BUTLER (2)1
CITY OF. IA OUINTA
HOME OCCUPATION PERMIT
APPLICATION
78-105 Call* Eat
P.O. !ox 1504
La oulnl., CA •
(619)664-2246
Read each condition listed on t1.e attachment to this form to see if the
proposed activity can comply with the City's Moore Occupation Regulations.
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APPLICANT'S NAME 6L.d r_ t,-rL PHONE r _
PROPERTY OWNER I SAIIIIA ; PHONE
PROPERTY ADDRESS r�4� 1W_ Avow 1PAI�L7G' KD
TYPE OF .RESIDENCE (single, multiple, mobile home, etc.) SI tT.4�a.t.E
TYPE OF BUSINESS 1J1�-�iil'TIAI 4 SE"aCIGE
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS 1
LIST NAMES OF PERSONS EMPLOYED Et<�
RAID Ma PA
SQUARE FOOTAGE OF USABLE F OR AREA IN `SIA QUINTA
HOUSE IEXCLUDE GARAGE) — LID
VAATION
LOCATION AND SQUARE FOOTAGE..OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE. O C T p 4 �gg�
"BEDROOM - 125 SQUARE FEET")
• DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES �EING1f5l •� .�.'�:,.;,,ee�
OPERATION ,�,p 'ti� ��t� l P�,� 'I , ].JLc .tELt,J M I
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUP TION IS ALLOWED (CONDITIONS ATTACHED).
LICANT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
REQUIRED.
OWNER/AGENT SIGNATURE DATE
IMPORTA.WT: 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.
BUILDING AFETY D£PARTIIERT
APPROVED BY 63L J, DATE l�� z 9 CONDITIONS ATTACHED T_
DEN: ED BY DATE
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1991 BUSINESS LICENSE APPLICATION FORM
BUS ..: kJ C . NO.
7
t -I-
: I -Fq�)
*APPROVED INITIALS DATE
*DENIED IN-ITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES Z -1L NO
2. Business Name: G?=e:Cg � �RAF�SM�n1
3. Business Address: 51-1-2_() Av(;0,,6, 4. Mailing Address: P)�- ,Y
A MISJ� CA 51225 , LJA ,�1 �;,� CA
5. Business Phone: ((�q ) S(,2/t- OS I P�
6. Owned By: CORPORATION PARTNERSHIPINDIVIDUAL
?. If Corporation or Partnership: Tax I.D.#
S. If Individual Owner: Social Security #
•9. Name of Owner ����a ��.l%iL�� Title: C�lnllyr R
Or Officers
10. Type of Business:��Ci����c7,��yL
11. SBE Resale Number:
12- BUSINESS.LO.CATED WITHIN THE.CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$ !0,0001 V°
B. Previous Year Gross Receipts For Established Businesses:
$ i005iRSPi1? AL0108-9118.00 1U
I HEREBY CERTIFY that all the information supplied by me is correct and
an licenses required by the County, State or Federal Government have been
ist ed to me and are in full force and effect.-
. 1 Sig ature Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
z Iq 1
Date
RECEIVEU
OCT I 1GO i
O jTY OF LA ou1NTA
C,OMMIUNITY SAFETY OW?T•