SAINTIS•
C7
CITY OF. to OUINTA
HOME OCCUPATION PERMIT
APPLICATION
7e-105 Calls Eat•
P.O. Bo: 1504
to Oulnta. CA 92
(619)6e4-2210
Read each condition listed on tte attachment to this form to see if the
proposed activity can comply with the city's Home Occupation Regulations.
(TYPE OR PRINT IN INK)
APPLICANT'S NAME �/T I� (t�y • �4� `� Re PHONE 5l 3
k1t A-1 AA1«s P40/ "on 12il— 67-t:xl0
PROPERTY OWNER
PROPERTY ADDRESS �j— D /a III �'I{ P&A/2- �' G Qli/�� j ,A G/ S
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) //l1G hr
-
TYPE OF BUSINESS / I��
BRI;F DESCRIPTION OF HOW THE BUSINESS WILT OPERATE _ �¢e10-0% C'A1,15
A4e& zf44/1/ AND �jn 7r3 s2� P/�aivT
HUMPER OF PERSONS INVOLVED IN BUSINEES,S/ D��G
/
LIST NAMES OF PERSONS EMPLOYEDOQQ
SQUARE FOOTAGE OF USABLE FLOOR AREA IN W W AD
V�i1Bt�AQl1NW1�4
HOUSE (EXCLUDE GARAGE) %OXID
LOCATION AND SQUARE FOOTAGE..OF AREA OF SEP
BUSINESS ACTIVITY IN HOME (EXAMPLE, 12 �gg�
"BEDROOM - 125 SQUARE FEET")
,&:.0460M 115 X/ a81111:01NO MID So Are —IT" urr 1
DESCRIPTION OF KACHINERY, EQUIPMENT, AND SUPPL D IN THE BU• NESS
OPERATION (C w g L
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
AJ-LOWED ( NDITIONS ATTACHED).
OCCUPATION IS IL
A ez?l
APP I T SIGNATURE DATE
IF APPLIC 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.
7LDEN:EnG iSAFE-N DEPAR7F APROVEDBYDATE I CONDITIONS AITACH£D
BY DATE
I II�III I76
"II (III IIII`1
0
0
0
0
• BUS. ]AC. NO.
u�;K,tw
1991 BUSINESS LICENSE APPLICATION FORM .
10 g�r AL *APPROVED INITIALS
A * 30.00
*DENIED INITIALS DATE
******************************************************************
I. IS THIS BUSINESS LOCATED AT YOUR HOME: YES ✓ NO
2. Business Name:
3. Business 'Address: 4. Mailing Address :"—
5 . Business Phone: ( (.0 ) �'� y Oo�-r C6 o6l,C���f
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
:'. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # �5-6 - 3 Z--6Y,S-3'
9. Name .of. Owner ��,¢,2{lj. St{-��✓T�S Title: L96V ee-
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:
$ v0 0�0
B. Previous Year Gross Receipts For Established.Businesses:
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.-
gna ure
6�Jlvge-
Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
iZ -,�
Date