FICTITIOUS NAME PERMIT

On-Line Renewal Instructions

Welcome to the DCA Breeze Online Services system

Renewing on -line requires payment by credit card Please do not submit a paper renewal to the

Osteopathic Medical Board if you have successfully completed this on-line process

Note Do not attempt to renew a delinquent Permit on-line (ie expired 12312014 or prior)

Important The first step in renewing a Ficticious Name Permit (FNP) on-line requires linking the

personal information of the DO who is the majority shareholder of the business or corporation to the

FNP If you cannot provide the information required the transaction will fail and you must send the

renewal form and check to our office

F~a lcds Http

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DCA BreEZe Online Services

We-lcoine to the Cahfom 1a Department of Consumer Atra~rs (DCA BreEZ~ Onhne S eMCes ~El~ ts DCAs new licens ing and nfotcement sy st em and a one-stop shop for consumers hcensees and af)plicanJ ~ SteEle ~nables consumers to wnfy a professional hcense and file a consumer compfaff11 Lunseeo and aopfcants can subrrul license appbcallons ren~ a lteense and change lhtllr addtSS among othar SeMCegt

bull If you wre regtstered W1Lh th DCA Onlme Professl0n3lltcensrng 4Metgt before_ you Mil Med U) re-ttgtsterwrth BteEZe bull BreEZe only acupts Crtdd card payments fu1Amencan Expr-~5 Oasca-Pr MaiterCard and VtSa

FOR CONSUMERS

Ched licenses and file complaints

FOR APPLICANTS AND LICENSEES

Applicant iind licensing needs lire avlli l able here You will need to~ or U5e youf

existing user nllme and password

Returning User

fields marked WJtb are reqUJred

UserO

Password

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BreEZe R~m$lratl0n

Click the link Breeze Registration directly below New Users in the lower right hand box

User Registration

Please complete the mfomta11or1 reqUired belalaquo to become a reg~st~r~ BreEZe User You Yltlil recewe a confirmation ernal 35 part of the regtstrabon proc~ss

Enter your delatls and p~ess lext~

Press ~Cancr to cancelthts rampg~strahOn and tampWm to he mam menu

Account Owner Contact tnfonnu tion

Fir$1 Name

Middle l~ame

Last llame

Account Logi n

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ConfiunEma1l ~Please enl er a r~hd ernatl address Ius email addre ss

Will not be sold to sohcrtors

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Secret Ouesllon Wbere wereyoo born

4 s~re-tArlswer LIARS

Communication middot~ Secm ity Lleasur es (Tbn bulllplm~t~lltll -~~as-J

bull Type the charactersllom the pclure below twnhoul spacas rvqcp

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This screen requires the personal information of the DO who is the majority shareholder of the business or corporation

Input is case sensitive Be sure to complete all areas containing a red

If everything is correct click the Next button then save or edit your information on the next page

04v User Registration- Temporary Passw ord Issued

A temporary pass NOrd has ~n bullssuedand sent to you 13 ~Hrull W11h the mstructlons on how to proc~ Read thiS e-nl3bulll and fDflobull the 111Structugtrts

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Check the e-mail address you just keyed to retrieve the temporary password

Copy the temporary password and click on the link provided in the e-mail to take you back to the log-in process

User Registration

Please complete the mfomta11or1 reqUired belalaquo to become a reg~st~r~ BreEZe User You Yltlil recewe a confirmation ernal 35 part of the regtstrabon proc~ss

Enter your delatls and p~ess lext~

Press ~Cancr to cancelthts rampg~strahOn and tampWm to he mam menu

Account Owner Contact tnfonnu tion

Fir$1 Name

Middle l~ame

Last llame

Account Logi n

Ema1l bull9~1Qgt)

ConfiunEma1l ~Please enl er a r~hd ernatl address Ius email addre ss

Will not be sold to sohcrtors

Usaf 10 ABABABA8

Secret Ouesllon Wbere wereyoo born

4 s~re-tArlswer LIARS

Communication middot~ Secm ity Lleasur es (Tbn bulllplm~t~lltll -~~as-J

bull Type the charactersllom the pclure below twnhoul spacas rvqcp

r v q c p

This screen requires the personal information of the DO who is the majority shareholder of the business or corporation

Input is case sensitive Be sure to complete all areas containing a red

If everything is correct click the Next button then save or edit your information on the next page

04v User Registration- Temporary Passw ord Issued

A temporary pass NOrd has ~n bullssuedand sent to you 13 ~Hrull W11h the mstructlons on how to proc~ Read thiS e-nl3bulll and fDflobull the 111Structugtrts

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Check the e-mail address you just keyed to retrieve the temporary password

Copy the temporary password and click on the link provided in the e-mail to take you back to the log-in process

04v User Registration- Temporary Passw ord Issued

A temporary pass NOrd has ~n bullssuedand sent to you 13 ~Hrull W11h the mstructlons on how to proc~ Read thiS e-nl3bulll and fDflobull the 111Structugtrts

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evc-r 1 iC I l Stn- fr bull 1 1

Check the e-mail address you just keyed to retrieve the temporary password

Copy the temporary password and click on the link provided in the e-mail to take you back to the log-in process

FOR CONSUMERS FOR APPLICANTS AND LICENSEES

Check Licenses and file complainlS Applicant and licensing needs are available here You w ill need to reg iste r or u~ your

existing U$er name and p assword

Returning User

fteJas m ar11ed wrth a re r-e qtnred

User lO ABABABAEI

PassmiddotNOfd

Fotgot Password FQtgot User 10

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BreEZo Remsuat10n

DCA BreEZe Online Services

Welcome to the Cahfombulla Oepattmem of Consumer Atfa1rs (OCAI BreEZe Online s~rnces BnEZe 1s OCAs ne-v ltceflsrng and enforcement system and a one-stop shop fur consumers ~censees and applicantsbull BreEZe enables consumers to v~nfy a l)fofess1onal Jc~nse 3nd file a consumer complamt l~eensees and applicants can subnul l~eense apofica11ons renew a hcense iHld change lheu addfass among other se-Mces

If you wtre reystered wrth the DCA Onhne ProfessiOnal LlcensuQ seMces before you wd need to rc--regrster wrth 8feEle

bull BreEZe only accepls cced1t card paymeflts for Arnenc an Express Dbullscovar M asterlard and Vtsa

