• Start Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Please fill in all that apply:

  • List address below where each individual consents to recieve service of process (business license) per AB2184 Sec. 16000 1(a) (2) and 16100 1(a) (2)

  • Fill in fields if mailing address is different from the Service of Process Address/Business Address:
  • Type of Business:

  • *
  • *
  • *
  • Exempt*
  • Home Occupation*
  • *

  • OWNERSHIP: (Please check below)

  • NOT PUBLIC INFORMATION*
  • Sole proprietorship, Partners or Corporate Officers: (If different from the Service of Process Address/Business Address)*

  •  Please call for business tax due. 

    Business Tax Due: BLTAXN  _________ 
    *State Mandated Fee: BLSTF $4.00
    Registration Application Fee: BLNEW $125.00

    Total : _________

  • BY MY ELECTRONIC SIGNATURE BELOW I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • 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
  • Should be Empty: