get Construction Project Experience Form

Cslb. ca.gov STATE OF CALIFORNIA Arnold Schwarzenegger Governor Construction Project Experience Form This form must be completed ONLY if the qualifying individual indicates on the Certification of Work Experience form that he or she obtained experience working on his or her own property as an owner/builder or as otherwise requested by CSLB. CONTRACTORS STATE LICENSE BOARD 9821 Business Park Drive Sacramento CA 95827 Mailing Address P. O. Box 26000 Sacramento CA 95826 800-321-CSLB 2752 www. Use a separate form for each project. If you need additional forms please make a copy of this blank form or visit CSLB s website. Please type or print neatly and legibly in black or dark blue ink. Incomplete forms are not accepted* 1. QUALIFIER S OWNER/BUILDER FULL LEGAL NAME last first 2. PROJECT STREET ADDRESS number/street NO P. O. boxes 3. START DATE Month/Day/Year middle PHONE NUMBER city COMPLETION DATE Month/Day/Year state ZIP code TOTAL PROJECT TIME YEARS and MONTHS 4. TYPE OF PROJECT For example residential room addition 5. TRADES PERFORMED For example framing electrical 6. PROJECT SIZE square feet linear feet or cubic yards Building Other 7. YOUR DUTIES AND WORK YOU PERFORMED For example prepared plans obtained permits installed all sheetrock installed 4-ton HVAC unit 8. YOUR POSITION LEVEL For example trainee apprentice journeyman supervisor 9. EXPLAIN HOW PAST EXPERIENCE TRAINING AND/OR EDUCATION PREPARED YOU FOR THE POSITION AT THE LEVEL STATED IN 8 ABOVE 10. SCOPE OF WORK For example placed 600 sf of mix sod installed 2500 sf of concrete tile roof poured 12 yds of concrete drive installed 20 linear ft of cabinetry 11. NUMBER OF LABORERS AND THE TRADES THEY PERFORMED 12. NUMBER OF GENERAL CONTRACTORS OR SUBCONTRACTORS AND THE TRADES THEY PERFORMED 13. Use a separate form for each project. If you need additional forms please make a copy of this blank form or visit CSLB s website. Please type or print neatly and legibly in black or dark blue ink. Incomplete forms are not accepted* 1. Please type or print neatly and legibly in black or dark blue ink. Incomplete forms are not accepted* 1. QUALIFIER S OWNER/BUILDER FULL LEGAL NAME last first 2. PROJECT STREET ADDRESS number/street NO P. QUALIFIER S OWNER/BUILDER FULL LEGAL NAME last first 2. PROJECT STREET ADDRESS number/street NO P. O. boxes 3. START DATE Month/Day/Year middle PHONE NUMBER city COMPLETION DATE Month/Day/Year state ZIP code TOTAL PROJECT TIME YEARS and MONTHS 4. O. boxes 3. START DATE Month/Day/Year middle PHONE NUMBER city COMPLETION DATE Month/Day/Year state ZIP code TOTAL PROJECT TIME YEARS and MONTHS 4. TYPE OF PROJECT For example residential room addition 5. TRADES PERFORMED For example framing electrical 6. TYPE OF PROJECT For example residential room addition 5. TRADES PERFORMED For example framing electrical 6. PROJECT SIZE square feet linear feet or cubic yards Building Other 7. YOUR DUTIES AND WORK YOU PERFORMED For example prepared plans obtained permits installed all sheetrock installed 4-ton HVAC unit 8.

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