Fillable 812 - Business license application final

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812 - Business license application final

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CITY OF HUNTINGTON PARK
Finance Department | License Division
6550 Miles Avenue, Huntington Park, CA 90255
Tel: (323) 584-6232 | license@hpca.gov
BUSINESS LICENSE
APPLICATION
Account No. __ __ __ __ __ __ __ __ __ __ __ __
The Huntington Park Municipal Code requires that all businesses operating in the City obtain a license.
It is the responsibility of the applicant to maintain an active business license by renewing each year.
Type of Application:
New Business
Change of Ownership
Change of Address
Change of Business Name
Change of Business Description
Type of License:
Commercial/Industrial
Non-Profit Organization
Contractor
Home Occupation
Property Rental
Type of Ownership:
Sole
Partnership
LLC
Corporation
Trust
Business Name / DBA
_______________________________________________________________________________
Business Address
_______________________________
City, State, Zip
__________________________________
Mailing Address
_______________________________
City, State, Zip
__________________________________
Business Phone
_______________________________
Email
__________________________________
Federal ID No.
_______________________________
State Tax No.
__________________________________
State Class
_______________________________
Board of Equalization No.
License No.
Estimated Gross Receipts
Property Owner’s Name
______________________________________________________________________________
Owner’s Address
______________________________
City
__________________________________
State
______________________________
Zip Code
__________________________________
Owner’s Phone
______________________________
Business Description
Business operation statement. Include products/services offered or produce
as well as any parts of the business that are incidental to the primary use.
_____________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Number of Employees
__________________________
Gross Floor Area
__________________________________
Hours of Operation
__________________________
Tenant Improvement
Yes No
Sharing Tenant Space
Yes No
If yes, business name
__________________________________
Status of Business
Vacant Occupied
Current Business
Business Owner Information
Owner’s Name/
Corporate Officer
________________________________
Date of Birth
__________________________________
Owner’s Address
________________________________
City, State, Zip
__________________________________
Owner’s Phone
________________________________
Email
__________________________________
Driver’s License No.
SSN
2
nd
Owner’s Name
________________________________
Date of Birth
__________________________________
Owner’s Address
________________________________
City, State, Zip
__________________________________
Owner’s Phone
________________________________
Email
__________________________________
Driver’s License No.
SSN
CITY OF HUNTINGTON PARK
BUSINESS LICENSE APPLICATION
Page 2
12/2017
Supplemental
Will the business include any of the following? (Check all that apply)
Adult-oriented
items or activities Yes No
Alcohol sales Yes No
Counseling/assembly Yes No
Auto title loans Yes No
Banquet facility Yes No
Check cashing Yes No
Currency exchange Yes No
Cyber cafe Yes No
Dance Yes No
Entertainment Yes No
Firearm/weapons sales Yes No
Fortune telling Yes No
Gaming Yes No
Medical/Adult marijuana Yes No
Money transfer Yes No
Pawn brokering Yes No
Precious metals purchase Yes No
Restaurant with seating Yes No
Short-term/payday loans Yes No
Tobacco sales Yes No
Second hand/thrift store Yes No
Vending machines Yes No
Video machines Yes No
I hereby certify under penalty of perjury that the information provided herein is to the best of my knowledge and belief, a
true and complete statement. I understand that this application is not a license and that no business activity may
commence until a business license is issued.
Signature___________________________________________________ Date______________________________
Printed Name and Title
PLANNING (OFFICE USE ONLY)
General Plan:_____________________
Zone:___________________________
SIC Code:__________________________
Previous Use/Business:____________________________________________________________________________________
Note:___________________________________________________________________________________________________
Permitted Permitted with Entitlement (CUP/DP#________________________) Pending Denied
Planning Approval:_________________________________________________ Date:_____________________________
BUILDING / FIRE (OFFICE USE ONLY)
Building
Approval:
Date:
Fire
Approval:
Date:
FINANCE (OFFICE USE ONLY)
Business License Fee:
$
Occupancy Fee:
$
Misc. Fee:
$
Application Fee:
$
Change of Location Fee:
$
Penalty Fee:
$
Total:
$
If processing by mail please include the following:
Completed Application Form
All applicable schedules
Check payable to City of Huntington Park
Mail to the attention of:
City
of Huntington Park – Business License Division
6550 Miles Avenue,
Huntington Park, CA 90255
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812 - Business license application final

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Completed 13 July 2020

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