Individual License/Certificate Renewal Application Packet
2024 Renewal Information for DPR License and Certificate Holders
Dates for Renewal
October 1,
2024
DPR encourages submitting completed
renewal applications to DPR by this
date to best ensure you receive your
new license/certificate before January
1, 2025.
November 1,
2024
Processing time is 60 days for
applications with payments processed
by this date. Applications received
after Nov 1 may experience a longer
processing time and you may not
receive your license/certificate by
January 1.
January 1,
2025
Your license/certificate must be
renewed by this date to continue
working legally and without
interruption.
Address Changes
Always notify DPR in writing immediately of any
address or name changes. When emailing DPR it is best
to include your full name (First MI Last) or business
name, as well as your DPR License or Certificate
Number.
Mailing of Renewal Packets
DPR is mailing renewal packets in August to provide
sufficient time for license and certificate holders to
submit their applications by October 1. Renewal
applications must be postmarked on or before
December 31, or a late fee applies.
If you did not receive your renewal
application or misplaced it, download a
renewal packet from DPR’s website.
Qualified Person for Business
Business applications are held until the Qualified
Person’s license or certificate has processed. It is best
to submit the Business and Qualified Person’s
individual application by October to allow time to
register with the county before the New Year.
Individual License and Certificate Renewal
The following forms will be included in the renewal
packet:
•
Renewal
Application
•
License/Certificate
Renewal Information
•
CE Records Renewal Summary
•
Visa/MasterCard
Transaction
Renewal applications need to be signed and
must include the required CE records
summary and correct fee.
Check your renewal sta
tus on DPR’s
Valid License Web page:
Continuing Educati
on
You must retain copies of your CE records for three
years. DPR may request copies of your CE records to
audit at any time. DPR does not track CE hours for
individuals.
Your CE records must in
clude:
•
License/Certificate
holder’s
name
•
License/Certificate number and type
•
Course location
•
Course title
•
Course date
•
DPR course I.D. code
•
Course hours attended for each CE category
•
Name of instructor or sponsoring organization
•
Your signature
The CE Record Renewal Summary (LIC-141 Page 2) is
now a r
equired document. Submit this form with your
renewal application.
General Informati
on about CE Courses
DPR-approved CE hours must be ob
tained during the
valid period of the license or certificate. The valid
period is listed on the license or certificate (from the
‘date of issue’ until the ‘valid through’ date). No grace
period is given to obtain CE hours. No CE hours can be
carried over to the next renewal period.
If renewing multiple l
icenses or certificates, you only
need sufficient CE hours to meet the
license/certificate with the most CE hours required.
Questions about your CE hours?
For questions about your CE hours,
you must contact the course sponsor
or your professional association. See
DPR’s website for current or previous
years’ courses and sponsors’ contact info.
DPR Electronic Mailing List
Sign up for important information
and updates from DPR about
Licensing and CE.
License or Certificate
Type
DPR Staff Name and Contact Information
General Questions LicenseMail@cdpr.ca.gov
Pest Control Advisers
(PCA)
Amber Rousseau
Ambe
r.Rousseau@cdpr.ca.gov
Qualified Applicator
License/Certificate
(QAL/QAC)
Robin Caserta
Robi
n.Caserta@cdpr.ca.gov
Pest Control Businesses
Alpha: A-D, S-Z
Regina Maglia
Regina.Maglia@cdpr.ca.gov
Alpha: E-R
Heather Allen
Heat
her.All[email protected].gov
Pilots
Manned and
Unmanned
(APC/JPC/Vector)
Kenneth King
Kenneth.King@cdpr.ca.gov
Dealer Designated
Agents (DDA)
Regina Maglia
Regin
a.Maglia@cdpr.ca.gov
State of California
Individual License/Certificate Renewal Application
LIC-141 (Rev. 07/24) Page 1 of 3
Department of Pesticide Regulation
Licensing and Certification Program
PO Box 4015
Sacramento, California 95812-4015
E-Mail: [email protected]
Web site: http://www.cdpr.ca.gov/
Return application and continuing education (CE) hours by mail.
