City of Glendale OFFICIAL USE ONLYof Glendale (hereinafter "the City") does not entitle me or any authorized representative to conduct any business in the City that is in violation

OFFICIAL USE ONLY

FILING OPTIONS FOR BUSINESS REGISTRATION

ONLINE BUSINESS REGISTRATION:Go To: http://Glendale.HdLGov.Com

FORM BY MAIL TO:City of Glendale – Business Support Center

8839 N. Cedar Ave #212 Fresno, CA 93720-1832FORM BY E-MAIL TO: [email protected]

NOTICE: 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:

BUSINESS REGISTRATION FORM

Business Registration #

Expiration Date

NAIC Code

Registration Fee $

Corporate Name (if applicable)

Home Address(Cannot be P.O. Box)

Trust Sole Proprietor Partnership Corp-Ltd Liability Corporation Ownership

PERSONAL INFORMATION - Enter below names of Owners, Partners, or Corporate Officers (attach additional sheet, if necessary)

Alt. No. Primary Phone No.

PLEASE TYPE OR PRINT WITH PEN

New Business

1st Owner Name Title

2nd Owner Name

Home Address(Cannot be P.O. Box)

Business Location (Cannot be P.O. Box )

Bus. Start Date

Change Current Registration

Description of Business (In Detail)

Mailing Address

Business Name

Non-Profit

SSN

Phone No.

Alt. Phone No.

Title

Thank you for doing business in the City of Glendale!

Application Date

City of GlendaleBusiness Registration Center

Phone: 818-551-4681 • F.A.X: 909-348-0465 8839 N. Cedar Ave #212 • Fresno, CA 93720-1832

Register Online Today At: http://glendale.hdlgov.com

BusinessCellHome

BusinessCellHome

Federal ID No.Email Address

STREET

STREET

CITY

CITY

STATE

STATE

ZIP CODE

ZIP CODE

Please provide any relevant details for your business below. Only account for work activity conducted within the City of Glendale.

SSN

Phone No.

Alt. Phone No.

Title

PLEASE FILL IN THE APPROPRIATE BOXES BELOW AND SIGN

CERTIFICATION AND ACKNOWLEDGEMENT I acknowledge that payment for the Business Registration Certificate to the City of Glendale (hereinafter "the City") does not entitle me or any authorized representative to conduct any business in the City that is in violation of any applicable local, state, or federal laws. I further acknowledge that the City's issuance of a Business Registration Certificate does not waive the City's right in any way to enforce compliance with applicable laws against me or any authorized representative. Additionally, I understand that payment for the Business Registration Certificate is not refundable and the Registration Certificate is non transferable. I hereby declare under the penalty of perjury that to the best of my knowledge and belief the statements made on this application are true and correct.

SIGNATURE

PRINT NAME

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

No. of Employees

SQ. FT. of Business Location

( ) ( )

CITY STATE ZIP CODE

CITY STATE ZIP CODE

Are you subleasing your space?

If YES, what type of business was the space previously used for?

Is this a new business? YES NO

YES NO

*Please note that additional fees may apply once your Business Registration application has been reviewed.

Minimum Registration Fee Due

Please submit payment in the amount shown below.

265.42$

( )

( )

( )( )

City of Glendale Community Development Department, Licensing Division 8839 N Cedar Ave #212 Fresno, CA 93720 818.551.4681 https://glendale.hdlgov.com/

1. Will you be providing any massage related services?Yes No

2. Will you be conducting any door to door soliciting?Yes No

3. Does your business sell alcohol AND is located in any of the Maryland, Alex Theatre, or Broadway Center Districtswithin the Downtown Specific Plan?

Yes No 4. Will you have any live entertainment such as a DJ, karaoke, bands, dancers, etc.?

Yes No 5. Will you have a dance floor?

Yes No 6. Will you be teaching dance lessons?

Yes No 7. Will you be selling any products containing tobacco?

Yes No 8. Will you be allowing any onsite smoking?

Yes No 9. Will you be selling any secondhand items?

Yes No 10. Will you be operating as a pawnshop?

Yes No 11. Will you be operating as a place of amusement such as a theatre, roller rink, laser tag, children’s amusement, etc.?

Yes No 12. Will you have any amusement or arcade machines such as pool tables, air hockey, video games, etc.?

Yes No 13. Do you deliver food or beverages to retail or wholesale markets?

Yes No 14. Will you be selling any gasoline or oil products?

Yes No 15. Will you be charging for parking?

Yes No 16. Will you allow any outdoor or sidewalk dining?

Yes No

__________ (Applicant’s Initials)

I have read and understand the provisions, rules and regulations of the City of Glendale, California and the Municipal Code governing the type of certificate, license or permit for which I am applying. I declare, under penalty of perjury, that all of the information contained in this application and any accompanying documents is true and correct, with full knowledge that all statements made in this form are subject to investigation. Any false or dishonest answer to any question may be grounds for denial or subsequent revocation of the certificate, license or permit. I understand that it is my responsibility to inform the City of Glendale of any changes to any information on this application or any attached forms or documents.

___________________________________________________________ ________________ Applicant’s Signature (must be of the applicant listed in Part 4B) Date

Renewal District: Exp. Date: NAICS #: BRC #: Zone:

Comments, conditions, restrictions:

Issue:

17. If your business is a restaurant, how many total indoor seats?____________________

18. I acknowledge my understanding that placing merchandise, temporary signs, and/or banners outside of my place ofbusiness is prohibited within the City of Glendale, except as provided within the Glendale Municipal Code.