Enter your User 10 and Temporary Password Click Sign In

f4v Update Default Regi stration Information

Enter your new passWOfd and ptess middotsave~

Your rteY password must contain the foiiOWtng

a m1mmum of(8) c haracliHS

bull must not be the same as your user 1d

must not be J V3R31on cl your user ld

musl contain at ~ast (11 uppertase alphabetiC charaeter

must cofllam at least (1) lowercase alpOabellc character

must contain at least (1) numenc character

bull must contam at least t1J ipecral charactet

TempOJary Pass-vord

~lew Password

bull Confirm Password middotmiddotmiddotmiddotmiddotmiddotmiddot-

Create your new password and click IISave

Add Ucenses To Registration before with DCA1 Ste p1 Eve r held a lice nse

WtlcomoloOCA~

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No

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Se lect Yes and click Next

f4v Update Default Regi stration Information

Enter your new passWOfd and ptess middotsave~

Your rteY password must contain the foiiOWtng

a m1mmum of(8) c haracliHS

bull must not be the same as your user 1d

must not be J V3R31on cl your user ld

musl contain at ~ast (11 uppertase alphabetiC charaeter

must cofllam at least (1) lowercase alpOabellc character

must contain at least (1) numenc character

bull must contam at least t1J ipecral charactet

TempOJary Pass-vord

~lew Password

bull Confirm Password middotmiddotmiddotmiddotmiddotmiddotmiddot-

Create your new password and click IISave

Add Ucenses To Registration before with DCA1 Ste p1 Eve r held a lice nse

WtlcomoloOCA~

Slep2 froodeldentifying By onswomg bull fow po- bull oil ~~o~pcogoc ~eci lnlormation

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No

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Se lect Yes and click Next

Add Ucenses To Registration before with DCA1 Ste p1 Eve r held a lice nse

WtlcomoloOCA~

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------------------------------------------------

Step1 Ever h eld a licen se before with DCA

Sl ep2 PCOIIide Jdenti fying Information

Ste-pJmiddot Confiml lnformation

Add Uunses To Registration- Select Ucense Type

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For DCA BoardBureauCommittee select Osteopathic Medical Board of California For Lice nse Registration Type select Fictitious Name Permits then click Next

St tp1 Ewr held a licenss bolo withDCA

Step2 Provid e Identifying lnformotion

StepJ Conirm lriormation

Add Ucenses To Reglstradon - VaDdadon

Holp us lnd your 10eons

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Enter the FNP license number- NUM ERIC PORTION ONLY Business Name lndivOrg Number (provided on the sticker attached to the paper Renewal Form) and security characters Click Next

Note If you misplaced the Renewal Form you cannot renew the permit on-line unless you contact our office to obtain the lndivOrg Number You the primary shareholder or sole proprietor must be able to verify personal information in order for us to release the lndivOrg Number to you over the phone Phone 916928-9898 or 916928-8390

I Step I Ever held a license bolote with OCA

Step2 PnMde ldentilywlg tnlonno6on

Step3 Confirm tnfonnotion

Skm

Add Ucenses To Registration - Preview

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Select th e appropria te button then click Next

~-middot You have successfully linked your online registration to a license (s) Wou ld you like to link your online registration to more license (s)

Select No

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File Edit View F~tS Tools Help

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Department of Comum Alfoln

BRE~E

UcenseJR~Istrelfon Show Details Quick Start Menu lnf0flll8lion

LicenseiReobullstrailon

--------------------------------TAdditional Activities

To s1a11 choose an opt1on and you Wlll rltlum to thi s 2371Number LJcenseJRegislratl on

Fictitious lf~me PermitpeLicense Activities

bull It is time to Renew bull Add Authorized Representative

Dl bull license Hotiftcation Subscfipdons

Applications

bull Start a Uew Application 01 Take an Exam

ltChoose Boardgt

ltChoose AppUconongt bull

bull View Appliialion Status

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Under the heading License Activities click the Select bo x

I Step I Ever held a license bolote with OCA

Step2 PnMde ldentilywlg tnlonno6on

Step3 Confirm tnfonnotion

Skm

Add Ucenses To Registration - Preview

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licyou ~---lndfv 1Org Number 101111t1

Nome DR HOUSl CALL

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Select th e appropria te button then click Next

~-middot You have successfully linked your online registration to a license (s) Wou ld you like to link your online registration to more license (s)

Select No

_______D middot Qcan ___ BreEZe middot_ _ _______ e middot State of Californ1a

File Edit View F~tS Tools Help

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Department of Comum Alfoln

BRE~E

UcenseJR~Istrelfon Show Details Quick Start Menu lnf0flll8lion

LicenseiReobullstrailon

--------------------------------TAdditional Activities

To s1a11 choose an opt1on and you Wlll rltlum to thi s 2371Number LJcenseJRegislratl on

Fictitious lf~me PermitpeLicense Activities

bull It is time to Renew bull Add Authorized Representative

Dl bull license Hotiftcation Subscfipdons

Applications

bull Start a Uew Application 01 Take an Exam

ltChoose Boardgt

ltChoose AppUconongt bull

bull View Appliialion Status

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Under the heading License Activities click the Select bo x

~-middot You have successfully linked your online registration to a license (s) Wou ld you like to link your online registration to more license (s)

Select No

_______D middot Qcan ___ BreEZe middot_ _ _______ e middot State of Californ1a

File Edit View F~tS Tools Help

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Department of Comum Alfoln

BRE~E

UcenseJR~Istrelfon Show Details Quick Start Menu lnf0flll8lion

LicenseiReobullstrailon

--------------------------------TAdditional Activities

To s1a11 choose an opt1on and you Wlll rltlum to thi s 2371Number LJcenseJRegislratl on

Fictitious lf~me PermitpeLicense Activities

bull It is time to Renew bull Add Authorized Representative

Dl bull license Hotiftcation Subscfipdons

Applications

bull Start a Uew Application 01 Take an Exam

ltChoose Boardgt

ltChoose AppUconongt bull

bull View Appliialion Status

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Under the heading License Activities click the Select bo x

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File Edit View F~tS Tools Help

