PEEIFFERCITY OF to OUINTA
HONI1 OCCUPATION PERMIT
APPLICATION
76-106 Calls Ests
P.O. box 1604
Le Quints. CA 2
(610)664-2216
Read each c0ridit'On listed on tt.e attachment to this form to see lr the
proposed activity Can comply with the City's Home Occupation Regulations.
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(TYPE OR PRINT IN INK)�j 62 % �Q
APPLICANT'S NAMEli�Vl.t�V 1 T ( 11 ' „� PHONE
PROPERTY OWNER
PHONE
PROPERTY ADDRESS -/
TYPE OF RESIDENCE (single. mf�i ultiple, mobile
home, etc-)
TYPE OF BUSINESS I✓-%l�il �
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DESCRIPTIO � ^OF NOW TbM USI ESS IL O TE K LA -C IV TH O/V
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NUMEER OF PERSONS INVOLVED IN BUSINESSn*�/'t//VEL%
LIST NAMES OF PERSONS EMPLOYED �f J1V17�
SQUARE FOOTAGE OF USABLE FLOOR AREA IN VALIDATION STAMP
AR
HOUSE (EXCLUDE GAGE)
LOCATION AND SQUARE TOOTAGE..OF AREA OF
BUSINESS AcTIvITY IN HOME (EXAMPLE,
"BEDROOM - 115 SQUARE FEET") ► UU
• DESCRIPTION OF MACHINERY, EQUIPMENT. AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION
I HAVE READ, UNDERSTAND, AND AGREEI WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION 1S ALLOWED 1 OND IONS AT?ACHED).
If APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
IMPORTAVT: 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.
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BUILDING SA M DEV"M i
APPROVED 8 57 -DATE CONDITIONS ATTACHED OO'F_•Z�
. , . DFL:: ED BY DATE
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• BUS ...-ErIC .. NO.
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1991 BUSINESS LICENSE APPLICATION FORM
APPROVC INITIALS DATE
* D INITIALS DATE
******************************************************************
IS THIS BUSINESS LOCATED AT YOUR HOME: YES •/' NO
2. Business Name:
3. Business Address:
ZA- G_W,0t-,4 , W 4?aQ
5. Business Phone:( ) . 56erl
4. Mailing Address:
322,9
6.
Owned By: CORPORATION
PARTNERSHIP INDIVIDUAL,
i.
If Corporation or Partnership: Tax I.D.#
8.
If Individual Owner: Social
Security # `J�
c�
sFZ o � �T
• 9.
Name of Owner. -��� ���j
�j� Title:
Or Officers
10.
usiness:
Type of Business:-
11.
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:
$ i ,Q05182S 0, 4%OT 0i 08-9118.00 '0
I HEREBY C1e/and=_1a4A11yfU
RTIFY that all the information supplied by me is correct and
any lenss reqt� County, State or Federal Government have been
issue to force and effect. -
/01 3
�� Signature VTitle Date
Submit Form To: Ec , I'VE
CITY OF LA QUINTA OCT
BUSINESS LICENSE DIVISIONP.
O�x04M canuT,"0DLa QulntaCA 92253' aR