GRATAF-1
78-105 G j ll'lllllullll'lllll k Calle Estado
P.O. Box 1504
21 La Quinta, CA 92253
' CITY OF LA QUINTA (619).564-2246
v� HOME OCCUPATION APPLICATION
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.
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APPLICANT'S NAME
PROPERTY OWNER
PROPERTY ADDRESS
TYPE OF RESIDENCE
TYPE OF BUSINESS
BRIEF
NUMBER OF PERSON
mobile home,
PHONE CZ✓7.011
PHONE 6L4_ 4221
NESS WILL OPERATE
W 1117 n , /, zz, - J..4 -'aur" i
IN BUSINESS 3 -
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FL O EA IN
HOUSE (EXCLUDEPARAGE)
• LOCATION AND SQ U FC��AGE OF AREA OF
BUSINESS ACTIVI IN HOME (EXAMPLE,.
"BEDROOM - 125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND
BUSINESS .OPERATION )g6f/C!�
VA:BN STAMP.
CfTY OF LA QUfNTA
MAR 2 4.1992
0 -
BUILDING AND SAFETY DEPT.
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION/JS ALLOWED (CONDITIONS ATTACHED).
LICANT SI ATURE HATE
IF*AP CANT IS OT:7R THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
REQUIRVRA.�( 9, � �Y C3wm c'e/
241-q 2-
0 ER/AGENT SIGNATURE fDATE
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 and Safety De r ment
i
APPROVED BY DATE L� CONDITIONS ATTACHED
DENIED BY DATE
0-
•
Ll
OF
NON-EMPLOYER CERTIFICATE
I certify what in the performance of work for which, this City of La
Quinta business license is issued I shall not employ any person in
any manner so as to become subject to the workers' compensation
laws of California.
Note: If after signing the certificate, you hire any employee, you
become subject- to the workers' compensation provisions of the
California Labor Code, and you must immediately comply -with the.
provisions of Section 3700 or your license immediately becomes
revoked.
Business Name:
Business License Applicant:
Date: 02
_ OF
NON -EMPLOYER CERTIFICATE
I certify what in the performance of work for which this City of La
Quinta business license is issued I shall not employ any person in
any manner so as to become subject to the workers' compensation
laws of California.
Note: If after signing the certificate, you hire any employee, you
become subject to the workers' compensation provisions of the
California Labor Code, and you must immediately comply with the
provisions of Section 3700 or your license immediately becomes
revoked.
Business Name: 31, 11jer
Business License Applicant:.
•Date: -,--5--/- �'A,
I
® MLS
OEAEIOR
SADIE L. ELLIOTT, REALTOR
MELITAS FORSTER
REALTOR ASSOCIATE
80159 AVE. 50
I N DIO, CA 92201 (619) 564-4221