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Department of Comum Alfoln

BRE~E

UcenseJR~Istrelfon Show Details Quick Start Menu lnf0flll8lion

LicenseiReobullstrailon

--------------------------------TAdditional Activities

To s1a11 choose an opt1on and you Wlll rltlum to thi s 2371Number LJcenseJRegislratl on

Fictitious lf~me PermitpeLicense Activities

bull It is time to Renew bull Add Authorized Representative

Dl bull license Hotiftcation Subscfipdons

Applications

bull Start a Uew Application 01 Take an Exam

ltChoose Boardgt

ltChoose AppUconongt bull

bull View Appliialion Status

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Under the heading License Activities click the Select bo x

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Fictitious Name Permits Renewal Application -lnfonnation Privacy ActIntroduction

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Information Privacy Acl

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Informat ion Pmxy Act

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Contact Details

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You should make changes to all addresses at this time The address(es) may appear correct on the screen however you must add the Country to all existing addresses To add Country select the address title in BLUE (Address of Record )

If you want to ADD a confidential mailing address select Add

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Fictitious Name Permits Renewal Application - Add AddJeSs Details- Select Ad dress Type Introduction

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Nama and PersonalOrg~

Addross TypoDetails

Conta ct Oelzlils

Appicalian Sunvnary

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If adding a confidential mailing address select Confidential Address

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lntroducbon Rditlous Name Permits Renewal Application- Maintain Contact Details

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Press -cancr If you do not warw to s- your cNngu

AddrusotRoconl

Contact Details fdorns l11u 1 123 MAiN

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Remember to add Co untry to all addresses Be sure t o complete all areas containing a red When complete cli ck Done

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Person~Organrzatxn Pross Conal to llOt Ills OjJIIIicoion Details

FktitJoos Hamo P ennks Renewal Appllcadoltl Summary Contact Oeca~s

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Name and

Appllcadon Summary

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If everything is correct on each add ress and yo u have added the Count ry click Proceed t o Payment If you need t o correct infor mat ion click the Previous but ton

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F~a Tools Help

O ontygoodncnonode -~5 D lo9n OO OffiaoiW_S_ middot- gt~5Cll ~5tos ltil WelgtlictGelltty

Introduction

Information Pmacy Act

Namecwld Person~ Oets

Contact OUU

Appllcotlon Summlf

Actitious Name Pennits Renewal Application - Attestation

Prtss Prwwiaus to mum to rhe pwous MdJon_

AnnriltYosbull or lo to rile-pnu Proceed ID ~middotto cor01uo

Prus Cancer to lXII tin~

Tho -gdodoraboniTIJSI bo Jd by oliconud ostiOpllllc ~wllo the_~an- -ersllp or a portnot h ponnershl or corporllt laquo t 1 corponiiOOIclftiy -ay olpe~Jgtry undtttht laws afiM Statoaf Calwnla thlt all stabmtnts mswers md Jn-Stnbltloas US appialion bullbull but md acante

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Click the Yes button and click Proceed to Payment

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e4v Fee and Summary Report

Your application data has been su bmrtted Cfick on V1ew PDF Summary Re-portbull and pnnt t h1s rep01t for your records

You are requued lo pay the amount below for your appllcat1on lobi p~ocessed

Press Pay Now~ to proceed 10 the fee payme01 page

Press ~Add to Cart to Add lo Shopping Cart ano re twn to the ntaJn menu

Fshy

FHP Annual Ren ewal fee $5000

Tolai AmoontDue 5 5000

View PDF Summary ReportMJN middotflUb+ fiK~ lf~ r1L_21~ ~~ ~middot

Copmiddot gt- 0 10l ~rot~ ~i - 3bulllt1bullrmiddotu

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IAtiAll 111ltbull H 1 ~ LsKamf tswJKUlJ

O nlin e Application Pay ment

Opllonally reduce payment amoun1 where alkwftd by dtseiKttng the chbullcttboxts below

Press middotshaw Fee Oet~tsmiddot to shaw a breakdown olltlt fee iJIYlOuots

Press Cancer to canc el the payment

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flctitiovs Uame Pennils 13974209 fiCtitious tampame PermiiS S5000 bullRenewaiApplicatloa

Payment Uelhod v MastetCMd

f O=shyAme~ expess

Show Fee De1lt~11s

Enter Payment Method then cl ick Next

Follow the prompts and comp lete the payment screens

Print your Payment Confirmation Information screen We cannot investigate missing payments without this inrormation

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File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

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BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

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FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line

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You should make changes to all addresses at this time The address(es) may appear correct on the screen however you must add the Country to all existing addresses To add Country select the address title in BLUE (Address of Record )

If you want to ADD a confidential mailing address select Add

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Fictitious Name Permits Renewal Application - Add AddJeSs Details- Select Ad dress Type Introduction

Solocl oddruslypo iorn tho _ ist one pnss llullnformation PrivxyAd Prtss Bad( to taan to the Adchss Orauil Summaty SctHn

Nama and PersonalOrg~

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If adding a confidential mailing address select Confidential Address

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lntroducbon Rditlous Name Permits Renewal Application- Maintain Contact Details

Ecil tho daa t pntn Dono to yow cNngn

Press -cancr If you do not warw to s- your cNngu

AddrusotRoconl

Contact Details fdorns l11u 1 123 MAiN

Appication Summaty Address Lmo2

Adltuslonel

cay- SACRAMEiflO

Sf~ Cafiforma

Zip Coclo 9S834

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Country

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lU m_rp ~c f_Jf ~-middot ~ ~~--1 hrbullmiddot b f_ P-~11 fi 203 Sllttl~ M I~ltJ~Vrii

Remember to add Co untry to all addresses Be sure t o complete all areas containing a red When complete cli ck Done

bull Brr EZr - Stur of Cdfom~~----~----~------- ~ p O UmF~bull---~~~------------~-~ ~ VirM FM1011tu Toe Help

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Flditlous Name Permits Renewal App8cation - App8cation Summary Introduc tion

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Person~Organrzatxn Pross Conal to llOt Ills OjJIIIicoion Details

