ANDERSON19
/ �I VIII) VIII IIII IIID" , 78-105 Calle Estado
P.O. Box 1504
03 ' La Quinta, CA 92253
CITY OF LA QUINTA (61.9) 564-2246
_ r
HOME OCCUPATION APPLICATION
condition listed on the attachment to this form to
proposed activity can comply with the City's Home Occupation
see if the
Regulations.
APPLICANT'S NAME"v��'� -- - PHONE`�D3S
PROPERTY OWNER PHONE "
PROPERTY ADDRESS 53 -791 AMPA awnm
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS 14yow (VUA(%_�
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE-
yot �tzoP�-IC�Cor�vN'tP IN -*f/qzV _ 6pkth �.;
NUMBER OF PERSONS INVOLVED IN BUSINESS Q
�• ter'� �'" s <zc't7 ••e�. �,..:e
LIST NAMES OF PERSONS EMPLOYED #3 .4�:.<.
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE ( EXCLUDE GARAGE) L r L °� (v 5�
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S . F . " )j(, Q(D S
VALIDATION -STAMP.
►�� �'��
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION �AM_ FEW -IL , fEjrZ,, ! dMYTL �GTEF�,
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
`.0\00UPATION IS O ED ONDITIONS ATTACHED).
CANT 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.
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`'
Buildi_pq and Safety Department
APPROVED BY e ..S. DATE z,Z- /�2 CONDITIONS ATTACHED AL__q_
DENIED BY DATE
t
s
•
T.,iaf 4
BUS. LIC. N0.
1992 BUSINESS LICENSE APPLICATION FORM
******************************************************************
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES_ NO
2. Business Name:
3 . Business Address: S;!7'791 14*• 4. Mailing Address: `t%• $�
AWIW44 Cak3 X77 011A, a �'Ly
5. Business Phone: (__)
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security #
9. Name of owner I'CU(, IS. Title:
Or Officers
10.4 Type of Business:
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:
$�'
H. Previous Year Gross Receipts For Established Businesses:
$ NA
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******
I HEREBY CERTIFY that all the information supplied by me is correct and
any licenses County, State or Federal Government have been
e d are 11 force and effect.
1gzCMMcT VX P2 -
Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box.1504
La Quinta, CA 92253
L.