Business License - P.O. Box 520, Pleasanton, CA 94566
Business License Office – 200 Old Bernal Ave., Pleasanton, CA 94566
Phone (925) 931-5440
www.cityofpleasantonca.gov
Email: [email protected]


BUSINESS LICENSE TAX APPLICATION

General Business Information






Same as Business Address






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OWNER NAME/HOME ADDRESS:

LIST ALL OWNERS INFO or LLC/CORP- LIST CORP OFFICERS

Contact 1

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Contact 2

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Contact 3

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Additional Business Information

Provide the following when applicable:




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Estimated Gross Receipts

This license period is for twelve months ending

Estimated Gross Receipts are based on months

*State Mandated Fee ($4.00) for Disability Access & Education Revolving Fund:

AB1379 was imposed by the state to increase the $1 state mandate fee to $4.00 for licensing years 2018 thru 2023. The State of California enacted SB1186 (Dutton; Special access: liability) in 2012 which imposed a $ 1.00 State fee on every applicant for a local business license or renewal (including all in-city commercial and home-based, all exempts, all non-profits, landlords, out -of-city, and all contractors) and is required to be collected by all cities and counties throughout California, including the City of Pleasanton.

This law requires that you be provided the following notices: 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 https://www.dgs.ca.gov/dsa
• The Department of Rehabilitation at https://www.dor.ca.gov/
• The California Commission on Disability Access at https://www.dgs.ca.gov/CCDA

Agreement

I declare under penalty of making a false certification that the foregoing information is true and correct to the best of my knowledge and belief.

Executed this I, By submitting this application I accept the conditions and declare under penalty of perjury the foregoing is true and correct.

Please sign your name below, using the mouse or your touch screen enabled device.