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P.O. sox 1604
HOME ,OCCUPATION PERMIT Le 0i1„16, CA
. MOI
APPLICATION
Pead each corsdjtlon 115ted on tt.e attachment to this form to see if the
• Proposed activity can comply with the City's Nome Occupation Regulations.
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(TYPE OR PRINT IN INK)
•
APPLICANT'S NAME MIM Yom. -j.6 , T�i LL PHONE 5L�- 3 �3
PROPERTY OWNER I�lrJ , RbLut PHONE
Ol PROPERTY ADDRESS �J Z ' -1 IDS NQ !'1 l Q. -A-) l A 7- . LQ Qv NfA a r A. 97-7 _S3
tJ — TYPE OF RESIDENCE Issingle, multiplee,mobile home, etc.) le� Q
TYPE OF BUSINESS l e -y -a � i [� 1 i (Q1 &Y1� Qr �'oY
BR F DESCRIPTIOP OF HOIA H JBUS NES MIL OPERATE ! a- f12 6YQ,— s
NUFkER OF PERSONS INVOLVED IN BUSINESS I
LIST NATES OF PERSONS EMPLOYED r,
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE) 1400 �411I►{�P
LOCATION AND SQUARE FOOTAGE.OF AREA OF SEP )991
SUSINESS ACTIVITY IN HOME (EXAMIPLE 1
015ED7POOM - 125 SQUARE FEET") 1Z5jjKk
OPERATPTION;, F,n�HINERY, �QN , UIPKE+ AND SUP : N . SINESS
I HAVE READ. UNDERSTAND, AND AGREE WITH THE CONDITIONS eY WHICH A HOME
OCCUPATION IS ALLOWED ICONDITIONS ATTACHED).
APPLICANT SIGNATURE Hire
IF APPLICANT IS O?HER THAN PROPERTY OWNER, AUTHORIZATION of OWNER OR AGENT
REQUIRED.
OWNER/AGENT SIGNATURE DATE
IM.PORTA.WT: False or misleading Information shall he grounds for denying your
Home Occupation; failure to comply with Conditions listed on the attached page
shall be grounds for revocation of permit.
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IUILDING i SAFETY DEPARTKEWT
APPROVED BY DATE CONDITIONS A1?ACHED
T
DEN:ED BY DATE. 0
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•
BUS. ErIC . NO.
903
0
f, =�
�4 OF
1991 BUSINESS LICENSE APPLICATION FORM
=t C
A1C? 201991
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
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i.. IS THIS BUSINESS LOCATED AT YOUR HOME: YES Y/ NO
2. Business Name • E��u��
3. Business Address: &Jc- j�1(k7- 4. Mailing Address: 5Z
Ot R, 922S3
5. Business Phone: ((c { ) S(„t-� - 3 (3
6. Owned By: CORPORATION PARTNERSHIP 1--001WW q'09-20-91 i0
H-iD�L i 18.00
If Corporation or.Partnership: Tax I.D-#
8. If Individual Owner: Social Security # JAS - y
•9. Name of Owner pbQ �� rri (� Title': 0wo-kl
Or Officers C,P-QJ9AJ0)
10. Type of Business � �e ��O�t✓�1(� _ C�E'il�. �G� �ti >CUY
1,1. 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':. l�
$ O
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
ssed to me and are i(i f 11 force and effect.-
Signature Title Vate
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION ,
P.O. Box 1504
La Quinta, CA 92253