MarzekIII'llllll'llllll"I � 78-105 Calle Estado
P.O. Box 1504
08 La Quinta, CA 92253
4 Z (619) 564-2246
CITY OF LA QUINTA
r`if HOME OCCUPATION APPLICATION
Read each`*' ition listed on the attachment to this form to see if the
proposed activity can comply with the City's Home Occupation Regulations.
APPLICANT'S NAME C7u�i A-ej A-1 n n3T t a g-1--r-k— PHONE 5&1-4 'S 3 zqg
PROPERTY OWNER � 12� ��t-Q,� le . PHONE 5644 531's
PROPERTY ADDRESS rJ q �� \USS �.�� .0 ,rJC� 0I:,_
TYPE OF RESIDENCE (single, -multiple, mobile home, etc.)
TYPE OF BUSINESS j�Gc %�� 71� �5 i5 &,t) f �iu5 i"uC� J�� O &U
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS ®.0 el
LIST NAMES OF PERSONS EMPLOYED A-,)OAJ C
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE ( EXCLUDE GARAGE) ,�Lo 90 -
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.") / b
APR 2 4 1992
STAMP
4
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLI THE
BUSINESS OPERATION
O A-)
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
C./
APPtICANTVGNATURE 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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• Building and Safety Department
n
�-/APPROVED BY 13,62, DATE "e��12 CONDITIONS ATTACHED
DENIED BY DATE
40
3 s
OF
NON -EMPLOYER CERTIFICATE
I certify what in the performance of work for which this City of La
Quinta business license is issued I shall not employ any person in
any manner so as to become subject to the workers' compensation
laws of California.
Note: If after signing the certificate, you.hire any employee, you
become subject to the workers' compensation provisions of the
California Labor Code, and you must immediately comply with the
provisions of Section 3700 or your license immediately becomes
revoked.
Business Name:
Business License Appli ant:,
Date : �'l cL
jc_
N
Tihf 4 4Q"
1992 BUSINESS LICENSE APPLICATION FORM
Send Completed Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
BUS. LIC. NO
YA
1. Business Name: 1
2. Business Address:h�Cc. e-
1
,.1 0- Lzs
3. Mailing Address: J I/lc ek-5 11, �oy�
4. Business Phone: ( LQ (ci te41 r 5:3`i
5. Owned By: CORPORATION PARTNERSHIP INDIVIDU
6. If Corporation or Partnership: Tax I.D.#
7. If Individual Owner: Social Security # < 3 CSU
8. Name of Owner or Officers and Title:, GUL"
9. SBE Resale Number:
10. Number of Decals Needed:
11. CONTRACTORS ONLY:
A.
B.
C.
Type of Contractor: (torJCa(,6 c`
Classification:
State License Number: 2b I
CONTRACTORS - GENE 100. or
CONTRACTORS - SUB 5 . Per Year or
$50.00 Semi-annual
$25.00 Semi-annual
CONTRACTORS ARE ON A CALENDAR YEAR BASIS ONLY; ANNUAL FROM JANUARY 1ST
THROUGH DECEMBER 31ST. SEMI-ANNUAL FROM JANUARY 1ST THROUGH JUNE 30TH; OR
JULY 1st THROUGH DECEMBER 31ST.
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.
0 "� . , , k (2L1LiAA_&\ 2
Sig ature Title qDate