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APPLICATION FOR RETIRED LICENSE

($300 APPLICATION FEE)

NAME: (NAME ON LICENSE RECORD)

FOR OFFICE USE ONLY RECEIPT # ________________ FEE PAID ________________

EXP. DATE ________________

LICENSE NUMBER:

PRESENT ADDRESS:

(STREET AND NUMBER OR P.O. BOX)

BIRTH MONTH:

CITY:

STATE:

ZIP CODE:

LICENSE EXPIRATION DATE:

SOCIAL SECURITY NUMBER*: ___ ___

DAYTIME PHONE NUMBER: ( )

TYPE OR PRINT NAME EXACTLY HOW YOU WANT IT TO APPEAR ON YOUR WALL CERTIFICATE (ONLY LEGAL NAME/ABBREVIATION):

Pursuant to Section 5600.4 of the Business and Professions Code, Chapter 3, Division 3: (a) The board shall issue, upon application and payment of the fee fixed by this chapter, a retired license to an architect who holds a license that is current and active or capable of being renewed pursuant to Section 5600.2 and whose license is not suspended, revoked or otherwise punitively restricted by the board or subject to disciplinary action under this chapter. (b) The holder of a retired license issued pursuant to this section shall not engage in any activity for which an active architect's license is required. An architect holding a retired license shall be permitted to use the title "architect retired" or "retired architect." (c) The holder of a retired license shall not be required to renew that license. (d) In order for the holder of a retired license issued pursuant to this section to restore his or her license to active status, the holder of a retired license shall comply with Section 5600.3. To apply for a retired license, please complete this application, attach a money order, cashier's check, or personal check in the amount of $300 made payable to the CALIFORNIA ARCHITECTS BOARD, and mail to 2420 Del Paso Road, Suite 105, Sacramento, CA 95834. DO NOT SEND CASH. For more information, see the reverse side of this application.

CERTIFICATION

I hereby certify that I have read and understand both sides of this form. SIGNATURE OF APPLICANT DATE

* See reverse side

19L-5 (1/2011)

IMPORTANT PLEASE READ CAREFULLY

Pursuant to Section 5600.3 of the Business and Professions Code, "a license which is not renewed within five years after its expiration may not be renewed, restored, reissued, or reinstated thereafter. The holder of the expired license may apply for and obtain a new license only if he or she pays all of the fees, and meets all of the requirements set forth in this chapter for obtaining an original license..." Your architect license must be renewed and kept in good standing for you to practice architecture in the State of California. The practice of architecture by any individual whose license is not current and in good standing, for any reason, is punishable as a misdemeanor under Sections 5536 and 5536.1 of the Business and Professions Code. RETIRED LICENSE - - Effective January 1, 1993, Section 5600.4 of the Business and Professions Code, Chapter 3, Division 3, states: (a) The board shall issue, upon application and payment of the fee fixed by this chapter, a retired license to an architect who holds a license that is current and active or capable of being renewed pursuant to Section 5600.2 and whose license is not suspended, revoked, or otherwise punitively restricted by the board or subject to disciplinary action under this chapter. (b) The holder of a retired license issued pursuant to this section shall not engage in any activity for which an active architect's license is required. An architect holding a retired license shall be permitted to use the title "architect retired" or "retired architect." (c) The holder of a retired license shall not be required to renew that license. (d) In order for the holder of a retired license issued pursuant to this section to restore his or her license to active status, the holder of a retired license shall comply with Section 5600.3. HANDICAPPED ACCESS - - In accordance with Section 5600.1 of the Business and Professions Code, informational materials on requirements for interior and exterior barrier-free design can be obtained by contacting the following agencies: Dept. of Rehabilitation Community Access/ Rehabilitation Engineering 830 K Street Mall, Room 128 Sacramento, CA 95814 (916) 322-3078 Division of the State Architect Access Compliance Unit 1102 Q Street Suite 5100 Sacramento, CA 95814 (916) 323-2292 (916) 445-9471 Dept. of Housing & Community Development Division of Codes and Standards P.O. Box 1407 Sacramento, CA 95812-1407

*Disclosure of your social security number is mandatory. Collection is authorized by Section 30 of the Business and Professions Code and Public Law 94-455 [42 U.S.C.A.(c)(2)(C)]. Your social security number will be used exclusively for tax enforcement purposes, for purposes of compliance with any judgment or order for family support in accordance with Section 11350.6 of the Welfare and Institutions Code, or for verification of licensure or examination entity which utilizes a national examination and where licensure is reciprocal with the requesting state. If you fail to disclose your social security number, you will be reported to the Franchise Tax Board which may assess a $100 penalty against you.

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