The mailing address indicated on this application is your address of record for your license/certificate, therefore, it is public information.
To use a post office box in lieu of the physical address or to submit any other address change, indicate in box below.
Name: _________________________________________
Address: _______________________________________
City, State, ZIP: __________________________________
Cell or Home Phone Number: _______________________
E-Mail
Address:
__________________________________
Information is Correct Information has Changed (see below)
For Complete Instructions,
See Page 3.
CE hours must be completed by the expiration date on your license/certificate.
Current License/Certificate
Number(s), Type, and Category(ies)
Renewal
License/
Certificate?
(Circle Y or N)
Required CE hours to renew all licenses and
certificates
Renewal
Fees
Late Fees
Laws
Aerial Other
Total CE
Hours
Postmarked on
or before 12/31
Postmarked
after 12/31
(see page 3)
Y / N
$
Y / N
$
Y / N
$
Y / N
$
Enter the number of CE hours you have completed.
Laws
Aerial Other
Total CE
Hours
Total Due
(Include late fees if applicable)
Continuing Education Record Renewal Summary.
Submit a Continuing Education Record Renewal Summary located on page 2 of this application.
Fees. All fees are non-transferable and non-refundable.
Medical Certificate Card. Manned Apprentice and Journeyman Pilots must submit a copy.
Vector Control Technician certification (Category B). Unmanned Vector Control Technician Pilots must submit a copy.
I declare under penalty of perjury, under laws of the State of California, that the submitted information is true and correct.
Signature Date Signed
Employer/Business Name: ______________________
____________________________________________
____________________________________________
Business Phone Number: _______________________
Information is Correct
Information has Changed (see below)
Employer/Business Information
Information Corrections
License/Certificate Holder Information: ____________________________________________________________________________________
Employer/Business Information: __________________________________________________________________________________________
Continuing Education.
-
Excess "Laws" hours can be used towards "Other." Only pest control aircraft pilots may use excess “Aerial” hours towards “Other.”
$ 0
CE Hours Completed
Laws and Regulations (L)
Aerial Application and
Techniques (A)
Other (O)
Total Hours (T)
Applicant Name Certificate/License Type Certificate/License Number
Continuing Course Education Information
Course Title
DPR Course I.D. Code
(L) (A) (O) (T)
Name of CE Sponsor
Course Completion Date
Location (City and State)
Course Title
DPR Course I.D. Code
(L) (A) (O) (T)
Name of CE Sponsor
Course Completion Date
Location (City and State)
Course Title
DPR Course I.D. Code
(L) (A) (O) (T)
Name of CE Sponsor
Course Completion Date
Location (City and State)
Course Title
DPR Course I.D. Code
(L) (A) (O) (T)
Name of CE Sponsor
Course Completion Date
Location (City and State)
Course Title
DPR Course I.D. Code
(L) (A) (O) (T)
Name of CE Sponsor
Course Completion Date
Location (City and State)
Course Title
DPR Course I.D. Code
(L) (A) (O) (T)
Name of CE Sponsor
Course Completion Date
Location (City and State)
Course Title
DPR Course I.D. Code
(L) (A) (O) (T)
Name of CE Sponsor
Course Completion Date
Location (City and State)
Total CE Hours _
State of California
Continuing Education Record Renewal Summary
LIC-141 (Rev. 07/24)
Page 2 of 3
Instructions (Electronic fillable copies of this form are available on DPR’s website.)
1. Before the "Continuing Education Course Information" section, enter the following: applicant name, certificate/license type, and
certificate/license number. For each approved continuing education (CE) course completed, enter the following: title of course, name of CE
sponsor, DPR course I.D. code, location of course, course completion date, and hours attended in each CE category. CE hours must be DPR-
approved courses and obtained during the valid period of your license/certificate. Excess CE hours cannot be carried over to your next renewal
period. You must meet the minimum required CE hours for “Laws,” and “Aerial,” if required; extra hours in “Laws” may be applied towards “Other.”
On
ly pest control aircraft pilots may use excess “Aerial” hours towards “Other.” In the boxes located in t
he bottom right- hand c
orner, enter the
total number of CE hours you have completed for the current renewal period. The Continuing Education Record Renewal Summary form must be
returned with your renewal application. If the information on this form is incomplete, the processing of your renewal will be delayed.