FktitJoos Hamo P ennks Renewal Appllcadoltl Summary Contact Oeca~s

IJcenselypo FlclillousltaiMPannil

Name and

Appllcadon Summary

Fie- 2000170

IJcense- )lOZ ApplicaiOI1 ~ 13974209

AppliuiJon oc 09111112015

Organization Delall

~- 0( Ao-~ 2211EnbtyTypomiddot

Addresaa

l icense Spedllc Addfesses p HOImiddot X campL qAddres s of Record Nome

123 UAIH SACRAUEHTO CA -middot 95834 us

CA us

wgg y wy + middotMfWIsectIM fa~l_ Trjl ke_ol~ ~ amp~

CmiddotJPbullil zqbull SIJ P -atkrra

shy

If everything is correct on each add ress and yo u have added the Count ry click Proceed t o Payment If you need t o correct infor mat ion click the Previous but ton

~--~~~-middot~~- ________________a 8reEZe -Suteo4Califomrbull--~ ~-~ P (

F~a Tools Help

O ontygoodncnonode -~5 D lo9n OO OffiaoiW_S_ middot- gt~5Cll ~5tos ltil WelgtlictGelltty

Introduction

Information Pmacy Act

Namecwld Person~ Oets

Contact OUU

Appllcotlon Summlf

Actitious Name Pennits Renewal Application - Attestation

Prtss Prwwiaus to mum to rhe pwous MdJon_

AnnriltYosbull or lo to rile-pnu Proceed ID ~middotto cor01uo

Prus Cancer to lXII tin~

Tho -gdodoraboniTIJSI bo Jd by oliconud ostiOpllllc ~wllo the_~an- -ersllp or a portnot h ponnershl or corporllt laquo t 1 corponiiOOIclftiy -ay olpe~Jgtry undtttht laws afiM Statoaf Calwnla thlt all stabmtnts mswers md Jn-Stnbltloas US appialion bullbull but md acante

By HlocU1g -vosmiddot t clicking ProcHe~ ID p~middot1 attut tllalllow rud t lftltrstlnd tin _

bull llo

MQIJII ifW MQlJ middotbiki isectM IBJI fl_~k h middotrmiddot11bull1bulld -- rlbulltx_middotu ~

C ur 1 lJ1J $tit ~ Cl0zJnbulld

Click the Yes button and click Proceed to Payment

_

Fil~ pounddll vtw F_ts Tools Http

_ () ontgoodncs10shy middotshy -~SO~ogon OfficcoiW-SV- bull- ~S(Z) SuggcsudSita lt Woblioo Goley bull -11 bull ~ bull

e4v Fee and Summary Report

Your application data has been su bmrtted Cfick on V1ew PDF Summary Re-portbull and pnnt t h1s rep01t for your records

You are requued lo pay the amount below for your appllcat1on lobi p~ocessed

Press Pay Now~ to proceed 10 the fee payme01 page

Press ~Add to Cart to Add lo Shopping Cart ano re twn to the ntaJn menu

Fshy

FHP Annual Ren ewal fee $5000

Tolai AmoontDue 5 5000

View PDF Summary ReportMJN middotflUb+ fiK~ lf~ r1L_21~ ~~ ~middot

Copmiddot gt- 0 10l ~rot~ ~i - 3bulllt1bullrmiddotu

Click Pay Now

~~~~----------FIIc poundc5t YNW fworcts T Http

()~ middot- --5 D bull Offiad___ middot bull ~51l) ~Sooggaud- i W~5iCIGIIoly bull

IAtiAll 111ltbull H 1 ~ LsKamf tswJKUlJ

O nlin e Application Pay ment

Opllonally reduce payment amoun1 where alkwftd by dtseiKttng the chbullcttboxts below

Press middotshaw Fee Oet~tsmiddot to shaw a breakdown olltlt fee iJIYlOuots

Press Cancer to canc el the payment

Appllcatlon thnnber lleocriptlon llceMeTypo bullApplkant Home Fee

flctitiovs Uame Pennils 13974209 fiCtitious tampame PermiiS S5000 bullRenewaiApplicatloa

Payment Uelhod v MastetCMd

f O=shyAme~ expess

Show Fee De1lt~11s

Enter Payment Method then cl ick Next

Follow the prompts and comp lete the payment screens

Print your Payment Confirmation Information screen We cannot investigate missing payments without this inrormation

C 9repoundZr bull Sttte of CbulllifotnU

File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

O~tmenl ol Coruumfi Attain

BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

bull If JOU -vere fegJStered oNJh thamp DCA Onhne Profess1onal Ucens1ng iel1Ces before you Vllll ne~ to reflg1ste1 With BreEU bull Br~EZi only accepts cr~rt card paymems ror Amencao Express 01scover MasterCard and V 153

FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line

c Wolo lktGIItfy bull ~ bull liJ bull

~~~--~~shyF~a Tooh Http

~ OonlygoodntS~niOdo bull-~5 Q 1ogon Offiaolwr-SV_ middot- ~5tll ~Sita

e4v ~ IAHAEI ll_Rt_H~ ~i L2ggf ~

Fictitious Name Permits Renewal Application - Add AddJeSs Details- Select Ad dress Type Introduction

Solocl oddruslypo iorn tho _ ist one pnss llullnformation PrivxyAd Prtss Bad( to taan to the Adchss Orauil Summaty SctHn

Nama and PersonalOrg~

Addross TypoDetails

Conta ct Oelzlils

Appicalian Sunvnary

ft~ ~ p ~tont_ 11 ~ ~o -~u ampmiddotbull boiL ((PI(j ~L0 1 J IHbull _A al frnf31

If adding a confidential mailing address select Confidential Address

bull ~ bull li3 bull F Tools Holp

() onlyltJoodn- middot- --s O~agon OffiaoiW SV- _ ~5(2) ~odSU d Woblict Goley

lntroducbon Rditlous Name Permits Renewal Application- Maintain Contact Details

Ecil tho daa t pntn Dono to yow cNngn

Press -cancr If you do not warw to s- your cNngu

AddrusotRoconl

Contact Details fdorns l11u 1 123 MAiN

Appication Summaty Address Lmo2

Adltuslonel

cay- SACRAMEiflO

Sf~ Cafiforma

Zip Coclo 9S834

c-y

Country

-middotshyExonsol

E-moil

PJiltNle Phone

lU m_rp ~c f_Jf ~-middot ~ ~~--1 hrbullmiddot b f_ P-~11 fi 203 Sllttl~ M I~ltJ~Vrii

