JOHNSONC11V OF LA OUINIA
�\0 HOME OCCUPATION PERMIT
APPLICATION
78-106 cello to
P.O. sox 1504,
is Ou1n1s, CA
(e 19)664-2246
Read each condition listed on tte attachment to this form to see if the
proposed activity can comply With the City's Home Occupation Regulations.
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ITYPE OR PRINT 1N INK)
APPLICANT'S NAME f `ENNe-r-H ' o co"
PROPERTY OWNER
PHONE 565 -/37
PHONE
PROPERTY ADDRESS cS Z % �i 4 ✓� �! ! q7,4 lt4EA/ � [0�Zy4
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) c71AJ64-E
TYPE OF BUSINESS d Ayo CtZ4FrS
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE j)Ea1W_,6---1.111 o�
Cp/i/'r-�o NF/LcY r4 N 0 6.alIiNE.vT�
NUKEER OF PERSONS INVOLVED IN BUSINESS Z
LIST NAMES OF PERSONS EMPLOYED /Z/dy I A/E WA
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE) VALM&ION STAMPQn**
LOCATION AND SQUARE FOOTAGE. OF AREA OF OCT 1 991
BUSINESS ACTIVITY IN HOME (EXAMPLE,
^BEDROOM - 125 SQUARE FEET") '.-0 BUILDING. AND SAFE WT
• DESCRIPTION OF MACHINERY- LQUIPMFA'T, AND SUPPLIES 1LING {(SED IN THE B SINESS
OPERATION I✓oa -Txle- P.41x'm . 'Se-voV6 '444owIme FA82ic ".
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I HAVE READ. UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
APPLI CANT 7GNATUM
Srl►TE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORISATION OF OMNER OR AGENT
REQUIRED. ••
OWNER/AGENT SIGNATNRE DATE
IMP0R7A.WT: False or misleading information shall be grounds for denying your
Hole Occupation; failure to comply with conditions listed on the attached page
shall be grounds for revocation of permit.
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APPRDVED BY DATE O CONDITIONS ATTACKED
DEN: ED BY DATE �
� I IIIIII VIII (III (III
10
1.
BUS.__LIC. NO.
4
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1..q 91
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1991 BUSINESS LICENSE APPLICATION FORM
********************************** * ******************* *** **
*APPROVED INITIALS DATE. 7
*DENIED INITIALS DATE
******************************************************************
IS THIS BUSINESS LOCATED AT YOUR HOME: YES_ NO
2. Business
Name: (,kQqT! 11 xE�1�SAK r
r
3. Business Address: 4. Mailing Address:
5d--211 ALCALODM 114 Quix)-m
5. Business Phone:( CQ(�_) 5Zo IL/- 14137
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL J
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # SSa2-SS-SS�S�
• 9. Name of Owner Kitl E -n4 T :Yo tf/"So t/ Title: UWV&-
Or Officers
10. Type of Business: i4A,00
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 BusinessesOppnly:
jp 60SOOOSiL8� iiOj'4 AL 22-`�11 .00
B. Previous Year Gross Receipts For Established Businessgs:
$ �-Ib
********GOOD ONLY FOR JANUARY 1,1991 THRU DECEMBER 31,1991*******
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 an are in full force and effect.
• Signature Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quintal CA 92253
10