Use an additional sheet of this form if necessary.
2. Do not s
ubmit application and fee unless all required CE hours have been completed. If you fail to complete the required minimum CE hours
by December 31 of your expirati
on year, you will be required to re-examine in laws and regulations, as well as categories you want to hold. A
person who violates California's pesticide laws and regulations including making a false or fraudulent statement, record, report, or use any fraud
or misrepresentation with meeting any license requirement is subject to penalties up to $5,000 per violation; this includes falsifying a CE record.
State of California
Individual License/Certificate Renewal Application Instructions
LIC-141 (Rev. 07/24) Page 3 of 3
Failure to complete or provide the requested information may delay the processing of your application.
DPR will only disclose personally identifiable information, such as home phone number and personal email address, to
third parties as required by state or federal law or regulation and consistent with the Information Practices Act (Civ.
Code, sections 1798-1798.78).
Changes in Information: License/certificate holders shall notify DPR immediately of any changes in information including,
but not limited to: name changes, address changes, phone number changes, and employer/business information changes.
Name changes shall include a copy of government-issued identification as proof of identity and name change. This proof of
identity shall include the individual’s previous name and their new name. Indicate any corrections to the information included
on the front of the renewal form in the space provided.
License(s)/Certificate(s) to be renewed: Verify or list all license(s) and/or certificate(s) to be renewed.
Submit a Continuing Education Records Renewal Summary form located on page 2 of
this application. Electronic
fillable copies of this form are also available on DPR’s website. Please note the following when submitting CE hours:
•
CE hours must be DPR-approved courses and obtained during the valid period of your license/certificate.
•
Excess CE hours cannot be carried over to your next renewal period.
•
You must meet the minimum required CE hours for “Laws,” and “Aerial,” if required; extra hours in “Laws” may be applied
towards “Other.” Only pest control aircraft pilots may use excess “Aerial” hours towards “Other.”
•
If renewing multiple licenses or certificates, you only need to complete CE hours for the license or certificate with the most
CE hours required,
including specific category hours required (e.g. “Aerial”).
Medical Certificate Card (Manned Apprentice and Journeyman Pilots Only): Submit a copy of your valid medical
certificate card issued by the Federal Aviation Administration. DPR requires this information to determine compliance with
Food and Agricultural Code Section 11901(a).
Department of Public Health Vector Control Technician certification (Category B-mosquito): Unmanned Vector Control
Technician pilots are required to submit a copy of their certification.
Fees: All fees are non-transferable and non-refundable. Fees must be paid for each renewed license and/or certificate. A
late penalty fee of fifty percent (50%) of the renewal fee will be assessed for each license and/or certificate postmarked
after December 31.
License Renewal (2 Year) and Late Penalty Fees
License Type
Fee
Late
License Type Fee Late
Agricultural Pest Control Adviser $320 $160 Qualified Applicator Certificate
$140
$70
Qualified Applicator License $270 $135
Dealer Designated Agent
License
$110 $55
Pest Control Aircraft Pilot
Certificate, Manned
$200 $100
Pest Control Aircraft Pilot
Certificate, Unmanned
$200 $100
Declaration/Signature: Sign here to indicate that all of the information submitted is true and correct.
Payment: Enclose a check or money order payable to “Cashier, Department of Pesticide Regulation” or credit card payment.
Mail:
•
Send payment;
•
Completed renewal application form including the Continuing Education Records Renewal Summary form;
•
Pilot’s Federal Aviation Administration medical certificate or Vector Control certification (if applicable); and
•
Mail to:
Department of Pesticide Regulation
Attn
: Cashier MS-4A
PO Box 4015
Sacramento, CA 95812-4015
Questi
ons? Your name and license/certificate number will be posted to the valid license list on DPR’s Web site as soon as
your application is approved and logged into the database. For other questions about your application, please contact the
Licensing and Certification Program at (916) 445-4038 or by E-Mail at LicenseM[email protected]ov.