Remember to add Co untry to all addresses Be sure t o complete all areas containing a red When complete cli ck Done

bull Brr EZr - Stur of Cdfom~~----~----~------- ~ p O UmF~bull---~~~------------~-~ ~ VirM FM1011tu Toe Help

(] o ntygoodnomnudlt -~S D io9on 4 0 ffinolw-s-_ -~ ~Sill ~Sites o Wdgtliu~

Tllt1ll Pfl1 ~ lmm ~

Flditlous Name Permits Renewal App8cation - App8cation Summary Introduc tion

Prus ~middotto me rwtum 1o the p-WOUS stCDCn-thediU and prus -otdto~ to -Ills opplitDn

Person~Organrzatxn Pross Conal to llOt Ills OjJIIIicoion Details

FktitJoos Hamo P ennks Renewal Appllcadoltl Summary Contact Oeca~s

IJcenselypo FlclillousltaiMPannil

Name and

Appllcadon Summary

Fie- 2000170

IJcense- )lOZ ApplicaiOI1 ~ 13974209

AppliuiJon oc 09111112015

Organization Delall

~- 0( Ao-~ 2211EnbtyTypomiddot

Addresaa

l icense Spedllc Addfesses p HOImiddot X campL qAddres s of Record Nome

123 UAIH SACRAUEHTO CA -middot 95834 us

CA us

wgg y wy + middotMfWIsectIM fa~l_ Trjl ke_ol~ ~ amp~

CmiddotJPbullil zqbull SIJ P -atkrra

shy

If everything is correct on each add ress and yo u have added the Count ry click Proceed t o Payment If you need t o correct infor mat ion click the Previous but ton

~--~~~-middot~~- ________________a 8reEZe -Suteo4Califomrbull--~ ~-~ P (

F~a Tools Help

O ontygoodncnonode -~5 D lo9n OO OffiaoiW_S_ middot- gt~5Cll ~5tos ltil WelgtlictGelltty

Introduction

Information Pmacy Act

Namecwld Person~ Oets

Contact OUU

Appllcotlon Summlf

Actitious Name Pennits Renewal Application - Attestation

Prtss Prwwiaus to mum to rhe pwous MdJon_

AnnriltYosbull or lo to rile-pnu Proceed ID ~middotto cor01uo

Prus Cancer to lXII tin~

Tho -gdodoraboniTIJSI bo Jd by oliconud ostiOpllllc ~wllo the_~an- -ersllp or a portnot h ponnershl or corporllt laquo t 1 corponiiOOIclftiy -ay olpe~Jgtry undtttht laws afiM Statoaf Calwnla thlt all stabmtnts mswers md Jn-Stnbltloas US appialion bullbull but md acante

By HlocU1g -vosmiddot t clicking ProcHe~ ID p~middot1 attut tllalllow rud t lftltrstlnd tin _

bull llo

MQIJII ifW MQlJ middotbiki isectM IBJI fl_~k h middotrmiddot11bull1bulld -- rlbulltx_middotu ~

C ur 1 lJ1J $tit ~ Cl0zJnbulld

Click the Yes button and click Proceed to Payment

_

Fil~ pounddll vtw F_ts Tools Http

_ () ontgoodncs10shy middotshy -~SO~ogon OfficcoiW-SV- bull- ~S(Z) SuggcsudSita lt Woblioo Goley bull -11 bull ~ bull

e4v Fee and Summary Report

Your application data has been su bmrtted Cfick on V1ew PDF Summary Re-portbull and pnnt t h1s rep01t for your records

