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TOWN OF DANVILLE Please Check One  New Application 510 La Gonda Way • Danville, CA 94526 (925) 314-3326 www.ci.danville.ca.us  Change of Owner  Change of Address  Change of Business Name BUSINESS LICENSE APPLICATION  Home Occupation Business Name Bus. Start Date Business Owner Name State Resale No. Federal ID No. Business Address State Employer ID No. (Cannot be P.O. Box per State of California Business & Professions Code-Section 17538.5) State Contractors Lic. No. State Lic. Type Mailing Address Expire Date Email Address Business Phone Fax No. APN Number Description of Business Business Location  Owned If Rental: List Building Enter below names of Owners, Partners, or Corporate Officers (attach additional sheet, if necessary) Owner Name Building Owner Address Title 1st Owner Name  Corporation  Corp-Ltd Liability Ownership  Partnership  Sole Proprietor  Trust  Rented Home Address (Cannot be P.O. Box) Driver Lic. No. Cell / Pager No. Home Phone No. Soc. Sec. No. Title 2nd Owner Name Home Address (Cannot be P.O. Box) Driver Lic. No. Home Phone No. Contact Name Phone # Cell # Alarm Company, if applicable (attach additional sheet) Company Name License # O F Phone # Approved  Date Denied  C I A L Received By Amount CK# Permit # Zoning Police Business License # L sign the appropriate statement on the fee schedule. The fee schedule is attached. Please select the proper fee for your business and show your calculation here: Class: Other: A B C C1 (Circle One) Flat Fee $ TOBACCO RETAILER'S LICENSE Audit  Home Occupation  Y  If you are no longer doing business in Danville, BUSINESS FEE CALCULATION Does your business have hazardous materials on site? Yes  No  E N EXEMPTIONS AND OUT OF BUSINESS HAZARDOUS MATERIALS Land Use O DBA Personal Email (internal use only) Business Email (for customers) Website URL statement on the fee schedule. U S Businesses in Danville commercial districts will be listed in the directory of the Danville In Style all-inclusive website designed to promote local businesses (www.danvilleinstyle.com)  If you are exempt from fees, sign the appropriate F I Soc. Sec. No. Cell / Pager No. In case of emergency, please contact (attach additional sheet) PLEASE LIST ONLY THE PEOPLE WHO ARE ABLE TO RESPOND Health Dept. Chapter 7-6 of the Danville Municipal Code requires all persons or entities selling tobacco products on a retail basis within the Town of Danville to maintain a tobacco retailers license. If you are a tobacco retailer, please indicate below.  I'm planning to sell tobacco products on a retail basis within the Town of Danville and I'm enclosing an application for tobacco retailer's license. See Fee Schedule for more details. Danville Employee Fee $ Total Amount Due $ A check for the appropriate fee payable to "Town of Danville" must accompany this application. No license will be issued without payment. I declare under penalty of perjury that all statements contained herein are, to the best of my knowledge and belief, true and that all necessary land use permits, building permits and any other permits required by law have been or will be secured prior to the commencement of the business activity which is the subject of this application. Executed at California on Signature of Owner or Representative: 20 Print Name: AVOID PENALTIES - FILE PROMPTLY - ALL BUSINESSES ARE SUBJECT TO AUDIT Printed 5/20/2009:10:14 am Date: