Porras25
• FEE $35.00
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT
Read each condition listed on the attachment to this form to see if
the proposed activity can comply with the City's Home Occupation
Regulations.
BUSINESS NAME Lie-L-Nomeiii HONE Sjq
PROPERTY OWNER PHONE
PROPERTY ADDRESS
MAILING ADDRESS
TYPE OF RESIDENCEsin le, multiple, mobil home, etc.) e_
TYPE OF BUS INES I ML � hy\� e OjAk e f \
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE'VtxioCe_ r,)M n r V:
NUMBER OF PERSONS-INVOLVBD IN BUSINESS
LIST NAME OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA �f 522 -0 IN HOUSE ( EXCLUDE GARAGE) ��.(x) SQ �! I,,j 3 i Z
LOCATION AND SQUARE FOOTAGE OF AREA 3 o 5q
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATIONS
I HAVE -READ UNDERSTAND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCAT 0 IS 'A WED ONDI` IONS ATTACHED) .
APPLICANT S
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS 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.
________________________________
�Building and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
/s T /Z�'
11C,4 -Ur L-( Ca,n/�91'/Y 011514 .v� rvR
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
Every employer who applies for any license or a renewal of any
license for a business issued pursuant to Section 37101 of the
Government Code or Section 7284 of the Revenue and Taxation Code
shall complete and sign a declaration that states the.following:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury, one of the following
declaration:
I have and will maintain a certificate of consent to self-
insure.for worker's compensation, as provided by Section 3700 for
the duration of any business activities conducted for which this
license is issued.
I have and will maintain worker's compensation insurance, as
required by Section 3700 for the duration of any business
• activities conducted for which this license is issued.
My worker's compensation insurance carrier and policy number:
•
Carrier:
Policy Number:
A "COPY" OF THE POLICY SHOWING THE AMOUNT OF COVERAGE AND
EXPIRATION DATE -FOR WORKMEN'S COMPENSATION IS REQUIRED TO PROCESS
THIS APPLICATION.
I certify that in the performance of any business activities
for which this license is issued I shall not employ any person in
any manner so as to become subject to the worker's compensation
laws of California, and agree that if I should become subject to
the worker's compensation provisions of ection 3
Date: kt) 3 I (DApplicant:
WARNING: Failure to secure workman's compensation coverage is
unlawful, and shall subject an employer to criminal penalties and
civic fines up to $100,000. In addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
Code, interest, and attorney's fees.
bus.fac
0LMAILING ADDRESS - P.O. BOX. 1504 - LA OUINTA, CALIFORNIA 92253 �.
Copyright (C)1996 Dataquick Information Systems
•
rm
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Page
APN
773-333-002
Use: SINGLE
RESIDENCE
Phone (716)549-0211
Owners:
FAHNESTOCK,FAYE L SCHLUETER,RENE A
Pg-Grd: 224 -D2/879 -F2
Site
52790 AVENIDA MENDOZA*'LA QUINTA
CA 92253
Census: 0451.047
1
716 HERR
RD*ANGOLA
NY
14006
Zoning: R1
F1oodP:
Legal
LOT 25 BLK 147 MB 018/092 SANTA
CARMELITA VALE
LA Map: MB -018-092
Tr/Lot/B1:
00000-00/L-0025/147
Assd
$75,000
TRA
020017.
SaleDt:
Sale_Am:
Land
$18,750
Tax
$1,214.14
Doc #
1st Td:
PerImp:
750-o
Sta/Ex:
CUR
Lender:
Addl:
Ownshp:
JOINT
TaxYr':
95-96
Title
PrevDt:
Last Trans W/O $:
09/01/90
331532
$/SgFt:
PrevAm:
Yr Blt:
1978
SgFeet:
1,286
OutImp:
GarSgF: 437
BedBth:
4/2.0
Addtnl:
StSurf: Y
GarTyp: ATTACHED
#Story:
1
Roof :
ROLL COMP
MscBdg: -
CarSgF:
#Units:
1
Electr:
DEVELOPED
Ht/Cl : B
GarSF2:
LotSz
4,791
Gas
NO
FirePl:
GarTy2:
Water
DEVELOPED
Pool
CarSF2:
Sewer
NO
View
Copyright (C)1996 Dataquick Information Systems
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1 -13 96 09:22
17:121PMW". 42W
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ILI
CITY OF LA QUINTA
78-495 Calle Tampirc, P. O.Sox 1504, La Quint&, CA 9225I
HOME OCCVPhTION PERMIT
Read each condition listed on the attachment to thin form t4 se• if
the proposed activity can comply with the City's Home OCGupation
Regulations.
=s+s���===ss:��s��a:=�:�z===:��.s�_:..■sw■ssrs:s��■�a�:a====�:�r.�a
BUSINESS NAME MOVE'G'y�--
PROPERTY OWNER HONE
PROPERTY ADDRRSS 1- 4 (k)U1ftA I `A 'Ta -
RAILING ADDRESS
TYPE OF RESIDENCE n e multi le, mobil hams, etc.)
TYPE OF EUSINESS� ��:
BRIEF DESCRIPTIO OF HOW THEUSIN LSS -GILL OPERATL_UJLK' _ C1C'r-. L(
Wgo,aER DF PERsbt0_!N_VOLVtD IN BUSINESS _ r
LIST NAME OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE IrLOOR AREA 1
GJ + 3 �0
IN HOUSE (EXCLUDE GARAGE) j20(x) so {-f
LOCATION AND'SQUARE'FOOTAGK OF AREA
OF BUSINESS ACTIVITY IN HOME
(MMPLEI "BEDROOM -125 S.F.")
OrSC91VTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING US£fl -IN THE
BUSINESS OPERATION
I
HAVE -READ ..UNDERS;Pk
•AHp AGREE WITH THE COMA TIONS !3Y WHICH A
KQME OC TxO� is D �ONUITIONS ATTACHED) . - �
J _'�� L
Apptic VT SIGNA'T'URE
IF A ICANT IS „OTHER THAN PROPERTY OWNER,
OR T IS
r.
AUTHORIZATION OF OWNER
/v _W
DATE
_AQ IMPORTANT: FALSE OR MISLEADING INFORMATION SMALL BE GROUNDS FOR
DINYSfdG'YDUR HOME OCCUPATION;
FAILURE TO St�LL 8E GROUNDS LfOR ITH REVOCATIONONS
OF
LISTED ON THE ATTACHEJD
PERMIT.
■:3__ozs='a�®saas=Stir■==s.�s�.■■ss_m:ate :.-��t�s�aa--caxa�-:aa.-s:ses►
9uildinv and Safety D• artr *nt-
AiPPR01lEp DENIED CONDITIONS ATTACHED
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