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Business Name
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Corporate Name (if applicable)
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Business Address
(Must be physical location, not a Post Office Box)
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Mail Address
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Business Description
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Ownership Type
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Start Date in City of Modesto
(estimate if in the future)
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Contact Information
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Business Phone
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Mobile Phone
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Fax
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Website
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Email Address
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State Seller's Permit# (REQUIRED FOR RETAIL BUSINESSES) Example: 123456789-WXYZ
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FEIN - ##-#######
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SEIN - ###-####-#
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Contact Preference
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The SIC Code is a requirement by the State of California, Senate Bill 205. Enter the first 3 characters of your SIC Code or business description in the section below. As you enter the first 3 characters, a list of SIC Codes will appear. Select the one that applies to your business.
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SIC Code - Example: Accounting; Contractor; Landscape: Restaurant; etc. If you need help finding your SIC# visit https://www.osha.gov/data/sic-search
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State License Information (Contractor, Medical, CAMTC, etc.) |
State Contractor License # or Massage Therapist License #
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State License Type
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State License Expire Date
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State License Verification *
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Additional Information
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Are you operating out of your home? If yes, please fill out the Home Business Agreement.
*
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FOR CONTRACTOR'S ONLY - IS THIS A ONE TIME JOB (OTJ)
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IF YES, When does the contracted work begin (back date is allowed)?
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IF YES, What is the end date of contracted work?
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IF YES, What is the Contracted Amount for this OTJ? This will be used to calculate your license tax due.
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OTJ - List the location (address) of contracted job
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Are you a business that is a regulated industry with storm water discharge requirements in accordance with the SB205 NPDES permit program? If yes, please provide the Waste Discharge Identification Number below.
*
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Provide WDID # (If response above is yes) Want to verify if your SIC is regualted visit https://www.waterboards.ca.gov/water_issues/programs/stormwater/sicnum.html
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Full Time Employee Count will be provided to Community Economic Development Divison
*
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File Attachments (if required).
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[REQUIRED for Sole Owner and Partnership] Provide a copy of your Drivers License or other Gov't Issued Photo ID: Corporations provide a copy of at least one officers Gov't issued Photo ID
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*This file type is not allowed. List of supported file types.
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[REQUIRED for Massage Businesses] Please provide a copy of your CAMTC card
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*This file type is not allowed. List of supported file types.
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Other Attachments
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*This file type is not allowed. List of supported file types.
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*Cumulative file size can not exceed 89MB. Please reduce the size of your files and try again.
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