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P8010Boxa1504Estado
Z 16 La Quinta, CA 92253
/� CITY OF LA QUINTA (619) 554-2246
a
HOME OCCUPATION APPLICATION
Read eachcoa&ftion 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 PHONE
v
PROPERTY OWNER 52,A9 nn PHONE
PROPERTY ADDRESS s3`� 5 Ayw t JCti J
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) `P
TYPE OF BUSINESS �1Y Q�' �Gc r- r--OVd &.r,'Dk
NUMBER OF PERSONS INVOLVED IN BUSINnES]S (�
LIST NAMES OF PERSONS EMPLOYED !V I
SQUARE FOOTAGE OF USABLE FLOG AREA IN
HOUSE (EXCLUDE GARAGE) rq5 p
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME.(EXAMPLE,
"BEDROOM - 125 S.F.") HOME-
WSP
DESCRIPTION OF MACHI E Y, EQUIP T, AND
BUS�NESS OPERAT14N o< A�,}r n 4G7
ffidgN A STAMP .
MAY 121992 d 4 X97
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
Z
APPLICANT SIGNATURE DATE
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.
r
Buildin nd Safety Department
APPROVED BY DATE --YOGI CONDITIONS ATTACHED
` DENIED BY DATE
C)0
N
, - I RON BREWER
j Account Agent
Allstate Insurance Company
78060 Calle Estado, P.O: Box 5132
La Quinta, CA 922.53
Bus. (619) 564-2516
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0006;
All
, - I RON BREWER
j Account Agent
Allstate Insurance Company
78060 Calle Estado, P.O: Box 5132
La Quinta, CA 922.53
Bus. (619) 564-2516
•
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
4065 County Circle Drive
Riverside, CA 92503
Facsimile (FAX) Cover Sheet
FAX No. ( 619) 863- 8320
Location Indio - EHS
To: (619) 564-0369
(FAX NUMBER)
Attn: Ron Brewer
From: I`'Macha:el K: Garcia, REHS
Riverside County Health Services
Indio field Ofd,_
Date: May 14, 1992
Time: 10 s 433 (a.rr). p.m.
Charge to•( )
Program:
Transmitting 2 number of pages (including cover sheet)
Subject:
Message:
if you do riot receive all of the pages, or if (fie copy is illegible, please call our office
at ( )
Distribution. White - H1F Canary - Originator
r%nw A& naK (APV AIAM
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COto
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Appiicatioas
must be submitted to the
• La Quint& Chamber of Commerce
A minimum of 15 days prior to
Offiao•
the date
Of aotivity.
ALX, -FEES FOR THE
PERMITS
BE PAID
WHXN APPLICATION
IS FILED,
V1II.�
Sw .= t L ft 67z� .�t n t � .
} JW-ns-Iea Cpl ezcc: *
DATE OF ACf'Z'ViTYt_ - S-�(,,=gG,.
IF ONGOING, ROWOFTEN? (DATES J � � (� ! 1 12 `r 6 V&0l V 6
NAME OF BUSINESS or GROUP
CONTACT
PHON$__�
ADDRESS
•
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NUMD9ft OF PERSONS XNVOLVB'D P
YS NLNCTRXCAL POWER INVOLVED (If ysa, power cords x be
supplied by applicant, and parmiss-IQ obtained to use private ,Power
source)
IS THIS A NON- Pfi0, 'IT ORGANIZATION? TRS f.0
_. _..._
SELLER'S PERMIT NUMBZR_
LR CITY DusxjwSS bSCENSR' Nvxvj R
The undersigned acknowledges receipt of the rules and regulations
outlined and agrees that he/eche will comply with the rules.
Noncompliance will result in removal of thetr activity from the
streets. Undersigned further certifies that he/she is the
• responsible person referred to in the rules and that he/she is
authorized to execute the permit and release the waiver forms an
behalf of the group.
MAY- i 4-& ►tau i w e i
Village at La Quinta MainstreCt Market.pl%ce
• Application
Page 2
the undersigned has read- the release and w&iver clauaA in the
permit and 'hereby agrees to be bound by' its terms. Failure. to
comply with all rules and regulations will result• in forfeiture of
right to paztieip06te, in future Lei Quint& Mainiitreet Harketpl.ace
activities and/or removal from event sits.
Direct sales vendors must submit samples with their application. If
actual samples cannot be submitted, or in the case of food vendors,
the Reviewing Committee may consider a clear, distinct photograph.
(Exceptions ars made for the Farmer's Harket) these samples will be
available for pick-up the morning' -following the regularly scheduled
committee meeting.
If photographs are to be returned, please includo a stampede self-
addressed env lope.
Date: / Signature;
print name
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FQ�U� V�rT1f7ARs AN�'X
Prior to submitting this APPlioaticnp you must get approval
from the Riverside County Department of Health. Applications
without their signature CANNOT be considered.
Date:
Riverside County Health DepaatmOnt:
Authorised Signature W Telephone Number
Approved with the following criteria: all food and ingredients must be from an
approved source. BBA okay for cooking gabobsonly, any nrocessino such as assembli
must be done in an enclosurEDO NOT WRITE BELOW THIS LINE Eaintain raw kabobs a mi
4507 and�c�ol4ec-abc -� -ci w.•-7»4AR�.��avci.da..ar.t�s - (.]a0,�� s o
and paper towels, Once kabobs are cooked, can sell off BBr unit.
Approved: Deniedi
Space Assignment: : ._ Electrical Power?:
Committee Comment/Recomendation:
Authorization; 9
lk/292