GONZALEZr.
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Quinta,
LaCA 92253
Z (619) 56 2246
CITY OF LA QUINTA
HOME OCCUPATION APPLICATION o 6.3
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Read each condition listed on the attachment to this form to see if the
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proposedactivity can comply with -the City's -Home Occupation Regulations.
APPLICANT'S NAME G F R• PHONE
PROPERTY OWNER /0GC1� PHONE
.5
PROPERTY ADDRESS .4'
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS i'Ch T I" fib �
BRIEF DESCRIPTION OF HOW THE BYSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED �G
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE) Ia��
•LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME ( LE,
"BEDROOM - 125 S.F.") /3d�
DESCRIPTION OF MACHI
BUSINESS OPERATION _
AND
V'l - J.
I HAVE READ, UNDERSTAND, AND AGREE WITH THE
OCCUPATIO4 JeS ALLOW1M ,(CONDITIONS ATTACHED).
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-OFv.IWA
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CONDITIONS BY WHICH A HOME
IF APPLI
REQUIRED
IS OTHER
PROPERTY OWNER, AUTHORIZATION OF owNtK OR AGENT
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.
Buildin ,and Safety Department
_ APPROVED BY DATE
DENIED BY DATE
CONDITIONS ATTACHED
11111111111111111111
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T H E C I T Y
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La qinta
1982 - I992 Carat Decade
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Dear Business License Applicant,
Effective January 1, 1991, the State of California has passed
legislation, AB1576, which provide that an applicant for issuance
or renewal of a business license must provide proof of valid
current workers' compensation insurance.
Proof of workers' compensation can be satisfied in one of two ways:
1. Provide a copy of certificate of workers'
compensation insurance to. the. City that
contains the policy number and expiration
date.
2. Provide a copy of Certification of Self -
Insurance issued by the Manager of Self -
Insurance Plans of the Department of
Industrial Relations.
Proof of worker's compensation insurance is not required if the
applicant does not have employees; however, the applicant must sign
and return tho the City the attached "Non Employee Certificate".
A business license certificate will not be issued until one of the
above mentioned certificates has been provided to the City.
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City of La Quinta
Post Office Box 1504 * 78-105 Calle Estado
La Quinta, California 92253
Phone (619) 564-2246, Fax (619) 564-5617
Desion 6 Prooecl.on: Mark Palmer Devon 679.346-0772
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NON -EMPLOYER CERTIFICATE
I certify what in the performance of work for which this City of La
Quinta business license is issued I shall not employ any person in
any manner so as to become subject to the workers' compensation
laws of California.
Note: If after signing the certificate, you hire any employee, you
become subject to the workers' compensation provisions of the
California Labor Code, and you must immediately comply with the
provisions of Section 3700 or your license immediately becomes
revoked.
Business
.Business
Name: V�
License Applicant:
Date:
1992 BUSINESS LICENSE APPLICATION FORM
BUS. LIC. NO.
******************************************************************
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCAT�E�D A,/T� YLLOURR HOME: YES �/ NO
2. Business Name: V/c. fy&T
3. Business Address: 4. Mailing Address:- &.4 7P
5. Business Phone: (/) 3y?-
.6. Owned By: CORPORATION PARTNERSHIP I IVIDUAL
7. If Corporation -or Partnership: Tax I.D.#
8. If Individual Owner: Social Security #
9. Name of Owner '�io�ar/y% � Title: 0Lt/Wei✓'
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Or Officers 1
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:
$ /y'�'
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******.
I HEREBY CERTIFY that all the informationsupplied by me is correct and
any licenses required by the County, State or Federal Government have been
issued tq me nd are in full force and effect.
�-�
• Signature
Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta,. CA 92253
Date
BUSINESS LOCATED IN THE CITY OF LA QUINTA ONLY
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• GROSS
RECEIPTS
RANGE
CLASS 1 LASS CLASS 3
0
- 25,000
$ 15.00 $ 8 $ 21.00
25,001
- 50,000
25.00 30.00 36.00
50,001
- 100,000
30.00 36:00 43.00
100,001
- 250,000
46.0,0 55.00 66.00
250;001
- 500,000
76.00 90.00 108.00
500,001
- 750,000
114.00 135.00 162.00'
750,001
- 1,000,000
150.00 180.00 216.00
1,000,001
- 2,000,000
400.00 500.00 600.00
2,000,001
- 3,000,000
500.00 625.00 750.00
3,000,001
- 4,000,000
600.00 750.00 900.00
4,000,001
- 5,000,000
700.00 875.00 1,050.00
5,000,001
- 10,000,000
1,000.00 1,250.00 1,500.00
10,000,001
- and up
1,500.00 1,875.00 2,250.00
CLASS 1
Automobile Repair
and Services; Laundry, Dry Cleaning &
Garment Services;.Manufacturing;
Retail & Wholesale
Trade.
CLASS 2
Amusement & Recreation Services, including Motion
Pictures; Architectural Services; Automotive Sales;
Barbers & Hairstylists;
Beauty Shops; Engineering
Services; Landscape & Horticultural Services; Operators
Renters & Lessors
of Commercial Property; Services to
Buildings; and all
other persons engaged in business
not specifically
listed elsewhere.
CLASS 3
Accounting, Auditing
& Bookkeeping Services; Financial .
Services; Insurance Brokers & Services; Legal Services;
Management & Public
Relations Services; Medical &
Health Services;
Real Estate Agents, Brokers, Manager's
& Services.
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