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2. Name of Business:*
3. Name of Applicant:*
5. Address of Home Business:*
6. Zip Code:*
7. Business Phone:*
9. Is your Mailing Address different from your Business Address?*

   1. Yes
   2. No
11. Mailing Address:*
12. Mailing Zip Code*
14. Describe the Type of Business:*
16. What Activities Will Be Done At The Home (examples: office use, internet sales, consulting, tutoring, tailoring, etc.):*
18. Hours of Operation:*
19. Days Of Operation*

    (check all that apply)

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday

    1. Friday
    2. Saturday
    3. Sunday
21. BUSINESS WILL INVOLVE SALES/SERVICES CONDUCTED ON THE PREMISES*

    1. Yes
    2. No

    (note: sales must be incidental/secondary to the business, such as a hairstylist selling shampoo; retail sales are not permitted as a primary use for home businesses. Please specify if sales will be online or in-person.)

22. IF YES, DESCRIBE THE SALES/SERVICES PROPOSED:*
24. BUSINESS WILL INVOLVE SALES/SERVICES CONDUCTED AWAY FROM THE PREMISES*

    1. Yes
    2. No
25. IF YES, DESCRIBE THE SALES/SERVICES PROPOSED:*
27. BUSINESS WILL INVOLVE CUSTOMERS VISITING THE HOME*

    1. Yes
    2. No

    (example: training, consultation, appointments)

28. IF YES, HOW MANY CUSTOMERS PER DAY?*
30. A VEHICLE WILL BE USED FOR THE HOME BUSINESS*

    1. Yes
    2. No
31. IF YES, PROVIDE THE MAKE AND MODEL OF THE VEHICLE*
32. WHERE WILL THE VEHICLE BE STORED? *
34. BUSINESS INVOLVES A LARGE FAMILY DAY CARE*

    1. Yes
    2. No
35. IF YES, WILL YOU HAVE 14 OR FEWER CHILDREN?*
37. BUSINESS IS A COTTAGE FOODS OPERATION*

    1. Yes
    2. No
38. IF YES, HOW MANY EMPLOYEES OTHER THAN FAMILY MEMBERS OR HOUSEHOLD MEMBERS? *

    (STATE LAW ALLOWS ONE FULL-TIME EQUIVALENT EMPLOYEE)

40. Acknowledgement*

    1. By checking this box, I agree to the below terms.

    I declare under penalty of perjury that I have read and hereby agree to abide by all the rules and limitations for operating a Home Business in the City of Modesto.

42. Note: If we receive a complaint about the operation of the business, it is our duty to investigate so that we can verify the facts and help to make corrections or adjustments so that the problems can be solved. Our desire is to help both the complainant and the licensee. If you have any questions, please call the Planning division at 209-577-5267. Mail the top two copies to the City of Modesto, P.O. Box 3442, Modesto, CA, 95353.

44. Business Owner Name:*
45. Business Home Address:*
47. Digital Signature*
    Provide your digital signature in order to indicate your agreement with the terms of this application. Your digital signature must be between two forward-slash (/) symbol. An example of a valid digital signature is /John Doe/.
48. Link for Home Business Municipal Code Reference
    10-3.207 Home Business Municipal Code
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field