You are requued lo pay the amount below for your appllcat1on lobi p~ocessed

Press Pay Now~ to proceed 10 the fee payme01 page

Press ~Add to Cart to Add lo Shopping Cart ano re twn to the ntaJn menu

Fshy

FHP Annual Ren ewal fee $5000

Tolai AmoontDue 5 5000

View PDF Summary ReportMJN middotflUb+ fiK~ lf~ r1L_21~ ~~ ~middot

Copmiddot gt- 0 10l ~rot~ ~i - 3bulllt1bullrmiddotu

Click Pay Now

~~~~----------FIIc poundc5t YNW fworcts T Http

()~ middot- --5 D bull Offiad___ middot bull ~51l) ~Sooggaud- i W~5iCIGIIoly bull

IAtiAll 111ltbull H 1 ~ LsKamf tswJKUlJ

O nlin e Application Pay ment

Opllonally reduce payment amoun1 where alkwftd by dtseiKttng the chbullcttboxts below

Press middotshaw Fee Oet~tsmiddot to shaw a breakdown olltlt fee iJIYlOuots

Press Cancer to canc el the payment

Appllcatlon thnnber lleocriptlon llceMeTypo bullApplkant Home Fee

flctitiovs Uame Pennils 13974209 fiCtitious tampame PermiiS S5000 bullRenewaiApplicatloa

Payment Uelhod v MastetCMd

f O=shyAme~ expess

Show Fee De1lt~11s

Enter Payment Method then cl ick Next

Follow the prompts and comp lete the payment screens

Print your Payment Confirmation Information screen We cannot investigate missing payments without this inrormation

C 9repoundZr bull Sttte of CbulllifotnU

File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

O~tmenl ol Coruumfi Attain

BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

bull If JOU -vere fegJStered oNJh thamp DCA Onhne Profess1onal Ucens1ng iel1Ces before you Vllll ne~ to reflg1ste1 With BreEU bull Br~EZi only accepts cr~rt card paymems ror Amencao Express 01scover MasterCard and V 153

FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line

bull ~ bull li3 bull F Tools Holp

() onlyltJoodn- middot- --s O~agon OffiaoiW SV- _ ~5(2) ~odSU d Woblict Goley

lntroducbon Rditlous Name Permits Renewal Application- Maintain Contact Details

Ecil tho daa t pntn Dono to yow cNngn

Press -cancr If you do not warw to s- your cNngu

AddrusotRoconl

Contact Details fdorns l11u 1 123 MAiN

Appication Summaty Address Lmo2

Adltuslonel

cay- SACRAMEiflO

Sf~ Cafiforma

Zip Coclo 9S834

c-y

Country

-middotshyExonsol

E-moil

PJiltNle Phone

lU m_rp ~c f_Jf ~-middot ~ ~~--1 hrbullmiddot b f_ P-~11 fi 203 Sllttl~ M I~ltJ~Vrii

Remember to add Co untry to all addresses Be sure t o complete all areas containing a red When complete cli ck Done

bull Brr EZr - Stur of Cdfom~~----~----~------- ~ p O UmF~bull---~~~------------~-~ ~ VirM FM1011tu Toe Help

(] o ntygoodnomnudlt -~S D io9on 4 0 ffinolw-s-_ -~ ~Sill ~Sites o Wdgtliu~

Tllt1ll Pfl1 ~ lmm ~

Flditlous Name Permits Renewal App8cation - App8cation Summary Introduc tion

Prus ~middotto me rwtum 1o the p-WOUS stCDCn-thediU and prus -otdto~ to -Ills opplitDn

Person~Organrzatxn Pross Conal to llOt Ills OjJIIIicoion Details

FktitJoos Hamo P ennks Renewal Appllcadoltl Summary Contact Oeca~s

IJcenselypo FlclillousltaiMPannil

Name and

Appllcadon Summary

Fie- 2000170

IJcense- )lOZ ApplicaiOI1 ~ 13974209

AppliuiJon oc 09111112015

Organization Delall

~- 0( Ao-~ 2211EnbtyTypomiddot

Addresaa

l icense Spedllc Addfesses p HOImiddot X campL qAddres s of Record Nome

123 UAIH SACRAUEHTO CA -middot 95834 us

CA us

wgg y wy + middotMfWIsectIM fa~l_ Trjl ke_ol~ ~ amp~

CmiddotJPbullil zqbull SIJ P -atkrra

shy

If everything is correct on each add ress and yo u have added the Count ry click Proceed t o Payment If you need t o correct infor mat ion click the Previous but ton

~--~~~-middot~~- ________________a 8reEZe -Suteo4Califomrbull--~ ~-~ P (

F~a Tools Help

O ontygoodncnonode -~5 D lo9n OO OffiaoiW_S_ middot- gt~5Cll ~5tos ltil WelgtlictGelltty

Introduction

Information Pmacy Act

Namecwld Person~ Oets

Contact OUU

Appllcotlon Summlf

Actitious Name Pennits Renewal Application - Attestation

Prtss Prwwiaus to mum to rhe pwous MdJon_

AnnriltYosbull or lo to rile-pnu Proceed ID ~middotto cor01uo

Prus Cancer to lXII tin~

Tho -gdodoraboniTIJSI bo Jd by oliconud ostiOpllllc ~wllo the_~an- -ersllp or a portnot h ponnershl or corporllt laquo t 1 corponiiOOIclftiy -ay olpe~Jgtry undtttht laws afiM Statoaf Calwnla thlt all stabmtnts mswers md Jn-Stnbltloas US appialion bullbull but md acante

By HlocU1g -vosmiddot t clicking ProcHe~ ID p~middot1 attut tllalllow rud t lftltrstlnd tin _

bull llo

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C ur 1 lJ1J $tit ~ Cl0zJnbulld

Click the Yes button and click Proceed to Payment

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_ () ontgoodncs10shy middotshy -~SO~ogon OfficcoiW-SV- bull- ~S(Z) SuggcsudSita lt Woblioo Goley bull -11 bull ~ bull

e4v Fee and Summary Report

Your application data has been su bmrtted Cfick on V1ew PDF Summary Re-portbull and pnnt t h1s rep01t for your records

You are requued lo pay the amount below for your appllcat1on lobi p~ocessed

Press Pay Now~ to proceed 10 the fee payme01 page

Press ~Add to Cart to Add lo Shopping Cart ano re twn to the ntaJn menu

Fshy

FHP Annual Ren ewal fee $5000

Tolai AmoontDue 5 5000

View PDF Summary ReportMJN middotflUb+ fiK~ lf~ r1L_21~ ~~ ~middot

Copmiddot gt- 0 10l ~rot~ ~i - 3bulllt1bullrmiddotu

Click Pay Now

~~~~----------FIIc poundc5t YNW fworcts T Http

()~ middot- --5 D bull Offiad___ middot bull ~51l) ~Sooggaud- i W~5iCIGIIoly bull

IAtiAll 111ltbull H 1 ~ LsKamf tswJKUlJ

O nlin e Application Pay ment

Opllonally reduce payment amoun1 where alkwftd by dtseiKttng the chbullcttboxts below

Press middotshaw Fee Oet~tsmiddot to shaw a breakdown olltlt fee iJIYlOuots

Press Cancer to canc el the payment

Appllcatlon thnnber lleocriptlon llceMeTypo bullApplkant Home Fee

flctitiovs Uame Pennils 13974209 fiCtitious tampame PermiiS S5000 bullRenewaiApplicatloa

Payment Uelhod v MastetCMd

f O=shyAme~ expess

Show Fee De1lt~11s

Enter Payment Method then cl ick Next

Follow the prompts and comp lete the payment screens

Print your Payment Confirmation Information screen We cannot investigate missing payments without this inrormation

C 9repoundZr bull Sttte of CbulllifotnU

File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

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BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

bull If JOU -vere fegJStered oNJh thamp DCA Onhne Profess1onal Ucens1ng iel1Ces before you Vllll ne~ to reflg1ste1 With BreEU bull Br~EZi only accepts cr~rt card paymems ror Amencao Express 01scover MasterCard and V 153

FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line

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If everything is correct on each add ress and yo u have added the Count ry click Proceed t o Payment If you need t o correct infor mat ion click the Previous but ton

~--~~~-middot~~- ________________a 8reEZe -Suteo4Califomrbull--~ ~-~ P (

F~a Tools Help

O ontygoodncnonode -~5 D lo9n OO OffiaoiW_S_ middot- gt~5Cll ~5tos ltil WelgtlictGelltty

Introduction

Information Pmacy Act

Namecwld Person~ Oets

Contact OUU

Appllcotlon Summlf

Actitious Name Pennits Renewal Application - Attestation

Prtss Prwwiaus to mum to rhe pwous MdJon_

AnnriltYosbull or lo to rile-pnu Proceed ID ~middotto cor01uo

Prus Cancer to lXII tin~

Tho -gdodoraboniTIJSI bo Jd by oliconud ostiOpllllc ~wllo the_~an- -ersllp or a portnot h ponnershl or corporllt laquo t 1 corponiiOOIclftiy -ay olpe~Jgtry undtttht laws afiM Statoaf Calwnla thlt all stabmtnts mswers md Jn-Stnbltloas US appialion bullbull but md acante

