Fillable Out of Town Business License Application (City of San Dimas)

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Out of Town Business License Application (City of San Dimas)

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  • 14 check-boxes
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Business License # _________________
Out of Town Business License Application
New Business � Change of Address � Change in Ownership �
Business Name _________________________________________________________________________________________________
Business Owner ___________________________________________________ Business Email _______________________________
Business Address________________________________________________________________________________________________
City ________________________________________________ State _____________________ Zipcode ________________________
Business Phone # (______)_____________________________ Business Fax (______)______________________________________
Are you sharing this location with another business? NO YES Name:
Billing Address _________________________________________________________________________________________________
(If different from the Service of Process Address/Business Address)
City ________________________________________________ State ____________________ Zipcode _________________________
Please indicate business type: Retail Wholesale Manufacturing Service Office
Please check ownership type: Sole Partnership Corporation LLC
Description of business activity in detail: __________________________________________________________
(attach additional sheets if necessary) (if manufacturing, wholesale, import/export, or retail, please list products)
State Professional License # ___________________________________ Class ____________ Expiration Date _______________
State Contractor License # ____________________________________ Class ___________ Expiration Date _______________
Retail Sales # _____________________________________________ Gross Receipts (Video & Vending Only) $______________ / yr
# of Business Owners _____________ # of Full-time Employees ____________ # of Part-time Employees ______________
# Rental Units _________ # Billiard Tables/Bowling Lanes _________ # Mobile Home/Storage Spaces _________ # Beds _________
NOT PUBLIC INFORMATION NOT PUBLIC INFORMATION
Business Owner/CEO ____________________________________________________________________________________________
Service of Process Address _______________________________________ City ____________________ State ___ Zipcode ______
Phone # (____)___________________ Social Security/ Driver License # or Other ID _________________________
Federal Employer ID (FEIN) ______________________________ State Employer ID (SEIN) _______________________________
Business Partner/Owner: _________________________________________________________________________________________
Service of Process Address _______________________________________ City ____________________ State ___ Zipcode ______
Phone # (____)___________________ Social Security/ Driver License # or Other ID ___________________________
• I hereby certify under penalty of perjury that the information provided herein is true and correct to the best of my knowledge and ability.
Owner’s signature _______________________________________________________ Date _________________________________
City of San Dimas 245 E. Bonita Avenue San Dimas, California 91773 (909) 394-6200 Fax (909) 394-6209
For Office Use Only
Classification: __________ Catagory___________ Bus. Group: ______ Loc: _______ Lic Copies ____
Workers Comp: Y N E Chg Penalty: Y N Rate Code: _______ #Units: ________
Basic Fee $ ____________ # EE $_____________ NPDES $ __________ SB1186 $ _4.00_____ = TOTAL DUE: $______________
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Business License # ____________
Bus
iness Name ________________________________________________________ Phone _________________________
Bus
iness Address _______________________________________________________________________________________
City __________________________________________________ State ______________________ Zip code ___________
Workers Compensation Declaration
(Section 3711 of the Labor Code)
I hereby affirm, under penalty of perjury, one of the following declarations:
I have and will maintain a certificate of consent to self-insure for workers’ compensation,
as provided by Section 3700, for the duration of any business activities conducted for which this license issued.
I hav
e and will maintain workers’ compensation insurance, as required by Section 3700, for the duration of any
business activities conducted for which this license is issued.
I c
ertify that in the performance of any business activities for which this license is issued,
I shall not employ any person in any manner so as to become subject to the workers’ compensation laws of
California, and I agree that if I should become subject to the workers’ compensation provisions of Section 3700
