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• FEE $35.00
CITY OF LA QUINTA
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KV 15.1995 •'U
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78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT
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.
BUSINESS NAME (f*E 141057e �PHONE 617 - ?7/-'K3Z
PROPERTY OWNER
PROPERTY ADDRESSL
MAILING ADDRESS 4
TYPE OF RESIDENCE (si
TYPE OF BUSINESS __OAL
BRIEF DESCRIPTION OF
PHONE
Chl
e, multiple, mobil home, etc.)
HOW THE BUSINESS WILL OPERATE ,Mn�`Zjr ,v1US£G C.�vt°
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED I
• SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) 1L z.
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.") V
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPP��,IES BEING USED IN THE
BUSINESS OPERAT ON— �0 (�04af
I HAVE READ DET AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUP TI I ED (CONDITIONS ATTACHED).
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APPLIeANT SIGN TURE DATE
IF APPLICANT IS OTHER THAN.- PROPERTY 011IER, AUTHOR: CATION OF, OWNER
OR AGENT IS REQUIRED.
:OWNER/AGENT SIGNATURE DATE
IMPORTANT: FALSE OR MISLEADIIIG:INFORMATION SHAL.-,, BE GROUNDS FOR
DENYING YOUR HOME OCCUPATION;-SALILURE TO COMPLY WITH CONDITIONS
LISTED 0 THE ATTACHED PAGE SM'SLL BE GROUNDS FOR- REVOCATION OF
PERMIT. -.
• Bui===n=-and-Safet Department
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APPROVED DENIED— CONDITIONS ATTACHED
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