* Required     

DBA
Business Name
Business Address (Must be physical location, not a Post Office Box)	Verifying Address... Verified! Not recognized as a valid USPS address. Valid USPS address but is missing UNIT/STE #. Valid USPS address but UNIT/STE # is not recognized. Verify Address Edit
Mail Address	Same as address above
	Verifying Address... Verified! Not recognized as a valid USPS address. Valid USPS address but is missing UNIT/STE #. Valid USPS address but UNIT/STE # is not recognized. Verify Address Edit
General Business Description
Ownership Type	Corporation Exempt Ltd Liability Co Ltd Partnership Partnership Sole Proprietorship Trust
Employee Count *
Enter gross receipts estimate *
Start Date in City of La Mirada (estimate if in the future)
Contact Information
Phone
Phone 2
Fax
Website
Email Address
BEAN
FEIN
SEIN
Contact Preference	Contact me by email whenever possible, in order to ensure timely notices and help protect the environment by conserving resources.
State License Information (Contractor, Medical, CAMTC, etc.)
State License #
State License Type
State License Expire Date
State License Verification *
Additional Information
Building Square Footage - If business is primarily a warehouse facility.
What is the primary Standard Industrial Classification (SIC) Code for this business location?
Is the above SIC code regulated by the NPDES Industrial Activities Stormwater General Permit? *	Yes No
If Yes, provide the NPDES Industrial Activities Stormwater General Permit Identification # assigned by the State Water Resources Control Board to the business.
File Attachments (if required).  More Info
Home Occupation Regulations and/or Zoning Clearance/Plan Check Application - ALL LA MIRADA BASED BUSINESSES MUST ATTACH THIS FORM. OUTSIDE CONTRACTORS MAY ATTACH A BLANK DOCUMENT TO BYPASS THE SYSTEM REQUIREMENT.
File Description
	*This file type is not allowed. List of supported file types.
*Cumulative file size can not exceed 89MB. Please reduce the size of your files and try again.