"Pest Control Dealer License Renewal Application Packet" - California

Pest Control Dealer License Renewal Application Packet is a legal document that was released by the California Department of Pesticide Regulation - a government authority operating within California.

Form Details:

  • Released on April 1, 2018;
  • The latest edition currently provided by the California Department of Pesticide Regulation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the California Department of Pesticide Regulation.

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Download "Pest Control Dealer License Renewal Application Packet" - California

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2018RENEWALINFORMATIONFORDPRLICENSEANDCERTIFICATEHOLDERS
Dates   for   Renewal  
Renewal applications need to be signed and must
DPRencouragessubmittingcompletedrenewal
include the required CE records summary and correct
applicationstoDPRbyNovember1,2018,toreceive
fee.
yourlicense/certificatebyDecember31,2018. If
submittedafterNovember1,youmaynotreceive
Continuing   Education  
yourlicense/certificatebyJanuary 1. You cannot work
Licenseandcertificateholdersmustkeepcopiesof
legally without a valid license/certificate.
theirCErecordsforthreeyears.DPRmayrequest
Processingtimeis60days.
copiesofyourCErecordsatanytime.
NotethatsubmittingyourrenewalbeforeOctober,will
SubmittheCERecordsRenewalSummary,
ensureyouhaveyourlicensebyearlyDecemberand
DPR‐PML‐123orasummaryrecordofCEattendance
allowyoutorenewwiththeCountybytheNewYear.
fromathirdpartyprofessionalassociation.
YourCErecordsmustinclude:
Tocheckifyou’rerenewed,gotoDPR’swebsite:
License/Certificate Holder’s Name
<www.cdpr.ca.gov/docs/license/currlic.htm>
License/Certificate Number and Type
Course Location
Address Changes
Always notify DPR immediately of any address or name
Course Title
changes.
Course Date
DPR Course I.D. Number
Course hours attended for each CE category
Mailing of Renewal Packets
Name of instructor or sponsoring organization
DPR is mailing renewal packets in August to provide
Your Signature
sufficient time for license and certificate holders to
submit their applications by November 1. Renewal
General   Information   about   CE   Courses  
applications must be postmarked on or before
DPR does not track CE hours for individuals, but has
December 31, or a late fee applies.
the ability to audit CE records.
If you did not receive your renewal application or lost
DPR approved CE hours must be obtained during the
it, download a renewal packet from DPR’s website:
valid period of the license or certificate. The valid
<www.cdpr.ca.gov/docs/license/liccert.htm> or email
period is listed on the license or certificate (from the
us and request a copy.
‘date of issue’ until the ‘valid through’ date). NO grace
period is given to obtain CE hours. NO CE hours can be
Business License Renewal Application
carried over to the next renewal period.
The following forms will be included in the renewal
packet:
If renewing multiple licenses or certificates, you only
BusinessRenewalApplication
need sufficient CE hours to meet the license with the
RenewalInformationRequest
most CE hours required.
Visa/MasterCardTransactionDPR‐105
Renewal applications must be filled out completely,
Questions   about   your   CE   hours?  
signed, and submitted with the correct fee.
For questions about your CE hours, you must contact
Note: Your qualified applicator must be renewed
the course sponsor or your professional association.
before your business license can be renewed.
See DPR’s website for current or previous years’
courses and sponsors’ contact info:
Individual  
License and Certificate Renewal  
<http://www.cdpr.ca.gov/docs/license/cont_ed_cfm/classes.htm>
The following forms will be included in the renewal
packet:
DPR   List   Serve  
RenewalApplicationDPR‐PML‐141
Sign up for important information and updates from
License/CertificateRenewalInformation
DPR about Licensing and CE:
CERecordsRenewalSummary DPR‐PML‐123
<www.cdpr.ca.gov/docs/dept/listserv/sub1113.htm>
Visa/MasterCardTransactionDPR‐105
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
   
  
 
   
 
 
    
 
 
   
 
 
 
  
 
   
    
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
   
 
 
 
   
 
 
 
 
 
   
 
     
 
  
 
 
 
 
 
   
 
   
 
 
 
   
 
 
   
   
 
 
 
 
 
 
 
   
 
 
   
    
 
 
   
     
 
 
     
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
   
  
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
     
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
   
   
   
 
 
 
 
   
 
 
  
     
 
     
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
   
 
 
 
   
 
   
 
 
 
 
   
 
   
 
 
 
   
   
 
   
 
 
 
   
 
 
 
 
 
 
 
 
   
   
   
 
   
 
