CHALFONT•
• �C(/ BUS. LIC. NO.
1992 BUSINESS LICENSE APPLICATION FORM
*APPROVED 1 .1c4i INITIALS - /Z_ F2 DATE
*DENIED INITIALS DATE
******************************************************************
1.
IS THIS
BUSINESS
LOCATED AT
YOUR HOME: YES li ; NO
2.
Business
Name:
0#/Ac-1rnij-
4I2 -cc, .,r lrye-
3. Business Address: moo, Cnx rs"N 4. Mailing Address: Imo, o, ►�o�r gs3
S/-Yf9 A,rq . K.,cr►wce-
�U , �Tg . Co : 'q 7, Zs �t L.a Qu m coo
5. Business Phone: (_) '77l //S-
6.
IS6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7.
8.
9.
If Corporation or Partnership: Tax I.D.#
If. Individual Owner: Social Security # &-I # - 4 z - S 6 Q 3
Name o f Owner —1 CAN N E e"A 1_FcN
Or Officers
10. Type of Business: AccnLLki-reArc-,_ S Q u► cc
11. SBE Resale Number:
Title: Owoc,`
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$ (O GQl►
B. Previous Year Gross Receipts For Established Businesses:
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******
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.
• Signatu a Title D to
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION i IIIIIIIIIIIIIIIII'II
P.O. Box 1504 49
La Quinta, CA 92253 - -�
11111111111111111111
50
CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
condition listed on the attachment to this form to see if the
ctivity can comply with the City's Home Occupation Regulations.
APPLICANT'S NAME JEANS CNALVO�JT- PHONE S'(.4- g3oZ
PROPERTY OWNER S A K C- PHONE 5 6 N - q3 o Z -
PROPERTY ADDRESS Si- K8y Arc. MAAT, ty Z I -A GZtig rA . L'A . 'IZ2-S3
TYPE OF RESIDENC (singl , multiple, mobile home, etc.)
TYPE OF BUSINESS SER.I«F -- A eco LujroN 6—
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE <5;d 7-0 Cus7o)4CRL s
Tc� 'ho Accoutiirnir, SuPPo&
NUMBER OF PERSONS INVOLVED IN BUSINESS n4c
LIST NAMES OF PERSONS EMPLOYED ASoyE
SQUARE FOOTAGE OF USABLE FLOOR AREA IN PAID M5.00
HOUSE ( EXCLUDE GARAGE) %/o o V =1N5TAMP n f
• LOCATION AND SQUARE FOOTAGE OF AREA OF OCT 71992 (�-
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.") 5'o sFAl III Mr, A
BY
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USA IN THE
BUSINESS OPERATIONt4 a or. Fac -Esq bc-sr -
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS. ATTACHED).
Z --
APPLICANT SIGNATURE
IF
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.
Buil `nq and Safety Da tment
APPROVED BY ' eJyDATE CONDITIONS ATTACHED
DENIED BY DATE