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Corporation, LLC, or LP Information: Name (Must be Registered in California) /frc- Corp/LLC/LP # ,c72 5 Z;", e),2-0/7 FOR OFFICE USE ONLY: Page 2 TAX ACCT. # CONTROL # Names of Officers/Members President: Vice President: (ly ) ck- ':((167K--7 rc Authorized Agent: Atil.i/A-7 5 6:76,{c rye rt7 PLEASE NOTE: Contact Phone # 20 7/5 S' 76.; The Issuing of your Business License is for revenue purposes only. It does not relieve you from the responsibility of complying with the requirements of any other department of the City of Stockton and/or any other ordinance, law or regulation of the City of Stockton, State of California, or any other governmental agency. Business Licenses are not transferable. It is your responsibility to renew your Business License whether or not you receive a renewal notice. If you are no longer conducting business in the City of Stockton you must notify us in writing. CHAVE READ AND UNDERSTAND THE TERMS ABOVE • I HEREBY CERTIFY UNDER PENALTY OF PERJURY • " THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT. a i deo zet, Owner/Authorized Signature itle Date Owner/Authorized Signature , , Email Address: 1"1-421-k- Title elgad• 66741 Date Disability Access and Education Fee (SB 1186) On September 19, 2012, Governor Brown signed Senate Bill 1186 (SB 1186) into law. SB 1186 is intended to increase disability access, encourage compliance with construction-related accessibility requirements, develop education resources for businesses, and facilitate compliance with Federal and State disability laws. From January 1, 2013, and until December 31, 2017, cities and counties were required to collect a State mandated fee of $1.00 from any applicant for a local business license or equivalent instrument or permit, and from any applicant for the renewal of a business license or equivalent instrument or permit." Assembly Bill 1379 was passed on October 11, 2017 which extends the assessment of the fee indefinitely and also the State mandated fee from $1.00 to $4.00 from January 1, 2018 until December 31, 2023. **State Mandated Disability Access and Education Revolving Fund. 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.dos.ca.clovidsa/Home.aspx. The Department of Rehabilitation at www.rehab.cahwnet.gov. The California Commission on Disability Access at www.ccda.ca .qov. FOR OFFICE USE ONLY Processed By: Date: Business License Taxes Amount Dept. Must Approve or Deny Authorized Signature and Date Registration Tax $24.00 I Planning Approved II Denied ' ' License Tax , 'Building Approved 11 Denied ii Mill Tax - Fire Approved H Denied LI Penalty - Police Approved II Denied _I State Mandated Disability Access and Education Revolving Fund $4.00 : Other: Approved h Denied Total Due Expiration Date REMEMBER: TO PRINT A COPY FOR YOUR RECORD Revised 1/2018