By HlocU1g -vosmiddot t clicking ProcHe~ ID p~middot1 attut tllalllow rud t lftltrstlnd tin _

bull llo

MQIJII ifW MQlJ middotbiki isectM IBJI fl_~k h middotrmiddot11bull1bulld -- rlbulltx_middotu ~

C ur 1 lJ1J $tit ~ Cl0zJnbulld

Click the Yes button and click Proceed to Payment

_

Fil~ pounddll vtw F_ts Tools Http

_ () ontgoodncs10shy middotshy -~SO~ogon OfficcoiW-SV- bull- ~S(Z) SuggcsudSita lt Woblioo Goley bull -11 bull ~ bull

e4v Fee and Summary Report

Your application data has been su bmrtted Cfick on V1ew PDF Summary Re-portbull and pnnt t h1s rep01t for your records

You are requued lo pay the amount below for your appllcat1on lobi p~ocessed

Press Pay Now~ to proceed 10 the fee payme01 page

Press ~Add to Cart to Add lo Shopping Cart ano re twn to the ntaJn menu

Fshy

FHP Annual Ren ewal fee $5000

Tolai AmoontDue 5 5000

View PDF Summary ReportMJN middotflUb+ fiK~ lf~ r1L_21~ ~~ ~middot

Copmiddot gt- 0 10l ~rot~ ~i - 3bulllt1bullrmiddotu

Click Pay Now

~~~~----------FIIc poundc5t YNW fworcts T Http

()~ middot- --5 D bull Offiad___ middot bull ~51l) ~Sooggaud- i W~5iCIGIIoly bull

IAtiAll 111ltbull H 1 ~ LsKamf tswJKUlJ

O nlin e Application Pay ment

Opllonally reduce payment amoun1 where alkwftd by dtseiKttng the chbullcttboxts below

Press middotshaw Fee Oet~tsmiddot to shaw a breakdown olltlt fee iJIYlOuots

Press Cancer to canc el the payment

Appllcatlon thnnber lleocriptlon llceMeTypo bullApplkant Home Fee

flctitiovs Uame Pennils 13974209 fiCtitious tampame PermiiS S5000 bullRenewaiApplicatloa

Payment Uelhod v MastetCMd

f O=shyAme~ expess

Show Fee De1lt~11s

Enter Payment Method then cl ick Next

Follow the prompts and comp lete the payment screens

Print your Payment Confirmation Information screen We cannot investigate missing payments without this inrormation

C 9repoundZr bull Sttte of CbulllifotnU

File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

O~tmenl ol Coruumfi Attain

BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

bull If JOU -vere fegJStered oNJh thamp DCA Onhne Profess1onal Ucens1ng iel1Ces before you Vllll ne~ to reflg1ste1 With BreEU bull Br~EZi only accepts cr~rt card paymems ror Amencao Express 01scover MasterCard and V 153

FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line

~--~~~-middot~~- ________________a 8reEZe -Suteo4Califomrbull--~ ~-~ P (

F~a Tools Help

O ontygoodncnonode -~5 D lo9n OO OffiaoiW_S_ middot- gt~5Cll ~5tos ltil WelgtlictGelltty

Introduction

Information Pmacy Act

Namecwld Person~ Oets

Contact OUU

Appllcotlon Summlf

Actitious Name Pennits Renewal Application - Attestation

Prtss Prwwiaus to mum to rhe pwous MdJon_

AnnriltYosbull or lo to rile-pnu Proceed ID ~middotto cor01uo

Prus Cancer to lXII tin~

Tho -gdodoraboniTIJSI bo Jd by oliconud ostiOpllllc ~wllo the_~an- -ersllp or a portnot h ponnershl or corporllt laquo t 1 corponiiOOIclftiy -ay olpe~Jgtry undtttht laws afiM Statoaf Calwnla thlt all stabmtnts mswers md Jn-Stnbltloas US appialion bullbull but md acante

By HlocU1g -vosmiddot t clicking ProcHe~ ID p~middot1 attut tllalllow rud t lftltrstlnd tin _

bull llo

MQIJII ifW MQlJ middotbiki isectM IBJI fl_~k h middotrmiddot11bull1bulld -- rlbulltx_middotu ~

C ur 1 lJ1J $tit ~ Cl0zJnbulld

Click the Yes button and click Proceed to Payment

_

Fil~ pounddll vtw F_ts Tools Http

_ () ontgoodncs10shy middotshy -~SO~ogon OfficcoiW-SV- bull- ~S(Z) SuggcsudSita lt Woblioo Goley bull -11 bull ~ bull

e4v Fee and Summary Report

Your application data has been su bmrtted Cfick on V1ew PDF Summary Re-portbull and pnnt t h1s rep01t for your records

You are requued lo pay the amount below for your appllcat1on lobi p~ocessed

Press Pay Now~ to proceed 10 the fee payme01 page

Press ~Add to Cart to Add lo Shopping Cart ano re twn to the ntaJn menu

Fshy

FHP Annual Ren ewal fee $5000

Tolai AmoontDue 5 5000

View PDF Summary ReportMJN middotflUb+ fiK~ lf~ r1L_21~ ~~ ~middot

Copmiddot gt- 0 10l ~rot~ ~i - 3bulllt1bullrmiddotu

Click Pay Now

~~~~----------FIIc poundc5t YNW fworcts T Http

()~ middot- --5 D bull Offiad___ middot bull ~51l) ~Sooggaud- i W~5iCIGIIoly bull

IAtiAll 111ltbull H 1 ~ LsKamf tswJKUlJ

O nlin e Application Pay ment

Opllonally reduce payment amoun1 where alkwftd by dtseiKttng the chbullcttboxts below

Press middotshaw Fee Oet~tsmiddot to shaw a breakdown olltlt fee iJIYlOuots

Press Cancer to canc el the payment

Appllcatlon thnnber lleocriptlon llceMeTypo bullApplkant Home Fee

flctitiovs Uame Pennils 13974209 fiCtitious tampame PermiiS S5000 bullRenewaiApplicatloa

