Countywide Services Agency Bradley J. Hudson, County
Environmental Management Ann Edwards, Chief Deputy County
Val F. Siebal, Department Director
Environmental Health Division County of Sacramento
John Rogers, Chief
CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)
REGISTRATION / PERMITTING FORM
CFO Business Name: Date:
CFO Physical Address: CFO City: CFO Zip:
Owner Name: Owner Phone: Owner Cell:
Mailing Address (if different): Mailing City: Mailing Zip:
TYPE OF PERMIT FEE PE
Class A Cottage Food Operation-Registration $ 107.00 1653
Class B Cottage Food Operation-Permit $ 227.00 1654
Class A (Direct Sales Only) Class B ( Direct & Indirect Sales)
2. Prohibited Items: I Agree: Yes No
Foods containing cream, custard, or meat fillings are potentially hazardous and are not allowed.
Only foods that are defined as “non-potentially hazardous” are approved for preparation by a
Cottage Food Operation (CFO). These are food items that do not require refrigeration to keep
them safe from bacterial growth that could be a cause of food-borne illness.
10590 Armstrong Ave • Mather, California 95655 • phone (916) 875-8440 • fax (916) 875-8513 •
Please check the items you will be preparing and/or selling.
Without Cream, Dried Pasta Honey Popcorn
Custard, or Meat
Candy Dry Baking Mixes Mustard Vinegar
Churros Fruit Butter Tortillas Waffle Cones
Dried Mole Paste Herb Blends Pizzelles Jams/Jellies
Cookies Fruit Tamales/Pies Nut Mixes Covered Non-
Fruit Empanadas Nut Butters Dried Tea Dried Fruit
Granola/Cereals Roasted Coffee Trail Mix
Pastries Preserves Other: Contact EMD (916) 875-8440
4. Product Labeling: I Agree: Yes No
• The words “Made in a Home Kitchen” in 12-point type on the cottage food product’s
primary display panel.
• The name commonly used for the food product or an adequately descriptive name.
• The name of the cottage food operation which produced the food product.
• The address of the cottage food operation which produced the food product.
• The registration or permit number of the “Class A” or “Class B” cottage food
• In the case of a “Class B” cottage food operation, the name of the county of the local
enforcement agency that issued the permit number.
• The ingredients of the cottage food product in descending order of predominance by
weight, if the product contains two or more ingredients.
MADE IN A HOME KITCHEN
The Grand Granola Company
123 H St, Sacramento, CA 95800
Sacramento County EMD
Permit # SR0000000
Ingredients: Oats, Wheat Germ, Almonds, Walnuts, Cranberries,
Honey, Canola Oil, Vanilla
5. “Class A” Self Certification Checklist:
Checklist completed (“Class A” CFOs Only)
6. Water Source:
Please check what type of water source will be used in Cottage Food Facility
Municipal Water Private Well*
*Additional forms may be required if food is prepared from a home with a private well.
7. Disposal of Waste:
Where does your sink waste water go to?
Public Sewer Service Private Septic System
۰ In the event of septic system failure or plumbing problem, you are required to notify the
Sacramento County Environmental Health Department immediately.
8. Employee: I Agree: Yes No
I understand that I may not have more than one full-time equivalent cottage food employee,
not including a family member or household member of the cottage food operator, within the
registered or permitted area of a private home where the cottage food operator resides and
where cottage food products are prepared or packaged for direct, indirect, or direct and
indirect sale to consumers.
9. Gross Annual Sales: I Agree: Yes No
I understand that I will lose my CFO status and will need to become permitted in a
commercial facility if my CFO business exceeds the following gross annual sales figures for
the calendar years in the following table:
Calendar Year Gross Annual Sales
In 2013 ......................................................... $35,000
In 2014 ......................................................... $45,000
In 2015 and in subsequent years .................. $50,000
I, ___________________________, agree to notify the Sacramento County Environmental
Health Department prior to modifying my food list, type of operation, and/or method of
selling, distributing, or otherwise providing my CFO products to the consumer or retailers
regardless of whether or not the product is sold, consigned or given away.
Signature of Owner:
Signature Print Name Date
W:\Data\EH-PROGRAMS & PROJECTS\COTTAGE FOOD INDUSTRY\CFO APPLICATION-REGISTRATION, Revised 12-31-