Fillable Business License Application 2018

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Business License Application 2018

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U.S.A. forms for City of Hayward

BROWSE CITY OF HAYWARD (CA) FORMS

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City of Hayward
Business License Application
777 B Street, Hayward, CA 94541-5077
T 510-583-4600 TDD 510-247-3340
www.hayward-ca.gov
***Pleaseseeotherside***
OfficeUseOnly
NewChangeExempt
Today’s Date: ______/_______/_______ Date Business Started in Hayward: _______/_______/_______
Business Location (No PO Boxes) Mailing Address (If Different)
Business Name:
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TTN: ____
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Street Address: _______________
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_ Street Address:
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City, State, Zip: _____________
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__ City, State, Zip: __
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_________________________
Telephone: ______________
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_______________ Telephone: _______
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Is this a residence? YES NO
Email: _____________________________________
Check here to receive renewals by email:
OWNER INFORMATION (Required by §19286.8 of the Revenue and Taxation Code):
Ownership Type: Business Owner/Corporation Head Information
Individually Owned Owner/CEO Partner Name
Social Security Number: _
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_______________ Name:
_
____________________
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Partnership LLC Corporation Home
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ddress: __________________
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FEIN: ___________
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________________ City, State, Zip: ___________________
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Telephone:
BUSINESS TYPE - Describe in detail the nature of the business to be conducted:
________________________________________________________________________________________
________________________________________________________________________________________
Is this business: Commercial/Residential Rental Storage/Warehouse (No Sales) Wholesale
Retail New Items Used Items Gold Items Manufacturing Office
Service Food Sales or Manufacturing Other: ____________________________
Average Number of People Working in Hayward (Including the Owner):_______________________________
Will the business include the sale, manufacture, or distribution of any of the following products?
Tobacco Products: YES NO Alcohol Products: YES NO Firearms: YES NO
Only answer this question if the business is a property rental:
Is there more than one address at location? YES NO If yes, number of units at location: ______________
Do you own additional rental property in Hayward? YES NO
Contractor Information (if licensed under California Business and Professions Code §7033):
Contractor Name: _____________________ Classification: ____________ Contractor License #: __________
Number of employees on the jobsite in Hayward: ____________ Job Start/End Dates: ___________________
Affidavit
I certify under penalty of perjury that the information provided on this form is true and correct. I understand that
payment of this tax, its acceptance by the City, and the issuance of this Business Tax receipt does not entitle
me or the business on behalf of which I have signed this affidavit to carry on any business unless that business
complies with all applicable laws.
Executed on _________________________ at ______________________________
Date City and State
_____________________________ _____________________________ _______________________
Signature Print Name Title
FOR OFFICE USE ONLY
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.
PERMITCENTER
USE: __________________________________
ZONING: _______________________________
AUP/CUP REQUIRED? Y N
IF YES, PROJECT #: _____________________
NON-CONFORMING USE? Y N
OPEN CODE-ENFORCEMENT CASE? Y N
CODE-ENFORCEMENT HOLD? Y N
STAFF: ________________________________
DATE/TIME: ____________________________
NOTES:________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
REVENUEDIVISION
VALID FROM __________ THROUGH __________
BUSINESS ACCOUNT #: _____________________
OWNER CID:____________DBA CID:___________
BILL NUMBER: _____________________________
BUSINESS TYPE CODE: _____________________
NAICS NUMBER: ___________________________
Business Name Change
Business Address Change
Business Officer / Ownership Change
Previous License # __________________________
NOTES:________________________________
______________________________________
______________________________________
Tax Paid: $___________
Penalty: $___________
Excise Tax Basis __________: $___________
Excise Penalty: $___________
SB 1186 Fee: $ 4.00___
Technology System Fee: $____10.00__
Application Fee: $____25.00__
Maintenance: $___________
Planning: $___________
TOTAL TAX DUE: $___________
City of Hayward
Hayward Based Business Information Form
777 B Street, Hayward, CA 94541-5077
T 510-583-4600 TDD 510-247-3340
www.hayward-ca.gov
***Please see other side***
ONLY COMPLETE THIS FORM IF THE BUSINESS IS LOCATED WITHIN HAYWARD CITY LIMITS
