Boiko� I I III III IIII IIII IIII .
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CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
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 l 30 lcci PHONE
PROPERTY OWNER C-) o N Lc0 PHONE
PROPERTY ADDRESS 57Z -SSS- d� V ���� O1 �Z LA_ Qj
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) e -
TYPE OF BUSINESS �P_�cc4*1 c. S�✓. �C�
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) \7_07 %*L'ft@YW STAMP
•LOCATION AND SQUARE FOOTAGE OF AREA OF MAR 2 4.1992 -? 3 3
BUSINESS ACTIVITY IN HOME ( LE,.
"BEDROOM - 125 S . F . " ) \Z_� BUILDING D ETY DEPT.
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED .IN THE
BUSINESS OPERATI. T � LZ 0
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS.BY WHICH A HOME
OCCUPATION IS ALLOWEDA CONDITIONS ATTACHED).
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APPLICANT SI NATURE
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.
•--------------- ________________________________________________-----------
.Building
_ ---.Building and Safety Department / !
APPROVFJD. JBX atgg_-�, CONDITIONS�1'
DENI 7 � ' BY DATE - '"
t,/ 4 4
• " . BUS. LIC. NO.
J' '
1992 BUSINESS LICENSE APPLICATION FORM 0 */1
......PROOF OF W RKERS COMPENSATIOSURANCE IS REQUIRED.....PDA
...
************* ******************** ******************* * * ***
*APPROVED INITIALS! DATE/
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES. C),-- NO
2. Business Name:
3. Business Address: 5a-57575 4. Mailing Address:
fNVQr !,d -L
5 . Business Phone: (6 IS ) SG - <
6. Owned By: CORPORATION PARTNERSHIP3IJ �DUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security #
9. Name of Owner -JZCU-\5 n L4 Ai -V 4601'6 Title : 6�) res 1
•
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:
B. Previous Year Gross Receipts For Established Businesses:
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******
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,
• (J Signatur
Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253