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\1 La Quinta, CA 92253
CITY OF LA QUINTA (619) 564-2246
r 1111111 IIIII IIII IIII
or r,t.��` HOME OCCUPATION APPLICATION 28
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.
Zi --- -------
APPLICANT'S NAME a
PHONE
PROPERTY OWNER 11 V CJI'
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile home, etc
TYPE OF BUSINESS
EF DESCRI
BUSINESS
NUMBER OF PERSONS INVOLVED IN BUSINESS I
LIST NAMES OF PERSONS EMPLOYED
v
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE)
• LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME AMPLEpt,
"BEDROOM - 125 S.F.") 20 6�
DESCRIPTION OF MACH
BUSINESS OPERATION
KO
ASTAMP
MAY 2 6 1993
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OC UP TION IS ALL WED (CONDITIONS ATTACHED).
/ 9,
APPLICANT SIGNATUW bATE
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.
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Build',ng and SafetyjD a tment
ZAPPROVED B ZDATE CONDITIONS ATTACHED
DENIED BY DATE
TlUtf af
BUS. LIC. NO.
1993 BUSINESS LICENSE APPLICATION FORM
&a7
......PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
APPROVED BY BUILDING & SAFETY DEPARTMENT
1. IS THIS BUSINESS LOCATED AT YOPR HOME: YES_ NO
2. Business Name: t'Ld
3. Business Address ti'�L', wn 4. Mailing Address:
5. Business Phone:
6. Owned By: CORPORATION PARTNERSHIPINDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individualner: �Soc al Security # 1
9.
Name of Owner Title:��
• Or Officers
10. Type of Business:
11. SBE Resale Number: '!2a 5-79G ,�3 -,--zZ 4Z
12. ,BUSINESS_,LOCATED WITHIN THE CITY OF LA QUINTA (Does Not.Apply To
Buiiding "Contractors) i
A. Estimated Gross Business Receipts for New Businesses Only:
B. Previous Year Gross Receipts For Established Businesses:
********GOOD ONLY FOR JANUARY 171993 THRU DECEMBER 31,1993*******
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
issye)A to me apd are in full force and effect.
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253