1. Is the business: New Activity at Location Same Activity at Location New Owner
2. Did you obtain a Use Permit to operate this business: Yes, #________________ No
3. How many persons do you estimate will be working at the Hayward location? _______________
4. Do you plan to install any new signage or modify an existing sign? Yes No
5. What materials, if any, will be stored outside buildings?
__________________________________________________________________________________
__________________________________________________________________________________
6. Property Owner Information
Name: ___________________________________ Telephone: _______________________________
Street Address: ____________________________ City, State, Zip: ____________________________
7. Private Patrol or Alarm Company (If Applicable):
Name: ___________________________________ Telephone: _______________________________
Note: All alarm users are required to obtain an Alarm User’s Permit from the Hayward Police Department.
Call (510) 293-7158 to receive information about the City’s Alarm Ordinance.
8. Persons other than Business Owner to contact in case of emergency (24 hour contact):
Name: ___________________________________ Telephone: _______________________________
Name: ___________________________________ Telephone: _______________________________
9. Persons other than Property Owner to contact in case of emergency (24 hour contact):
Name: ___________________________________ Telephone: _______________________________
Name: ___________________________________ Telephone: _______________________________
10. Does your business require a state or federal permit or certification?
Yes No Unknown If Yes, indicate what is required: ___________________________________
11. What are your planned hours of operation?
M: ________ Tu: ________ W: ________ Th: ________ F: ________ Sa: ________ Su: ________
12. Does the building where the business will operate have a fire sprinkler system? Yes No
13. Will your business operate any of the following places of assembly or care facilities?
Day care (9 or more children) Restaurant/Banquet Hall (More than 49 patrons)
Care home Not Applicable
14. Will flammable or combustible liquid be:
Stored, handled or used Stored in tanks on premises
Used in cleaning or dipping operations Not Applicable
15. Will your business have any of the following on-site storage?
Rack or pallet storage over 12’ in height Area of storage over 2,500 square feet
Free-standing storage over 15’ in height Plastics in rack or pallet storage over 6’ in height
Not Applicable
16. Will any of the following processes occur in the facility?
Vehicle repair Combustible fiber generation or storage
Spray Painting Liquefied Petroleum Gas Storage or Use
Welding Laboratory Facility
Tire-Capping or Storage Dry-Cleaning
Dry Ovens Semi-Conductor Fabrication
Wood-Working Shop Electroplating/Metal Finishing
Waste Handling/Recycling Process/Cook Goods and/or Utilize Grease Hoods
Pharmaceutical Manufacturing Not Applicable
17. Will your business store, transport, or handle any of the following hazardous materials?
Acutely Hazardous Materials Fertilizer Pesticides
Carcinogens Flammable Gases Poisonous Gases/Liquids
Combustible Liquids Flammable Liquids Radioactive Materials
Compressed Gases Flammable Solids Reactive Materials
Corrosives Hazardous Waste Solvents
Cryogens Other Regulated Materials Toxic/Highly Toxic Materials
Explosives Organic Coatings Unstable Materials
Extremely Hazardous Substances Oxidizers Not Applicable
18. Will the business:
Use water for any purpose other than landscape irrigation and sanitary services
Use well water or water from sources other than the City of Hayward
Discharge cooling water of any type into the municipal sewer system
Discharge any waste other than from domestic sanitary services into the municipal sewer system
If any of the boxes are checked, explain: _________________________________________________
__________________________________________________________________________________
19. Affidavit
I certify under penalty of perjury that the information provided on this form is true and correct. I understand
that payment of this tax, its acceptance by the City, and the issuance of this Business Tax receipt does not
entitle me or the business on behalf of which I have signed this affidavit to carry on any business unless
that business complies with all applicable laws. The payment of a license tax, and its acceptance by the
City, and the issuance of such license to any person does not entitle the holder thereof to carry on any
business unless he has complied with all of the requirements of the Municipal Code and all other applicable
laws, nor to carry on any business in any building or on any premises designated in such license in the
event that such building or premises are situated in a zone or locality in which the conduct of such business
is in violation of any law. I understand that home based businesses must comply with the requirements of
the City of Hayward Municipal Code §10-1.3500.
_______________________ _______________________ _______________________
Signature Print Name Title
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Business License Application 2018

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Completed 11 July 2020

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