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BUS . LIC�iVOL
1994 BUSINESS LICENSE APPLICATION FORM
*APPROVED BY
DATE
......PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES X. NO
2. Business Name: /<FM /I/
3. Business Address: S4/060 .Mailing Address:
L � Q� ,�✓r,9 C.A 9��5..3
5. Business Phone:( �'/ 9 771 �br9
6. Owned By: CORPORATION PARTNERSHIP INDIV U
7. If Corporation or Partnership: Tax I,.D.#
8. If Individual Owner: Social Security
9. Name of Ownerv�/v Title: Q
Or Officers ju
10. Type 6 -t -
11.
f Business : L�. c ��
11. IF YOU ARE A FOOD VENDOR DO YOU HAVE A COUNTY HEALTH FERMI
YES NO
.
12. SBE Resale Number:_ ///1AZI cNc fq,51C7%0
13. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
s moo, 4v
B. Previous Year Gross Receipts For Established Business /
S
GOOD ONLY FOR JANUARY 1,1994 THRU DECEMBER 31,1994*******
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
issued to me-and//��are in full force and effect.
7�' 179 %- __ - 11-1) /
Signature
Title
Submit Form To:
CITY OF LA QUINTA.
BUSINESS LICENSE DIVISION
78-495 Calle TamDico
// /-T.y
Date
i
H 60 Al
MFEE $35.00 Q a
D
CITY OF LA QUINTA NOV 18 1994
78-495 Calle Tampico, P. O.Box 1504, La QuintaIB�A 2i 3
HOME OCCUPATION PERMIT
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.
BUSINESS NAME 7
PROPERTY OWNER
PROPERTY ADDRESS
MAILING ADDRESS
TYPE OF RESIDENCE
TYPE OF BUSINESS
BRIEF DESCRIPTION
single, multiple, mobi
C'
THE BUSINhaS
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED —
40 SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) l�
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
PHONE 771-3e-19
PHONE 3y/- 35g.5 -
home, etc.)
LL OPERATE
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES.BEING USED IN THE
BUSINESS OPERATION. j�,�s& �,�,�� �y A;
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OC: UPATIO I. ALLOWED (CONDITIONS ATTACHED).
////gAs,-1
APPLICANT SIGNATURE DATE
IF APPLICANT IS'OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
R/AGENT SIGNATURE
/,/// 9- y/1
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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1
Build' 'and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
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