This document is a declaration of non-employer status for the City of Huntington Beach. It states that the State of California requires all businesses to provide workers compensation insurance if they have employees. It provides a form for individuals or companies without employees to declare their non-employer status and return to the City of Huntington Beach. Signing the form certifies the applicant has no employees and authorizes the City to revoke any permits if they hire employees in the future requiring workers compensation insurance.