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Business License Application P.O. Box 3442, 1010 10th Street, Suite 2100, Modesto, CA 95353 [PHONE REDACTED] MUNICIPAL CODE SECTION 6-1.104 LICENSE DOES NOT PERMIT BUSINESS OTHERWISE PROHIBITED. The payment of a license tax required by the provisions of this chapter, and its acceptance by the City, and the issuance of such license to any person shall not entitle the holder thereof to carry on any business unless he has complied with all the requirements of this Code and all other applicable laws, nor to carry on business in any building or any premises designated in such license in the event that such building or premises are situated in a zone or locality in which the conduct of such business is in violation of any law. Start Date Business Name Zoning: Date: Fire: Date: Business License Application P.O. Box 3442, 1010 10th Street, Suite 2100, Modesto, CA 95353 [PHONE REDACTED] MUNICIPAL CODE SECTION 6-1.104 LICENSE DOES NOT PERMIT BUSINESS OTHERWISE PROHIBITED. The payment of a license tax required by the provisions of this chapter, and its acceptance by the City, and the issuance of such license to any person shall not entitle the holder thereof to carry on any business unless he has complied with all the requirements of this Code and all other applicable laws, nor to carry on business in any building or any premises designated in such license in the event that such building or premises are situated in a zone or locality in which the conduct of such business is in violation of any law. Start Date Business Name - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Date Position with Company Print or Type Name Signature • Do you plan to sell or buy secondhand (used) merchandise? YES / NO (circle one) If YES, notify Modesto Police Department . I have read the statements on this application and have indicated those conditions which are applicable to the nature of my business. Further, I have read and understand the provisions of Modesto Municipal Code Section 6-1.104 and I will obtain all necessary information from the appropriate City offices and employees regarding additional licenses and/or permits that may be required due to the nature, location or other characteristics of my proposed business activity. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Phone # Name After-hours Emergency Contact (Required by Modesto Police Department for Commercial Locations.) Driver's License # or Other ID # Social Security # / ITIN # Title Home Phone # Zip City Home Address (not a PO Box) Name Driver's License # or Other ID # Social Security # / ITIN # Title Home Phone # Zip State City Home Address (not a PO Box) Owner(s) or Officers(s) Information (List address where each individual consents to receive service of process.) LLC Corporation Partnership of partners ) Sole Owner Ownership (Check One): Exp. Date (must present state contractors pocket card or a copy) Resale # State Employer ID # Federal Employer ID # Fully Describe the Business Activity Non-Profit Manufacturing Transportation / Utility Construction Financial Wholesale Service Retail Email Address Check box to indicate your understanding that the information above with the exception of home addresses in Modesto will be public information, including but not limited to internet publication and public information requests. Corporate Name (if any) Name State Contractors # Check all that apply: Mailing Address Physical Business Address (if in Modesto City limits, not a PO Box) FOR OFFICE USE ONLY Business Website State Date Position with Company Print or Type Name Signature Zip State City Per AB 2184, you may protect your residential address by providing a different Service of Process address in accordance with Sections 16000.1(a)(2) and 16100.1(a)(2) of the Business and Professions Code. To do so, please fill out the section on the bottom of this form. SERVICE OF PROCESS ADDRESS, PURSUANT TO AB2184 - AVAILABLE FOR PUBLIC INSPECTION If you wish to protect your residential address with a different service of process address, please provide it here. NOTE - if your service of process address is a post office box or private mailbox, it must comply with paragraph of subdivision of Section 17538.5 of the California Business and Professions Code. Service of Process Address Residential Address to protect Business Location Mailing Address Owner/Partner/Officer Address Information below is confidential Information below is confidential Corporate Phone # Business Phone # Business Fax # LICENSE AB-1379 DEPOSIT TOTAL PAID $ $ 4.00 $ $ $ ACCT# RATE TYPE NAIC R C O CANCELLATION DATE & REASON DEPOSIT REFUND DATE & AMT DEPOSIT FORFEIT DATE & AMT FINAL _____LOCH _____ONTJB _____REAC Title Zip Information below is confidential - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Date Position with Company Print or Type Name Signature • Do you plan to sell or buy secondhand (used) merchandise? YES / NO (circle one) If YES, notify Modesto Police Department . I have read the statements on this application and have indicated those conditions which are applicable to the nature of my business. Further, I have read and understand the provisions of Modesto Municipal Code Section 6-1.104 and I will obtain all necessary information from the appropriate City offices and employees regarding additional licenses and/or permits that may be required due to the nature, location or other characteristics of my proposed business activity. