Form HCD OL90 "Application for Mh-Unit/Commercial Modular 90-day Certificate" - California

What Is Form HCD OL90?

This is a legal form that was released by the California Department of Housing & Community Development - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2009;
  • The latest edition provided by the California Department of Housing & Community Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form HCD OL90 by clicking the link below or browse more documents and templates provided by the California Department of Housing & Community Development.

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Download Form HCD OL90 "Application for Mh-Unit/Commercial Modular 90-day Certificate" - California

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STATE OF CALIFORNIA
BUSINESS TRANSPORTATION AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMIENT
DIVISION OF CODES AND STANDARDS
OCCUPATIONAL LICENSING PROGRAM
APPLICATION FOR MH-UNIT/COMMERCIAL MODULAR
90-DAY CERTIFICATE
SECTION 1 – PURPOSE OF APPLICATION
Check the appropriate box(es) to indicate the purpose of this application submittal and follow the instructions.
Applying for an Original 90-Day Certificate
Certificate Holder: Complete Sections 1, 2 and 6; and pay the fee of $134*, plus $13*
Dealer: Complete Sections 3, 4 and 5
Change in Supervising Managing Employee
Dealer: Complete Sections 1, 3 and 4; and pay the fee of $45*
Change in Employment of a
Certificate Holder: Complete Sections 1, 2 and 6; and pay the fee of $45*
90-Day Certificate Holder
New Dealer: Complete Sections 3, 4 and 5
*
THIS APPLICATION SHALL BE ACCOMPANIED BY THE APPROPRIATE FEES IN ACCORDANCE WITH THE CALIFORNIA
CODE OF REGULATONS, TITLE 25, CHAPTER 4, SECTION 5040 AND CHAPTER 5.5, SECTION 5814.
SECTION 2 – APPLICANT INFORMATION
(Type or Print)
90-DAY CERTIFICATE NUMBER (
): _______________________ HOME TELEPHONE NUMBER: (____) _______________
If applicable
APPLICANT NAME: _____________________________________________________________________________________________
Last
First
Middle
RESIDENCE ADDRESS: _________________________________________________________________________________________
Number and Street
City
State
ZIP Code
MAILING ADDRESS: ____________________________________________________________________________________________
(If different)
Number and Street or P.O. Box
City
State
ZIP Code
FORMER EMPLOYING DEALER (
): ________________________________________________________________________
If applicable
E-MAIL ADDRESS
: ___________________________________________________________________________________
(If applicable)
SECTION 3 – EMPLOYER INFORMATION
(Type or Print)
LICENSE NUMBER: _____________________________________
TELEPHONE NUMBER: (_____) _________________________
DEALERSHIP NAME: ____________________________________________________________________________________________
DEALERSHIP ADDRESS: ________________________________________________________________________________________
Number and Street
City
State
ZIP Code
LOCATION OF EMPLOYMENT: ___________________________________________________________________________________
(If different than dealership address)
Number and Street
City
State
ZIP Code
SECTION 4 – SUPERVISING MANAGING EMPLOYEE INFORMATION
(Type or Print)
Check if this is a change of the supervising managing employee responsible for supervising the 90-day certificate holder
LICENSE NUMBER: _____________________________________
SUPERVISING MANAGING EMPLOYEE NAME: ______________________________________________________________________
Last
First
Middle
SIGNATURE_____________________________________________________ DATE ________________________________________
The designated employee responsible for the supervising of the 90-day certificate holder hereby certifies that he/she shall
directly supervise the employed applicant identified herein.
Page 1 of 2
HCD OL 90 (Rev. 06/09)
STATE OF CALIFORNIA
BUSINESS TRANSPORTATION AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMIENT
DIVISION OF CODES AND STANDARDS
OCCUPATIONAL LICENSING PROGRAM
APPLICATION FOR MH-UNIT/COMMERCIAL MODULAR
90-DAY CERTIFICATE
SECTION 1 – PURPOSE OF APPLICATION
Check the appropriate box(es) to indicate the purpose of this application submittal and follow the instructions.
Applying for an Original 90-Day Certificate
Certificate Holder: Complete Sections 1, 2 and 6; and pay the fee of $134*, plus $13*
Dealer: Complete Sections 3, 4 and 5
Change in Supervising Managing Employee
Dealer: Complete Sections 1, 3 and 4; and pay the fee of $45*
Change in Employment of a
Certificate Holder: Complete Sections 1, 2 and 6; and pay the fee of $45*
90-Day Certificate Holder
New Dealer: Complete Sections 3, 4 and 5
*
THIS APPLICATION SHALL BE ACCOMPANIED BY THE APPROPRIATE FEES IN ACCORDANCE WITH THE CALIFORNIA
CODE OF REGULATONS, TITLE 25, CHAPTER 4, SECTION 5040 AND CHAPTER 5.5, SECTION 5814.
SECTION 2 – APPLICANT INFORMATION
(Type or Print)
