SOROKAr
CITY OF LA QUINTA
1111111111111111111
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 PHONE 771- H &I
PROPERTY OWNER PHONE
PROPERTY ADDRESS f4TA AUer,idam- k4_Q,,iK6 . 0A daa5-3
MAILING ADDRESS .e
TYPE OF RESIDENCE (single multiple, mobil home, etc.)
TYPE OF BUSINESS i esi. n
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE &m A ee—
ct rtca aEe5 *1 er "6,4 14 M ef-44 1 5 l "c cue ate, 745, o ces.
NUMBER OF PERSONS INVoLiFED IN aUSINE§S
LIST NAME OF PERSONS EMPLOYED 5e `4
SQUARE FOOTAGE OF USABLE FLOOR REA J
IN HOUSE ( EXCLUDE GARAGE) J?W S.F. :1
l
LOCATION AND SQUARE FOOTAGE OF AREA DF_r;, 1� a
OF BUSINESS ACTIVITY IN HOME D
( EXAMPLE , "BEDROOM -125 S . F . ") srea.k-�a a-� 1� `J
DESCRIPTION OF MACHINERY, EQUIPMEMTT, AND SUPPLIES BEING US D IN THE
BUSINESS OPERATION Yrinfer., Aloda�rn
.I HAVE R DERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME 0 IS ALLOWED (CONDITIONS ATTACHED).
a 9�
"OLICAM SIGNATURE TE
IF APPI;ICANT IS OTHER THAN PROPERTY OWNER;- AUTHORIZATION OF OWNER
` OR AGENT IS REQUIRED.
- OWNER G NT SIGNATURE - DATE
r
IMPORTANT: �_ FALSE, � OR Mi�LEADING INFORNAI w LL = B .GROUNDS FOR
..DENY19G YO HOME OCCUPATION; �"
,: FAILURE TU, -, COMPLY WitH CONDITIONS
LLg
I+LSlT.�ED ON ATTACHED .PA►GE L'L BE -G&OUAtS F69 REVOCATION OF
Buil n and -dafet De rtment �,.:
APPROVED DEMI:'. IN.&DIT001' , : TTACHED
19s�_