Payment Uelhod v MastetCMd

f O=shyAme~ expess

Show Fee De1lt~11s

Enter Payment Method then cl ick Next

Follow the prompts and comp lete the payment screens

Print your Payment Confirmation Information screen We cannot investigate missing payments without this inrormation

C 9repoundZr bull Sttte of CbulllifotnU

File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

O~tmenl ol Coruumfi Attain

BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

bull If JOU -vere fegJStered oNJh thamp DCA Onhne Profess1onal Ucens1ng iel1Ces before you Vllll ne~ to reflg1ste1 With BreEU bull Br~EZi only accepts cr~rt card paymems ror Amencao Express 01scover MasterCard and V 153

FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line

_

Fil~ pounddll vtw F_ts Tools Http

_ () ontgoodncs10shy middotshy -~SO~ogon OfficcoiW-SV- bull- ~S(Z) SuggcsudSita lt Woblioo Goley bull -11 bull ~ bull

e4v Fee and Summary Report

Your application data has been su bmrtted Cfick on V1ew PDF Summary Re-portbull and pnnt t h1s rep01t for your records

You are requued lo pay the amount below for your appllcat1on lobi p~ocessed

Press Pay Now~ to proceed 10 the fee payme01 page

Press ~Add to Cart to Add lo Shopping Cart ano re twn to the ntaJn menu

Fshy

FHP Annual Ren ewal fee $5000

Tolai AmoontDue 5 5000

View PDF Summary ReportMJN middotflUb+ fiK~ lf~ r1L_21~ ~~ ~middot

Copmiddot gt- 0 10l ~rot~ ~i - 3bulllt1bullrmiddotu

Click Pay Now

~~~~----------FIIc poundc5t YNW fworcts T Http

()~ middot- --5 D bull Offiad___ middot bull ~51l) ~Sooggaud- i W~5iCIGIIoly bull

IAtiAll 111ltbull H 1 ~ LsKamf tswJKUlJ

O nlin e Application Pay ment

Opllonally reduce payment amoun1 where alkwftd by dtseiKttng the chbullcttboxts below

Press middotshaw Fee Oet~tsmiddot to shaw a breakdown olltlt fee iJIYlOuots

Press Cancer to canc el the payment

Appllcatlon thnnber lleocriptlon llceMeTypo bullApplkant Home Fee

flctitiovs Uame Pennils 13974209 fiCtitious tampame PermiiS S5000 bullRenewaiApplicatloa

Payment Uelhod v MastetCMd

f O=shyAme~ expess

Show Fee De1lt~11s

Enter Payment Method then cl ick Next

Follow the prompts and comp lete the payment screens

Print your Payment Confirmation Information screen We cannot investigate missing payments without this inrormation

C 9repoundZr bull Sttte of CbulllifotnU

File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

O~tmenl ol Coruumfi Attain

BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

bull If JOU -vere fegJStered oNJh thamp DCA Onhne Profess1onal Ucens1ng iel1Ces before you Vllll ne~ to reflg1ste1 With BreEU bull Br~EZi only accepts cr~rt card paymems ror Amencao Express 01scover MasterCard and V 153

FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line

~~~~----------FIIc poundc5t YNW fworcts T Http

()~ middot- --5 D bull Offiad___ middot bull ~51l) ~Sooggaud- i W~5iCIGIIoly bull

IAtiAll 111ltbull H 1 ~ LsKamf tswJKUlJ

O nlin e Application Pay ment

Opllonally reduce payment amoun1 where alkwftd by dtseiKttng the chbullcttboxts below

Press middotshaw Fee Oet~tsmiddot to shaw a breakdown olltlt fee iJIYlOuots

Press Cancer to canc el the payment

Appllcatlon thnnber lleocriptlon llceMeTypo bullApplkant Home Fee

flctitiovs Uame Pennils 13974209 fiCtitious tampame PermiiS S5000 bullRenewaiApplicatloa

Payment Uelhod v MastetCMd

f O=shyAme~ expess

Show Fee De1lt~11s

Enter Payment Method then cl ick Next

Follow the prompts and comp lete the payment screens

Print your Payment Confirmation Information screen We cannot investigate missing payments without this inrormation

C 9repoundZr bull Sttte of CbulllifotnU

File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

O~tmenl ol Coruumfi Attain

BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

bull If JOU -vere fegJStered oNJh thamp DCA Onhne Profess1onal Ucens1ng iel1Ces before you Vllll ne~ to reflg1ste1 With BreEU bull Br~EZi only accepts cr~rt card paymems ror Amencao Express 01scover MasterCard and V 153

FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line

C 9repoundZr bull Sttte of CbulllifotnU

File Edit v~ Fworus loafs Help

O onlygoodn _ -~SIJ ~opt bull Officbull of_S_ middot- ~SCI) ~- WtbliaGoltiy

O~tmenl ol Coruumfi Attain

BRErJlE

DCA BreEZe Online Services

Wek ome to the Cahfom1 a Oepartmellt of Con sum e-r Afatfs (DCA) BreEZe Onltne SeMCes BreEZe tS OCAs new hcensrng and lnforcement sygttem and a on~slop shop iOf consumers hcensees and applicant sbull BreEZe tnabfes consum ers to wnfy a profes510nallcense and file a consumer complamt LJCenoees and ap~ICants can submit ltc~nse applicatiOns renew a fscense and change the~r address among other seMCes

bull If JOU -vere fegJStered oNJh thamp DCA Onhne Profess1onal Ucens1ng iel1Ces before you Vllll ne~ to reflg1ste1 With BreEU bull Br~EZi only accepts cr~rt card paymems ror Amencao Express 01scover MasterCard and V 153

FOR CONSUMERS

Check licenses and fila compllJinlS

FOR APPLICANTS AND LIC ENSEES

AppliclJnt and lice ruing needs are avojlobl e here You w ilt nHd to ~ or use your

existing user name and paisword

Returning User

ttelds marked vrilh bull ar e reqwred

Ustgtr 10

foroot Password Foroot U stt 10

NewUsero

BreEZ~gt Rems1rat10n

Fictitious Name Permit renewals update OVERNIGHT You may verify the next day that the registration is

current and updated by inquiring at wwwbreezecagov and se lecting the Verify a License button on

the left side of the screen

Thank you for renewing your Fictitious Name Permit on-line