90-DAY CERTIFICATE NUMBER (
): _______________________ HOME TELEPHONE NUMBER: (____) _______________
If applicable
APPLICANT NAME: _____________________________________________________________________________________________
Last
First
Middle
RESIDENCE ADDRESS: _________________________________________________________________________________________
Number and Street
City
State
ZIP Code
MAILING ADDRESS: ____________________________________________________________________________________________
(If different)
Number and Street or P.O. Box
City
State
ZIP Code
FORMER EMPLOYING DEALER (
): ________________________________________________________________________
If applicable
E-MAIL ADDRESS
: ___________________________________________________________________________________
(If applicable)
SECTION 3 – EMPLOYER INFORMATION
(Type or Print)
LICENSE NUMBER: _____________________________________
TELEPHONE NUMBER: (_____) _________________________
DEALERSHIP NAME: ____________________________________________________________________________________________
DEALERSHIP ADDRESS: ________________________________________________________________________________________
Number and Street
City
State
ZIP Code
LOCATION OF EMPLOYMENT: ___________________________________________________________________________________
(If different than dealership address)
Number and Street
City
State
ZIP Code
SECTION 4 – SUPERVISING MANAGING EMPLOYEE INFORMATION
(Type or Print)
Check if this is a change of the supervising managing employee responsible for supervising the 90-day certificate holder
LICENSE NUMBER: _____________________________________
SUPERVISING MANAGING EMPLOYEE NAME: ______________________________________________________________________
Last
First
Middle
SIGNATURE_____________________________________________________ DATE ________________________________________
The designated employee responsible for the supervising of the 90-day certificate holder hereby certifies that he/she shall
directly supervise the employed applicant identified herein.
Page 1 of 2
HCD OL 90 (Rev. 06/09)
SECTION 5 – EMPLOYING DEALER CERTIFICATION
I, _________________________________________________________________________________________, certify
Type or Print First, Middle and Last Name
under penalty of perjury under the laws of the State of California that I have reviewed the information contained in this
application and intend to employ the above-named applicant as a MH-Unit/commercial modular 90-day certificate holder. I
further certify and acknowledge that the above-named applicant will not act as a 90-day certificate holder until he/she
receives and delivers to me the 90-day certificate issued by the California Department of Housing and Community
Development (HCD). I further certify and acknowledge that the 90-day certificate holder will not continue to be employed
under my license, beyond the specified 90-day period, unless the certificate holder has become fully licensed as a
salesperson.
SIGNATURE ___________________________________________________________________________________________________
TITLE __________________________________________________________________ DATE ________________________________
EXECUTED IN THE COUNTY OF ____________________________________________ STATE OF ____________________________
SECTION 6 – APPLICANT CERTIFICATION
I, _________________________________________________________________________________________________, certify under
Type or Print First, Middle and Last Name
penalty of perjury under the laws of the State of California that the information given on this application is true and correct to the best of my
knowledge and belief.
SIGNATURE _____________________________________________________________ DATE ________________________________
EXECUTED IN THE COUNTY OF ____________________________________________ STATE OF ____________________________
SUBMIT APPLICATION AND FEES TO:
Department of Housing and Community Development
Division of Codes and Standards
Occupational Licensing Program
P.O. Box 31
Sacramento, CA 95812-0031
SECTION 7 – APPEAL RIGHTS
You, the applicant, may appeal directly to the Director of HCD and/or the Secretary of the Business,
Transportation and Housing Agency for a timely resolution of any dispute arising from a violation of the time
periods within which HCD must process this application. The appeal shall be decided in your favor, if HCD
exceeds the maximum time period of issuance or denial of the certificate and has failed to establish good cause
for reimbursement of any and all filing fees paid to HCD, in accordance with the California Code of Regulations,
Title 25, Chapter 4, Section 5020.5(g).
Director
Department of Housing and Community Development
P.O. Box 31
Sacramento, CA 95812-0031
(916) 323-9803
Secretary
Business, Transportation and Housing Agency
980 9th Street, Suite 2450
Sacramento, CA 95814
(916) 323-5400
Page 2 of 2
HCD OL 90 (Rev. 06/09)
Page of 2