Business License Tax Application LLC

BUSINESS LICENSE TAX APPLICATION

NEW LIC   Number of Employees: Full Time Part Time Temporary Square Footage

CHANGE   Date of Change   Bus Lic #

NOTE: Any change in ownership, address, or business activity, requires a new application. The City of Stockton does not guarantee that information on this form will be exempt from disclosure under the Public Records Act.

BUSINESS INFORMATION:

1. Business Name (DBA) Phone ( )

2. Business Address Ste/Apt # City State Zip

(Cannot be PO Box per CA Bus & Prof Code Section 17538.5) (List address where each individual consent to receive service of process AB2184 Sec 1600.)

3. Business Mailing Address Ste/Apt # City State Zip

(If different from the service process address/Business address)

4. Business Email Address

6. Detail Description of Business Activity

7. Standard Industrial Classification (SIC): Major Group:

8. Are you Chamber of Commerce Green Certified? Yes No

(For information contact Chamber of Commerce (209) 547-2770)

9. Start date in the City of Stockton Estimated Monthly Gross Receipts in Stockton $

10. Contractor’s only: Project Amount CA Contractor’s License #

Classification Expiration Date Annual Quarterly Contractors License

11. Seller’s Permit # SS# or Tax ID #

12. Check One: Single Owner Partnership Corporation LP LLC

OWNER(S) INFORMATION: (The following personal information is not public and will not be shared in accordance with city policy OL-103.) Proof of compliance with Business and Professions Code Section 17538.5(b)(2)(A)(B) may be submitted in lieu of home address.

1. Name Address

City State Zip Home Phone ( )

Date of Birth Driver’s Lic or Other I.D.# State

2. Name Address

City State Zip Home Phone ( )

Date of Birth Driver’s Lic or Other I.D.# State

**ALTERED OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED**

CORPORATION, LLC, or LP INFORMATION: (Must be Registered in California)

Name Corp/LLC/LP #

Names of Officers/Members

President: Secretary:

Vice President: Treasurer:

Authorized Agent: Contact Phone #

Authorized Agent: Contact Phone #

PLEASE NOTE:

The Issuing of your Business License is for revenue purposes only. It does not relieve you from the responsibility of complying with the requirements of any other department of the City of Stockton and/or any other ordinance, law or regulation of the City of Stockton, State of California, or any other governmental agency.

Business Licenses are not transferable. It is your responsibility to renew your Business License whether or not you receive a renewal notice. If you are no longer conducting business in the City of Stockton, you must notify us in writing. To appeal a business license that has been denied see SMC 5.04.210.A.

I HAVE READ AND UNDERSTAND THE TERMS ABOVE • I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT.

Disability Access and Education Fee (SB 1186)

**State Mandated Disability Access and Education Revolving Fund.

Under federal and state law, compliance with disability access laws is a serious and significant responsibility that applies to all California building owners and tenants with buildings open to the public. You may obtain information about your legal obligations and how to comply with disability access laws at the following agencies:

o The Division of the State Architect at www.dgs.ca.gov/dsa/Home.aspx.

o The Department of Rehabilitation at www.rehab.cahwnet.gov.

o The California Commission on Disability Access at www.ccda.ca.gov.

BELOW IS FOR OFFICE USE ONLY: PLEASE DO NOT WRITE IN ADDITIONAL INFORMATION BELOW THIS LINE

PLEASE RETAIN A COPY FOR YOUR RECORDS