   
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
   
   
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
2018RENEWALINFORMATIONFORDPRLICENSEANDCERTIFICATEHOLDERS
Dates   for   Renewal  
Renewal applications need to be signed and must
DPRencouragessubmittingcompletedrenewal
include the required CE records summary and correct
applicationstoDPRbyNovember1,2018,toreceive
fee.
yourlicense/certificatebyDecember31,2018. If
submittedafterNovember1,youmaynotreceive
Continuing   Education  
yourlicense/certificatebyJanuary 1. You cannot work
Licenseandcertificateholdersmustkeepcopiesof
legally without a valid license/certificate.
theirCErecordsforthreeyears.DPRmayrequest
Processingtimeis60days.
copiesofyourCErecordsatanytime.
NotethatsubmittingyourrenewalbeforeOctober,will
SubmittheCERecordsRenewalSummary,
ensureyouhaveyourlicensebyearlyDecemberand
DPR‐PML‐123orasummaryrecordofCEattendance
allowyoutorenewwiththeCountybytheNewYear.
fromathirdpartyprofessionalassociation.
YourCErecordsmustinclude:
Tocheckifyou’rerenewed,gotoDPR’swebsite:
License/Certificate Holder’s Name
<www.cdpr.ca.gov/docs/license/currlic.htm>
License/Certificate Number and Type
Course Location
Address Changes
Always notify DPR immediately of any address or name
Course Title
changes.
Course Date
DPR Course I.D. Number
Course hours attended for each CE category
Mailing of Renewal Packets
Name of instructor or sponsoring organization
DPR is mailing renewal packets in August to provide
Your Signature
sufficient time for license and certificate holders to
submit their applications by November 1. Renewal
General   Information   about   CE   Courses  
applications must be postmarked on or before
DPR does not track CE hours for individuals, but has
December 31, or a late fee applies.
the ability to audit CE records.
If you did not receive your renewal application or lost
DPR approved CE hours must be obtained during the
it, download a renewal packet from DPR’s website:
valid period of the license or certificate. The valid
<www.cdpr.ca.gov/docs/license/liccert.htm> or email
period is listed on the license or certificate (from the
us and request a copy.
‘date of issue’ until the ‘valid through’ date). NO grace
period is given to obtain CE hours. NO CE hours can be
Business License Renewal Application
carried over to the next renewal period.
The following forms will be included in the renewal
packet:
If renewing multiple licenses or certificates, you only
BusinessRenewalApplication
need sufficient CE hours to meet the license with the
RenewalInformationRequest
most CE hours required.
Visa/MasterCardTransactionDPR‐105
Renewal applications must be filled out completely,
Questions   about   your   CE   hours?  
signed, and submitted with the correct fee.
For questions about your CE hours, you must contact
Note: Your qualified applicator must be renewed
the course sponsor or your professional association.
before your business license can be renewed.
See DPR’s website for current or previous years’
courses and sponsors’ contact info:
Individual  
License and Certificate Renewal  
<http://www.cdpr.ca.gov/docs/license/cont_ed_cfm/classes.htm>
The following forms will be included in the renewal
packet:
DPR   List   Serve  
RenewalApplicationDPR‐PML‐141
Sign up for important information and updates from
License/CertificateRenewalInformation
DPR about Licensing and CE:
CERecordsRenewalSummary DPR‐PML‐123
<www.cdpr.ca.gov/docs/dept/listserv/sub1113.htm>
Visa/MasterCardTransactionDPR‐105
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
                                        
 
  