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Phone # Name After-hours Emergency Contact (Required by Modesto Police Department for Commercial Locations.) Home Address (not a PO Box) City State Home Phone # Social Security # / ITIN # Driver's License # or Other ID # Title Zip Name Home Address (not a PO Box) City State Home Phone # Social Security # / ITIN # Driver's License # or Other ID # Owner(s) or Officers(s) Information (List address where each individual consents to receive service of process.) LLC (must present state contractors pocket card or a copy) Exp. Date Partnership of partners ) Corporation Sole Owner Check all that apply: Retail Fully Describe the Business Activity Federal Employer ID # State Contractors # Ownership (Check One): State Employer ID # Resale # Non-Profit Manufacturing Transportation / Utility Construction Financial Wholesale Service Corporate Name (if any) Physical Business Address (if in Modesto City limits, not a PO Box) Mailing Address Email Address Check box to indicate your understanding that the information above with the exception of home addresses in Modesto will be public information, including but not limited to internet publication and public information requests. Name FOR OFFICE USE ONLY State Business Website Date Position with Company Print or Type Name Signature Zip City Per AB 2184, you may protect your residential address by providing a different Service of Process address in accordance with Sections 16000.1(a)(2) and 16100.1(a)(2) of the Business and Professions Code. To do so, please fill out the section on the bottom of this form. SERVICE OF PROCESS ADDRESS, PURSUANT TO AB 2184 - AVAILABLE FOR PUBLIC INSPECTION If you wish to protect your residential address with a different service of process address, please provide it here. NOTE - if your service of process address is a post office box or private mailbox, it must comply with paragraph of subdivision of Section 17538.5 of the California Business and Professions Code. Service of Process Address Residential Address to protect Business Location Mailing Address Owner/Partner/Officer Address Information below is confidential Corporate Phone # Business Phone # Business Fax # LICENSE AB-1379 DEPOSIT TOTAL PAID $ $ 4.00 $ $ $ ACCT# RATE TYPE NAIC R C O CANCELLATION DATE & REASON DEPOSIT REFUND DATE & AMT DEPOSIT FORFEIT DATE & AMT FINAL _____LOCH _____ONTJB _____REAC Title Zip Inf nfor ormat ation on bel below ow is con confiden dentialal Cannabis Zoning: Date: Fire: Date: SIGN ---PAGE BREAK--- 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: The Division of the State Architect at www.dgs,ca.gov/dsa. The Department of Rehabilitation at www.dor.ca.gov. The California Commission on Disability Access at www.ccda.ca.gov. Other agencies that you may need to contact before starting business: SALES TAX/SELLER’S PERMIT Sales or use tax may apply to your business activities. For general information, please contact the California Department of Tax and Administration: 3321 Power Inn Rd #210 Sacramento, CA www.cdtfa.ca.gov 1-[PHONE REDACTED] FEDERAL EMPLOYER ID NUMBER Internal Revenue Service 1700 Standiford Avenue (Monday-Friday - 8:30 a.m.- 4:30 p.m.) Modesto, CA 95350 (209) 900-6760 1-[PHONE REDACTED] STATE EMPLOYER ID NUMBER Employment Development Department 1-[PHONE REDACTED] FICTITIOUS BUSINESS NAME County Clerk/Recorder 1021 I Street Modesto, CA [PHONE REDACTED] STATE CONTRACTOR BOARD www.cslb.ca.gov 1-[PHONE REDACTED] HEALTH PERMITS County Health Department 3800 Cornucopia Way, Suite C Modesto, CA [PHONE REDACTED] STANISLAUS COUNTY DEPARTMENT OF AGRICULTURE AND WEIGHTS & MEASURES 3800 Cornucopia Way, Ste B Modesto, Ca 95358 [PHONE REDACTED] NON-PROFIT (Articles of Incorporation or letter from Secretary of State stating non-profit status) Secretary of State www.ss.ca.gov [PHONE REDACTED] IMPORT/EXPORT U.S. Customs Import 1-877-227-5511Export 1-[PHONE REDACTED] POLICE PERMITS Modesto Police Department 600-10th Street, first floor Modesto, CA [PHONE REDACTED] FRANCHISE TAX BOARD 1-[PHONE REDACTED] STANISLAUS COUNTY CHILD CARE [PHONE REDACTED] In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website at