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• FEE $35.00
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
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 AAA PHONE
PROPERTY OWNER L S PHONE
PROPERTY ADDRESS •1 33 2� A L/E • -,J
MAILING ADDRESS 9 m ,
TYPE OF RESIDENCE (single, multiple, mobil home, etc.)
TYPE OF BUSINESS L' /e,: z, Go
BRIEF DESCRIPTION OF HO,y THE BUS NESS WILL 0,PERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED e o
• SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) j1.5pS,g 064-.
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BU INESS OPERATIO OUI-71-
VE REA , UND RSTAND, AN1Y AGREE IWITH iTHE CONDiTTnMqf BY WHICH A
HONEOCCUPATIO IS ALLOWED (CONDITIONS ATTACHED).
APPLICANT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
O ER/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.
-112=
---------------------
• Buil in and'Safety Department
V. APPROVED.- DENIED CONDITIONS ATTACHED
C
8' ,v .
110
1.
Tity 4 4(v QUM&
BUS. LIC. NO.
1994 BUSINESS LICENSE APPLICATION FORM
*APPROVED BY Z`';;�
* DATE
......PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
IS THIS BUSINESS LO///��TED AT YOUR HOME: YE S I/ NO
I / zi A s %
2. Business Name:
3. Business Address: j4. Mailin
5. Busin ss Phone: O
Address:
6. Owned.By: CORPORATION PARTNERSHIP INDIVIDUAL
1
7. If Corporation or Partnership: Tax if
8. If Individual Owner: Soc' 1 Security#
9 . Name of Owner � Title
Or Officers
10. Type of Business:
11. IF YOU ARE A FOOD VENDOR, DO
YES
12. SBE Resale Number:
Y U HAVE A CC
NO
PERMIT:
- i"adSJ
13. 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:
$�
ov
********G00D 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
iss ed to mea d are in full force and, effect.
Signature it a Date
Submit.Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
La Quinta, CA 92253