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Business License Application City of Palmdale 38250 Sierra Hwy. Palmdale, CA 93550 (661) 267-5434 Fax (661) 267-5233 [EMAIL REDACTED] Complete all items (on both sides of this application) that pertain to your business. Submit copies that pertain to the business – Health Permit, State License, ABC, SBOE, DBA, etc. Business Name (DBA) Corporate Name (only if you have one) Business Address Street City State Zip Mailing Address (only if different from business address) Street City State Zip Business Phone # Emergency Phone # Email Address Describe the exact nature of kind of business for which a license is requested, including each separate and distinct type of business to be conducted on the premises under the same ownership. Will you be selling Tobacco? Will you be selling / or serving Alcohol? State Tobacco Permit # ABC License # Type of Business: Retail Wholesale Professional Service Rental Mfg. Number of: Employees Vehicles Rental Units **Coin Operated Machines **Laundry Machines **Pool Tables (**Please attach a list of locations for these items) Please provide the following information only if it applies to your business: Seller’s Permit # Federal Employer # State Tax ID # State License # Exp. Date Contractor Classification OFFICE USE ONLY HOP No. ZC No. CUP No. Planner’s Initials Planner’s Initials New Renewal Change Categ. Acct. # Exp. Date 9/19 ---PAGE BREAK--- Please check type of ownership and provide the information requested on the lines below. SOLE OWNER: (Please list name, home address, home phone Social Security and Drivers License PARTNERSHIP: (Please list names, home addresses, home phone Social Security Drivers License of each general partner.) CORPORATION: (Please submit a copy of the Articles of Incorporation.) The name shall be exactly as set forth in its articles of incorporation. Additionally, there shall be included the names and addresses and phone number, of all directors, any stockholder holding ten (10%) percent or more of the shares of the corporation, and the name, home address, and home phone number of an officer who is duly authorized to accept service of legal process. Manager’s name and telephone number for residential or commercial rentals only. Beginning January 1 of 2018, the State mandated $1 fee for accessibility training will increase to On October 11, 2017, Governor Jerry Brown signed into law Assembly Bill (AB) 1379 (Chapter 667, Statutes of 2017). Senate Bill 1186 (Steinberg, Disability Access) On September 19, 2012, Governor Jerry Brown signed into law Senate Bill 1186 (Steinberg, Disability Access). Part of the legislation established the Disability Access and Education Revolving Fund as set forth in Government Code Section 4465, et seq which adds a state fee of $1 to all new local business licenses or renewal thereof. Effective January 1, 2013, the City will begin collecting this fee on behalf of the state as required by Government Code Section 4467. The purpose of the fee is to provide a funding source for increased disability access and compliance with construction-related accessibility requirements and to develop educational resources for businesses in order to facilitate compliance with the federal and state disability laws. 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/Home.aspx. • The Department of Rehabilitation at www.rehab.cahwnet.gov. • The California Commission on Disability Access at www.ccda.ca.gov. I declare under penalties of perjury that this application is true and correct to the best of my knowledge and belief. Print Name Signature Title Date Print Name Signature Title Date 9/19