HTML Preview Business Fax page number 1.
STATE LICENSE NUMBER:
FULL BUSINESS NAME (as shown on contractor's card):
BUSINESS MAILING ADDRESS: City State ZIP code
BUSINESS PHONE NUMBER 4. BUSINESS FAX NUMBER
E-Mail address
TYPE DESCRIPTION EXPIRATION DATE:
CITY BUSINESS LICENSE FEES:
See page no. 2 of this worksheet for fees
CREDIT CARD DETAILS:
Name as it a
pp
ears on the Credit Card:
Payee's Address Information:
Credit Card Number:
Ex
p
iration Date:
The undersigned gives the City of Glendale Building & Safety Division
p
ermission to acce
p
t a facsimile of my signature on faxed license
a
pp
lication in lieu of my "in
p
erson" signature at your office. I hereby certify that I will com
p
ly with any and all declarations and
agreements on the faxed license a
pp
lication that bears my signature.
CONTRACTOR'S SIGNATURE:
Print: Sign: Date:
CLASSIFICATIONS
State Zip code
CITY BUSINESS LICENSE
(CALIFORNIA STATE LICENSED CONTRACTORS ONLY )
DATE:
ALL a
pp
licable s
p
aces on this 2
p
a
g
e worksheet must be filled out com
p
letel
y
or it can not be acce
p
ted
for processing. Please print legibly in ink or type in the application.
Renewal First Time in Glendale
Community Planning De
p
artment
Building and Safety Division
If you have several classifications, please check the Classification you need at this time)
6
33
E. Broa
d
way Rm. 101
Gl
en
d
a
l
e,
C
A 91
2
06
(
818
)
548-
32
00,
(
818
)
548-
32
15 FA
X
( ) ( )
FAX WORKSHEET & CREDIT CARD AUTHORIZATION
Please provide a copy of State Contractor's License Pocket Card.
Street Address
City
CARD ACCEPTED
CDB-CBL (01/14) Page 1 of 2