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
License or
DPR Staff Name and Contact Information
Certificate Type
General
LicenseMail@cdpr.ca.gov
Questions
Pest Control
Rebecca Olson
Advisers
Rebecca.Olson@cdpr.ca.gov
Heather Allen
Heather.Allen@cdpr.ca.gov
Qualified
Applicator
License/
Elizabeth Dummert
Certificate
Elizabeth.Dummert@cdpr.ca.gov
Alpha: A‐D, S,T, U‐Z
Regina Maglia
Regina.Maglia@cdpr.ca.gov
Pest Control
Businesses
Alpha: E‐L, M‐R, V
Shernee Tousant
Willie.Tousant@cdpr.ca.gov
Regina Maglia
Pilots (APC/JPC)
Regina.Maglia@cdpr.ca.gov
Dealer
Elizabeth Dummert
Designated
Elizabeth.Dummert@cdpr.ca.gov
Agents
DEPARTMENT OF PESTICIDE REGULATION
STATE OF CALIFORNIA
PEST MANAGEMENT AND LICENSING BRANCH
PEST CONTROL DEALER LICENSE
LICENSING AND CERTIFICATION PROGRAM
RENEWAL APPLICATION
P.O. BOX 4015
DPR-PML-191 (REV. 04/18)
SACRAMENTO, CALIFORNIA 95812-4015
Page 1 of 2
(916) 445-4038
E-Mail: LicenseMail@cdpr.ca.gov
Web site: http://www.cdpr.ca.gov
Business License Number:
Name Change
Mailing Address Change
Business Name:
Address:
City, State, Zip:
Enter Changes Above
IMPORTANT - PLEASE READ
COMPLETE ALL FIELDS BELOW - SEE PAGE 2 FOR COMPLETE INSTRUCTIONS
Qualified Person.
Each business location must have a qualified person who possesses a valid Agricultural Pest Control Adviser License (PCA), Pest
Control Dealer Designated Agent License (DDA), Pest Control Pilot Certificate, or Qualified Applicator License (QAL) to engage in pest
control from each location. If you need additional space, attach a separate sheet of paper.
Main/Branch
Main/Branch Location Address
Qualified Person's Name and License Number
License Number
(The Qualified Person’s license must be renewed before the Dealer License is
renewed)
Fees. Enclose a check, money order, or credit card information for the total amount due. Make payable to "DPR Cashier." ALL
FEES ARE NON-TRANSFERABLE AND NON-REFUNDABLE. Mail the payment, completed application form, and required
documents to: Cashier, Department of Pesticide Regulation, P.O. Box 4015 MS-4A, Sacramento, CA 95812-4015.
Amount Enclosed: $
E-mail Contact (optional) please provide your e-mail address below:
E-MAIL ADDRESS
I declare under penalty of perjury, under laws of the State of California, that the above information provided by me is true and
correct.
SIGNATURE
DATE SIGNED
PRINT NAME
TITLE
Instructions on Page 2
STATE OF CALIFORNIA
PEST CONTROL DEALER LICENSE RENEWAL APPLICATION INSTRUCTIONS
DPR-PML-191 (REV. 04/18)
Page 2 of 2
Failure to complete or provide the requested information will delay the processing of your application.
INSTRUCTIONS: To help ensure that your renewal application is completed before mailing, review the following:
Change of Name/Address. 3CCR Section 6508 requires all license/ certificate holders to notify DPR immediately, in
writing, of any change in information required on the application. Indicate any corrections that appear on the renewal form
in the space provided.
Licenses are not transferable. A new application is required if you had a change of business organization
(Corporation, Partnership, Individual, Non-Profit, Limited Liability, and Limited Liability Partnership), or ownership.
Qualified Person. Each pest control business location (Main or Branch) must have a qualified person who possesses a
valid Agricultural Pest Control Adviser License (PCA), Pest Control Dealer Designated Agent License (DDA), Pest
Control Pilot Certificate, or Qualified Applicator License (QAL) to engage in pest control from each location. Provide the
name(s) and license/certificate number(s) of the qualified person who is responsible for each location in the space
provided on the renewal form. If additional space is needed, attach a separate sheet of paper. If the qualified person’s
license is expiring, they must renew before the dealer license can be renewed.
Fees. All fees are non-transferable and non-refundable. Fees must be paid for each pest control license location
(Main and Branch) as totaled on the renewal form. A late penalty fee of fifty percent (50%) of the renewal fee will be
assessed for each license postmarked after December 31. Enclose a check, money order, or credit card
information payable to “DPR Cashier.”
License Renewal (2 Year) and Late Penalty Fees
Renewal
Late Fee
Renewal
Late Fee
Pest Control Dealer License
Pest Control Dealer License
$320.00
$160.00
$160.00
$80.00
(Branch)
(Main)
Declaration/Signature. Sign, title, and date the renewal application form.
Mail. Send payment, completed renewal application form, and all required documents to:
Cashier, Department of Pesticide Regulation
P.O. Box 4015, MS-4A
Sacramento, California 95812-4015
Your license number will be posted to DPR’s web site <http://www.cdpr.ca.gov/docs/ license/currlic.htm> as soon as your
license is renewed.
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
PEST CONTROL DEALER BUSINESS
PEST MANAGEMENT AND LICENSING BRANCH
LICENSING AND CERTIFICATION PROGRAM
LICENSE RENEWAL INFORMATION
P.O. BOX 4015, MS-4A
PR-PML-134 (REV 4/18)
SACRAMENTO, CA 95812-4015
(916) 445-4038
E-mail: Licensemail@cdpr.ca.gov
Web site: http://www.cdpr.ca.gov
E-mail Address
Business Phone Number
Fax #
A. Officer/Owner Information
Title
Officer/Owner Name
1.
2.
3.
4.
B. Pest Control Sales Information
Please indicate what type of product your pest control dealer business sells.
Check the appropriate box(es):
Sell Agricultural Use Pesticides.
Sell California Restricted Materials or Federal Restricted Use Pesticides.
Sell Antifouling Paints or Coatings Containin g Tributyltin.
Sell Non-Agricultural Use Pesticides.
Sell Methods or Devices (such as Biological Control Agents, Lures or Insect Trapping Devices) for the Control
of Agricultural Pests.