Office Use Only
New Change Exempt
City of Hayward
Business License Application
777 B Street, Hayward, CA 94541-5077
P. (510) 583-4600 F. (510) 583-3644
BusinessLicense@hayward-ca.gov
www.hayward-ca.gov
Today's Date: _______
/
______
/
______ Date Business Started in Hayward: _______
/
______
/
______
Is this business:
BUSINESS TYPE - Describe in detail the nature of the business to be conducted:
OWNER INFORMATION (Required by § 19286.8 of the Revenue and Taxation Code):
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 YES NO
Firearms:
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?
NOYES
Contractor Information
(if licensed under California Business and Professional Code §7033)
:
Contractor Name: Classification:
Contractor License #
Number of Employees on the jobsite in Hayward: Job Start/End Dates:
***Please see other side***
Mailing Address
(
if different
):
Business Location
(
No PO Boxes
):
Business Name:
Street Address:
City, State, Zip:
Telephone:
Is this a residence?
YES
NO
ATTN:
Street Address:
City, State, Zip:
Telephone:
Email:
Check here to receive renewals by email :
Ownership Type
:
Individually Owned
SSN/ITIN:
Partnership
LLC
Corporation
FEIN:
Business Owner
/
Corporation Head Information
Owner/CEO
Partner Name
Name:
Street Address:
City, State, Zip:
Telephone:
Other ID No.
Per AB 2184, you may protect your residential address by providing a different Service of Process address in accordance with Sections 16000.1(a)(2)
and 16100.1(a)(2) of the Business and Professions Code. To do so, please fill out the section on the back or bottom of this form.
Under federal and state law, compliance with disability access laws is a serious and significant
responsibility that applies to all California builiding 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
The Department of Rehabilitation at www.
dor
.ca.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:
FOR OFFICE USE ONLY
Title
Print Name
Signature
City and State
at
Date
Executed on
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.
REVENUE DIVISION
VALID FROM THROUGH
BUSINESS ACCOUNT #
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: $
SB1186 Fee: $
Technology System Fee: $
Application Fee: $
Maintenance: $
Planning: $
TOTAL TAX DUE: $
SERVICE OF PROCESS ADDRESS, PURSUANT TO AB2184 -
AVAILABLE FOR PUBLIC INSPECTION
If you wish to protect your residential address with a different service of process address, please provide it here.
NOTE - if your service of process address is a post office box or private mailbox, it must comply with paragraph(2) of subdivision (b) of Section
17538.5 of the California Business and Professions Code.
Service of Process Address
Residential Address to protect
Business Location Mailing Address Owner/Partner/Officer Address
City of Hayward
Business License Application
777 B Street, Hayward, CA 94541-5077
P. (510) 583-4600 F. (510) 583-3644
BusinessLicense@hayward-ca.gov
www.hayward-ca.gov
***Please see other side***
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: We: Th: F: Sa: Su:
ONLY COMPLETE THIS FORM IF THE BUSINESS IS LOCATED WITHIN HAYWARD CITY LIMITS
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 racks or pallett 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 Mterials Fertilizers Pesticides
Carcinogens Flammable Gses Poisonous Gases/Liquids
Combustible Liquids Flammable Liquids Radioactive Mterials
Compressed Gases Flammable Solids Reactive Materials
Corrosives Hazardous Wastes 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
Title
Print Name