License/Certificate Renewal Information
Providing this information is optional
(please complete the appropriate information below for license/certificate)
A. LICENSE/CERTIFICATE HOLDER INFORMATION
Name:
First Last
E-mail Address: Home/Cell Phone:
B. EMPLOYER/BUSINESS INFORMATION
Employer/Business Name: Business Phone:
Address City State Zip Code
C. TYPE OF EMPLOYER/BUSINESS
(Please check the appropriate boxes)
Currently inactive in pest control work.
Work for governmental agency.
City County State Federal
Work for special government district.
Irrigation District School District Mosquito Abatement
Other:
Work for a company that does its own pest control and does not offer its pest control services for hire to other persons.
Work for or own a Pest Control Business (check applicable ones):
Maintenance Gardener Pest Control Business Pest
Pest Control Business (for hire) - Aerial
Control Business (for hire) - Ground
Manufacturing/Distributing Chemical Company
Farm Labor Company
Pesticide Dealer Business
Other:
Independent Agricultural Pest Control Adviser
D. CLASSIFICATION OF PESTICIDES
Please indicate the classification of pesticide(s) you may recommend, sell or supervise the use of, by checking the appropriate box(es) below.
Federal Restricted Use Pesticides
General Use Pesticides
California Restricted Materials
Not involved with application or supervising the use of pesticides
E. COUNTY REGISTRATION INFORMATION
Please indicate the county(ies) you will be working in by checking the appropriate box(es) below:
1. Alameda 10. Fresno 19. Los Angeles 28. Napa 37. San Diego 46. Sierra 55. Tuolumne
2. Alpine 11. Glenn 20. Madera 29. Nevada 38. San Francisco 47. Siskiyou 56. Ventura
3. Amador 12. Humboldt 21. Marin 30. Orange 39. San Joaquin 57. Yolo
48. Solano
4. Butte 13. Imperial 22. Mariposa 31. Placer 40. San Luis Obispo 49. Sonoma 58. Yuba
5. Calaveras 14. Inyo 23. Mendocino 32. Plumas 41. San Mateo 50. Stanislaus
6. Colusa 15. Kern 24. Merced 33. Riverside 42. Santa Barbara 51. Sutter
7. Contra Costa 16. Kings 25. Modoc 34. Sacramento 43. Santa Clara 52. Tehama
8. Del Norte 17. Lake 26. Mono 35. San Benito 44. Santa Cruz 53. Trinity
9. El Dorado 18. Lassen 27. Monterey 36. San Bernardino 45. Shasta 54. Tulare
-- -- --
◻
◻
/
State of California
Department of Pesticide Regulation
Sacramento, CA
Web site:
http://www.cdpr.ca.gov
Email: [email protected]
DPR-105-A (Rev. 7/20)
Page 1 of 1
Licensing Visa / Mastercard Transaction Form
Complete this payment form and mail with completed application form(s) to:
ATTN: Cashier
Department o
f Pestic
ide Regulation
PO Box 4015
Sacramento,
CA 95812-4015
All sections must be completed. Do not e-mail or fax this form. Electronically received forms will not be
accepted.
Failure to complete all sections of this form will result in your application and payment being delayed or rejected.
Cardholder Information.
Name (as it appears on the card) Telephone Number
Card Information. (Visa and Mastercard only. No other cards are accepted)
Card Type (check one):
Visa Mastercard
Card Number (16 digits):
Expiration Date: Billing ZIP Code:
Total Amount of Payment: $
Signature of Cardholder
Billing Address (Street or PO Box Number)
If the cardholder is not the licensee, or if the cardholder is paying for multiple licensees, indicate who the
payment is for below. Please attach an additional sheet if needed.
1) Licensee Name
4) Licensee Name
License Number
(if applicable):
License Number
(if applicable):
2) Licensee Name 5) Licensee Name
License Number
(if applicable): License Number (if applicable):
City State
ZIP Code
3) Licensee Name 6) Licensee Name
License Number
(if applicable): License Number (if applicable):
(Department Use Only) – Entered on POS by: Date Entered: Date Mailed: Mailed By:
Notes:
( )