of the Labor Code, I shall forthwith comply with the provisions of Section 3700.
______________________________________ _____________________________________________
_______________
Applicants Signature Applicants Name and Title (please print) Date
(Warning: Failure to secure Workers’ Compensation Coverage is unlawful, and shall subject an employer to criminal penalties
and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor
Code, interest and attorney’s fees.)
Workers’ Compensation Insurance Information
Company ___________________________________
Address ___________________________________
___________________________________
City __________________________ State ________ Zip code _________
Policy Number __________________________
Expiration Date __________________________
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City of San Dimas
245 E. Bonita Avenue
San Dimas, California 91773
(909) 394-6200, FAX (909) 394-6209
____________________________________________________________________________________
Business License Fees
Effective 7/1/2019
C03 Businesses located in San Dimas $139.20 plus $10.50 per employee/partner
+ $4.00 (State fee)
C03 Businesses located Outside San Dimas $139.20 annual + $4.00 (State fee)
C04 Apartments & Business Rentals $139.20 plus $12.90 + $4.00 (State fee)
(for each unit over 2)
C06 Hotels, Motels, Hospitals &
Retirement Care & Nursing Homes $93.10 plus $9.80 per bed + $4.00 (State fee)
C07 Movie/Commercial Filming $386.80 per day + $4.00 (State fee)
C09 Solicitors $231.60 princple solicitor + $4.00 (State fee)
$154.50 (each additional) + $4.00 (State fee)
C12 Deliveries $116.00 per vehicle + $4.00 (State fee)
F01 Contractors $146.90 annual + $4.00 (State fee)
F05 Home Occupations $139.20 annual + $20.00 + $4.00 (State fee)
(planning fee)
F06 Exempt / Non-Profit $ 1.00 + $4.00 (State fee)
G01 Gross Receipts Variable Rates + $4.00 (State fee)
Vending Machines
Video Arcades
Certain businesses, professions, trades and occupations, because of their nature and circumstances,
shall have a different license fee than that set forth for general business licenses (SD 5.24.070)
Please contact the business license department for licensing procedures and fees.
Ordinance No. 956 7/1/95
Resolution No. 19-28, 05/28/2019
On October 11, 2017 Governor Brown signed into law SB-1379 which adds a state fee of $4 on any applicant for a local
business license or similar instrument or permit, or renewal thereof. The purpose is to increase disability access and compliance
with construction-related accessibility requirements and to develop educational resources for businesses in order to facilitate
compliance with federal and state disability laws, as specified. Additional $4.00 will be added at time of receipt.
____________________________________________________________________________________________________________________________
Workers' Compensation ( Section 3711 of the Labor Code):
Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to
criminal penalties and civil fines up to $100,000 in addition to the cost of compensation, damages
as provided for in Section 3706 of the Labor Code, interest and attorney fees.
BUSINESS LICENSE REFERRAL PHONE NUMBERS
City of San Dimas, Business Licenses..... 909/394-6200
City of San Dimas, Planning Dept......….... 909/394-6250
City of San Dimas, Building & Safety........ 909/394-6260
San Dimas Chamber of Commerce.…....... 909/592-3818
Alcohol Beverage Control..............…......... 626/256-3241
222 E. Huntington Dr., Ste 114, Monrovia, CA
www.abc.ca.gov
Alcohol Tobacco Firearms.......…............... 213/534-2450
350 S Figueroa St, Los Angeles, CA
www.atf.treas.gov
Child Care Information Service…...........… 626/449-8221
1460 E. Holt, Ste 130, Pomona, CA 909/397-4740
www.rrnetwork.org
Dept of Social Services/Community Care 323/981-3350
1000 Corporate Center Dr., Monterey Park
//ccld.ca.gov
Consumer Affairs…....................….............. 800/344-9940
State of California, Department of 800/952-5210
www.dca.ca.gov
Contractor’s State License Board.............. 800/321-2752
www.cslb.ca.gov
Fictitious Business Name......……...…....... 800/201-8999
County of L.A. Registrar/Recorders 562/462-2177
12400 E. Imperial Hwy, Norwalk, CA
//regrec.co.la.ca.us
Franchise Tax Board........…...........……....... 800/852-5711
www.ftb.ca.gov 800/338-0505
Health Permit......…….....................……........ 626/813-3380
L.A. County Environmental Health
5050 Commerce Dr., Baldwin Park
Cottage Food Permits.(Plan Check)..... 626/430-5560 & 626/430-5400
Public Health ……………………. 888-700-9995
www.lapublichealth.org
Resale Number/Seller’s Permit..........…....... 626/480-7200
State Board of Equalization,
1521 W. Cameron, #300, West Covina
www.boe.ca.gov
Bureau of Automotive Repair..........……....... 800/952-5210
www.bar.ca.gov
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Out of Town Business License Application (City of San Dimas)

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Completed 16 July 2020

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