HOWERY73
CITY OF LA QUINTA
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
• `you" 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 Q P O Q'Z PHONE :® `r 2L66 /
PROPERTY OWNER 4 �,e PHONE S__64 t
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESSc�s�P� J7
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS /
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA IN PAID$35.00
�,
HOUSE (EXCLUDE GARAGE) 5"Q0 VALIDATION -STAMP.
• LOCATION AND SQUARE FOOTAGE OF AREA OF FEB 0 61992
D�
BUSINESS ACTIVITY IN HOME(EX PLE, . BUILDING AND SAFETY
"BEDROOM - 125 S . F . " ) /Zd�.�,� /�U 5,�
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BF5ING USEDN THE
BUSINESS OPERATION' kXee 4i_6,Cr� 4,,Z - -�,��
I H VE READ
OC IN
APT
UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
S ALLOWED (CONDITIONS ATTACHED).
SIGNATURE
DATE
17
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.
Bui).ding and Safety De a ent
APPROVED BY DATE CONDITIONS ATTACHED
DENIED BY DATE
BUS. LIC. NO.
>e�z
1992 BUSINESS LICENSE APPLICATION FORM
......PROOF OF WORKERS COMPENSATION INSURANCE IS �jD14
IsAb
��1g
*APPROVED INITIALS DATE 3_
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS CAT AT OUR HOME: YES NO
2. Business Name: Q P jae
3. Business Address 63,;;,?06 4✓P �7,40 vx -44 . Mailing Address:
5. Business Phone:(.
6. Owned By: CORPORATION PARTNERSHIP INDIVIDU
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Soci�Lsc'
ecurity #
• 9. Name of Owner 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:
$ 4 � 2?A
B. Previous Year Gross Receipts For Established Businesses:
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******
IlI EREBY CE IFY that all the information supplied by me is correct and
li en$ required by the County, State or Federal Government,ha been
ue to/ a and are in full force and effect.
• Sfgnat
0Kel(-
Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253-
f M' AM
Date