Business Certificate Application Form - City Of Fontana
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1
2● Please Check All That Apply ●
□
New Application
8353 Sierra Avenue ● Fontana, CA 92335 ● (909) 350-7675 ● Attn: Business License
□
Change of Owner/Location
□
Altering Structure
Business Name
______________________________________________________________________
OFFICIAL USE ONLY
Business Address
______________________________________________________________________
BUSINESS CERTIFICATE NO _______________
(P.O. Box NOT Allowed)
EXPIRATION DATE ______________________
______________________________________________________________________
□
□
City
State
Zip
TOTAL PAID $ __________
CASH
CHECK
Mailing Address
______________________________________________________________________
CITY CODE ____________________________
SIC CODE _____________________________
______________________________________________________________________
ISSUING CLERK ________________________
City
State
Zip
Business Phone
(
) ___________________
Business Fax
(
) ____________________
REVIEWD/APPROVED BY: Initial/Date
Email Address/Website_____________________________________________________________________
Planning
□ Yes □ No _______/_______
Police
□ Yes □ No _______/_______
If business address is located within the City of Fontana please complete 1 thru 4
Building
□ Yes □ No _______/_______
1.
Previous use of building ___________________________________________________________
Environmental □ Yes □ No _______/_______
2.
Does use involve hazardous or highly flammable materials?
□ Yes □ No
Fire
□ Yes □ No _______/_______
3.
Do you operate more than one business at this location?
□ Yes □ No
Health
□ Yes □ No _______/_______
4.
Are you currently property owner of business location?
□ Yes □ No
Other
□ Yes □ No _______/_______
Describe EXACT Nature of Business (Various Businesses require Police Clearance)
_________________________________________________________________________________________
Ownership: □ Corporation
□ Corp-Ltd Liability
□ Sole Proprietor
□ Partnership
□ Trust
Resale/Sellers No. _________________________ Federal I.D. No. __________________________ State I.D. No. ___________________________________
Contractors State License No. ________________ License Type ____________________________ Expiration Date _________________________________
Disclosure of your U.S. Social Security Number is mandatory on this application. Public Law 94-455 (42 USC 405(2)(C) authorizes collection of your social security number. Your social security
number will be used exclusively for tax enforcement purposes.
Owner Name __________________________________________________________ Title ________________________ Phone (
) _______________________
Home Address _________________________________________________________________________________ Birthdate ______________________________
City _______________________________________ State ______________ Zip ____________________
Social Security No. ________________________________ Driver’s License No. _____________________________
Owner Name __________________________________________________________ Title ________________________ Phone (
) _______________________
Home Address _________________________________________________________________________________ Birthdate ______________________________
City _______________________________________ State ______________ Zip ____________________
Social Security No. ________________________________ Driver’s License No. _____________________________
PLEASE FILL IN THE APPROPRIATE BOXES BELOW AND SIGN
Estimated Gross Receipts
NOTICE: Under federal and state law, compliance with disability access laws is a serious and significant
For Next 12 Months
$
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
No. of
Rate
following agencies: The Division of the State Architect at
- The Department of
Employees
Schedule
Rehabilitation at
- The California Commission on Disability Access at
Business Tax Fee Due
$
NOTICE
Application Fee
Business certificates are issued pending the
Sales or use tax may apply to your business
$ 35.00
approval of any or all of the above named
activities. You may seek written advice
State CASp Fee
Regulatory Departments. Preliminary filing of
regarding the application of tax to your
$ 1.00
this application does not constitute evidence
particular business by writing to the nearest
Balance Due
that the above described business has met
State Board of Equalization office. For general
$
the requirements of the Fontana City Code or
information
please
call
the
Board
of
Regulatory Agencies of the City of Fontana.
Equalization at: 1-800-400-7115
□
□
Home Based Business
Yes
No
I declare under penalty of perjury that this application and any attachments thereto, have
If yes, mail and phone location only.
been examined by me, and to the best of my knowledge and belief represent a true,
correct and complete statement of facts.
FOR HOME BASED BUSINESSES, THERE IS TO BE NO
STORAGE, SIGNS, EMPLOYEES, IN/OUT TRAFFIC,
Signature _________________________________________________________________
LARGE VEHICLES. PLEASE INITIAL THAT YOU HAVE
READ: ______
Title ________________________________________ Date ________________________
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Parent category: Business