KEPLINGER37
CITY OF LA QUINTA
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
fyo TM "- HOME -OCCUPATION APPLICATION
*Read each condition listed on the attachment to this form to see*if the
proposed activity can comply with the City's Home Occupation Regulations.
APPLICANT' S NAME L ! i PHONE -0
PROPERTY OWNER Z � L / r ' PHONE 6
PROPERTY ADDRESS C�'Z--3zol7r_ttvv��
TYPE OF RESIDENCE ( single, multiple, ��m�/obile home, etc.)
TYPE OF BUSINESS �� � I'd?Z1 Y-A/ NA.-"_� hip-,,z
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
Td �v Y S d Oa A�A s c fz,
NUMBER OF PERSONS INVOLVED IN BUSINESS j
LIST NAMES OF PERSONS EMPLOYED - Kt=,o?/l
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE ( EXCLUDE GARAGE) Zoo-9 S r_
• LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S . F . " ) / o o S`
DESCRIPTION OF MACHI
BUSINESS OPERATION
PAID $35.00
N STAMP.
J A N 211992
BUILDING AND SAFETY D .
By
ZVUIPMENT, AND SUPPLIES BEING USED.IN THE
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
s.
I
DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER,, AUTHORIZATION OF OWNER OR AGENT
REQUIRED.
OWNER/AGENT SIGNATURE DATE
IMPORTANT: False or misleading information shall be grounds for denying
your Home Occupation; failure to comply with conditions listed on the
attached page shall be grounds for revocation of permit.
------------
Building and Safety De artment
APPROVED BY 12 DATE 11AI L,-/ CONDITIONS ATTACHED
A
DENIED BY DATE
a
r�
CJ
•
BUS. LIC. NO.
1992 BUSINESS LICENSE APPLICATION FORM
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
IS THIS BUSINESS LOCATED AT YOUR HOME: YES_ NO
2. Business Name:
3. Business
�QAddress: S2,3,70 1, -u. �l(�✓,�c�',gA Mai��lJing Addres"sue: SJ7- -3Z0
5. Business Phone:( 6/j ) .. 5-� `/ -0 Zl'-IS
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL,
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security #
9. Name of Owner.1�-J�''f ro �ihGf-� Title:
Or Officers
10. Type of Business:
11. SBE Resale Number:
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$
B. Previous Year Gross Receipts For Established Businesses:
$
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******
I HEREBY CERTIFY that all the information supplied by me is correct and
any licenses required by the County, State or Federal Government have been
issued to me and are in full force and effect.
` S
Signature
Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
/-2-1-ice
Date
16-24/689 WELLS FARGO BANK 847
1220(7)
PALM DESERT OFFICE 74105 EL PASEO PALM DESERT, CA 922600 Gam/
/ �� V 19 / i
PAY TO THE ORDER OF
DOLLARS
{ G.
o
RICK KEPLINGER
52-320 AVENIDA ALVARADO
LA QUINTA, CA 92253 ! "
MEMO
• 1: 12 2000 244l:8+7. 0689 3574991I'
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