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CITY OF COLTON BUSINESS LICENSE APPLICATION SUPPLEMENT (Please read reverse before completing this application) <,J Receipt # ousrness Name (at)a or Fictitious Name) Mailing Address SIQUIOrS 1395 E. Wa Business Location (Complete Address, City, State, Zip) hingtm., coif -on 1395 E. Washington, Colton 92324 Business Telephone # Owner's Telephone # Date Business Opened in City. _909 825-8106 900)''864- Manager's Name Emergency Telephone # Alarm: Yes N No❑ Alarm Company Name: Mark Gutierrez (909)872-0120/(909)864-0570 Type of Organization ® Sole Proprietorship ❑ Partnership ❑ Corporation SIC Code [R New ❑Renewal ❑ Changes ❑ Home Occupation Owner Name Telephone # Driver's License # Social Security # Hesiquio E. Gutierrez (909) 825-8106 - B1736297 Home A 568-32-0512 ddress City State Zip Code 3404 Willow Dr. Highland. Owner Name Telephone # Qrnia Driver's License # Social Security # -Home Address City State Resale # (Board of Equalization) State Employer ID # (DE3 Form) Health Permit # ABC License # (Alcohol) Home Occupation Permit # Zip Code Federal Employer # (Tax ID #) # of Business Vehicles State contractor's License #. Classification # Other State or Federa #s NONE ❑ A ❑ B ❑ C NONE Describe nature of business or activity for which permit is requested. (If contractor -site and duration) ilannr� TJ czenSP Under penalty of perjury I declare that all information on this application is to the best of my knowledge and belief true and correct statement of fact. I understand that, in addition to obtaining a business license, I must comply with all other City, County, State and Federal laws, regulations, and ordinances. Building Owner Information: Planning Building & Safety Fire Code Enforcement (Home Business only) Police Utilities (If applicable) Business Licenses Title Owner. Date 1, Fee Schedule----- - -- - Signature Date Non-refundable Application Fee (New License Only) Annual Fire Inspection Fee $ Deposit on Estimated Tax $ License Enforcement Fee $ (Category I,II,III,IV) Quarterly Fee $ Flat Rate $ . Renewal Fee ( Admin) Other- - ther - .-_...... „ 1.oning - Total Due $ Granting of a Business License does not entitle holder to operate or maintain a business in violation of any law or ordinance. City does not pass on qualifications of holder of license. This license may be revoked if information herein is found to be incorrect. License fee is due by January t or on the date the business opened. Fee is delinquent on the thirtieth day after opening. Penalties may be applied as provided by ordinance. Date Signature:Owner/Executive Officer: