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CITY OF LA OUINTA
HOME OCCUPATION PERMIT
APPLICATION
78-106 Call* Eslad
P.O. Boa 1604
Le Oulnta. CA 022
(619)664-2240
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)
APPLI CANT'S NAME Y1 �� V� ( PHONE
PROPERTY OWNER PHONE S °=
PROPERTY ADDRESS 20
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) 5 1 r 4 \ C,
TYPE OF BUSINESS TO O I �' /Pe-- G `� �� t� �� 5? V
BRIEF DESCRIPTION OF—HOW THE BUSINESS MILL OPERATE Oh kA Lk- SlY-1C- C)r�/
NUMBER OF PERSONS INVOLVED IN BUSIN�ESS,� �1
LIST NAMES OF PERSONS EMPLOYED (I
SQUARE FOOTAGE OF USABLE FLOOR AREA IN (!�nC=1 a ^;'i�P
HOUSE ( EXCLUDE GARAGE) �C > R'(I'A�j„7)5AAGU
LOCATION AND SQUARE FOOTAGE.,.OF AREA OF SEP 12 1991
BUSINESS ACTIVITY IN HOME (EX AMP E.
!J
"BEDROOM - 125 SQU. E FEET") It�
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SURE E•BUSINESS
OPERATION Vr % yz-k-& v f olps k -{ 1 •C.0.. 6 1 N P
I HAVE READ, UNDERSTAND, AND. AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
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.
0..11-0.�e,
BUILDING i SAFETY DEPARTME
APPROVED BY DATE l� J� / CONDITIONS ATTACHED �_ '.•
DENIED BY DATE
I lillll OMI IIIIlI�II __._�
17
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~ 1'i BUS. EIC. NO.
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1991 BUSINESS LICENSE APPLICATION F05,1RM .k 19,
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*APPROVED INITIALS DATE
*DENIED INITIALS DATE
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1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO
2.. Business Name:
:3. 13usiness Address: 3`l( -f /hoc -i, ck fr�4cz_. Mailing Address:
L� C �' � 11 3 �1 - (_.i
3usiness Phone:(
6. owned By: CORPORATION PARTNERSHIP INDIVIDUAL >
`f Corporation or Partnership: Tax I.D.#
8.
:f Individual Owner: Social Security #
Name of Owner cv-, C� P , 5M � P\
Title: 0 t,J v1 P r-�-
or Officers
10. Type of Business
1]..
:)'BE Resale Number:
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
ik. Estimated Gross Business Receipts for New Businesses Only: `
$ l J C,>
B. Previous Year Gross Receipts For Established jr5 01116�1�AL9i `0-9 18.00 i0
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.•
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Signature
Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
Date