DERIAN1111111 IIIII IIII IIII
PAID $35.00
CITY OF LA OUINTA
CITY OF LA QUINTA DEC 2 41993
78-495 Calle Tampico, P. O.Box 1504, La QuintB UIKDRd(rUMFETYDEPT.
HOME OCCUPATION PERMIT
Read each condition listed on the
attachment
ti Home O occupation
form to see if
the proposed activity can comply ithhe City's
Regulations______________________________________________________
• � �
BUSINESS NAME La, PHONEPHONE
PROPERTY OWNER A f N
PROPERTY ADDRESS 2
MAILING ADDRESS a etc.)
TYPE OF RESIDENCE in , multiple, mobil home,
TYPE OF BUSINESS e w r.r
CRIPTION OF HOW THE BUSI ESS WILL OPERATE
rr
BRIEF DESftie
JNUMBER OF PERSONS I OLVED IN BUSINESS On
LIST NAME OF PERSONS EMPLOYED One--...�•_•�_�`My,-`.`__'
• SQUARE FOOTAGE OF USABLE FLOOR AREA /�
IN HOUSE (EXCLUDE GARAGE).=
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINE
(EXAMPLE,.i104
SS ACTIVITY IN HOME an i
"BEDROOM-125 S.F. " ) f Ci c c/v a- $
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING
BUSINESS OPERATION P
lin-
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY 1ICH A
HOME CLZPAT N ALLO`(�1ED (CONDITIONS ATTACHED) .-
DATE
APPLICANT IGNATURE
PROPERTY OWNER, AUTHORIZATION OF OWNER
IF APPLICANT IS OTHER THAN
OR AGENT IS REQUIRED.
OWNER/AGENT SIGNATURE
DATE
IMPORTANT: FALSE OR MISLEADINGFAILURE INFORMATION
WITH
LBE GROUNDS
CONDITIONS
DENYING YOUR HOME OCCUPATION,
AGE SHALL BE GROUNDS FOR REVOCATION OF
LISTED ON THE ATTACHED P
PERMIT.
• B d n and Saf tY De artment ATTACHED �.
APPROVED DENIED CONDITIONS