BURNSCITY OF LA OUINIA
NOME OCCUPATION PERMIT
APPLICATION
76-106 Calle to
P.O. •o■ 1604
to Oulnls. CA 1
(e1o)664-2246
mead each COridatlon listed on tt.e attachment to this form to see if the
proposed activity can comply with the,City's Home Occupation Regulations.
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ITYpt OR PRINT IN INK) 79
APPLICANT'S NAME
PROPERTY OWNER
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) l HJ `i le-
TYPE
PTYPE OF BUSINESS
BRIEF DESCRIPTION OF NOW BUSINESS WILL OPERATE _ /?-e-J e__� Lld&44
k E
NUKfER OF PERSONS INVOLVED IN BUSINESS I
LIST NATES OF PERSONS EMPLOYED VV�St=L�
nun MG M
SQUARE FOOTAGE OF USABLE FLOOR AREA IN vn 1 %P1 b-- —--
HOUSE 1EXCLUDE GARAGE) O D _YALIDATION STAMP
LOCATION AND SQUARE FOOTAGE. OF AREA OF NOV 131991
BUSINESS ACTIVITY IN H017E MAMiPLE.
"BEDROOM - 125 SQUARE FEET -1 2- BUILDING PND SAFETY DEPT•
2ts 0 tM �mo-
• DESCRIPTION OF MACHINERY. LQUIPMEA?. AND SUPPLIES 1EING USED IN THE BUSINESS
OPERATION
, D J J
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I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A NOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED(.
0
IF APPLICANT Its OTHER THAN PROPERTY OWNER, AUTNORI=ATION OF OWNER OR AGENT
REQUIRED.
OWNER/AGENT SIGNATURE DATE
Ir.PORTAvT: False or misleading information shall be grounds for denying your
Nome Occupation; failure to comply with conditions listed on the attached page
shall be grounds for revocation of permit.
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UILDING &JAYM DIPARTPMPT
APPROVED BY (�[S�/�
. DATE'! CONDITIONS AITACHED
DEN: ED BY DATE
BUS._LIC. NO.
4
1991 BUSINESS LICENSE APPL'ICATION FORM
005182 10 5612 11-11-91 14
**1$.00
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES 'NO
2. Business Name:
(' 4
3. Business Address: 5�� 1oAue- Too -a6,2 4. Mailing Address: S
gI 3
5. Business Phone:(
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # 02 S S 1P �' 8
•9. Name of Owner 2 N Title: CU-)
Or Officers
10. Type of Business: �� "nJV 't-e� S -2 2 U %LAS
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:
$
B. Previous Year Gross Receipts For Established Businesses:
********GOOD ONLY FOR JANUARY 111991 THRU DECEMBER 31,1991
I HEREBY CERTIFY that all the information supplied by me is correct and
any li enses required by the County, State or Federal Government have been
issue to me and.are n full force and effect.
#
Sign ure. Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quintal CA 92253