JENSEN' I II'I" IIII' IIII I"I
• 39
TU�l 4
oQa
JAN 11 1994
CITY OF LA QUINTA BY
78-495 Calle Tampico, P. O.Box 1504, La Quinta, C 92
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 AA�nt,_\ 0 E ,504-2204
PROPERTY OWNER PHONE
PROPERTY ADDRESS 5
MAILING ADDRESS ssS o• a�S3
TYPE OF RESIDENCE sin le multiple, mobil home, etc.) cz,;;1q��
TYPE OF BUSINESS
BRIEF DESCRI TION OF HOW TRE B IN S WILL OPERATE
NUMBER OF P SON INVOLVED IN BUSINESSIPM
LIST NAME OF PERSONS EMPLOYED —-
SQUARE FOOTAGE OF USABLE FLOOR AREA
• IN HOUSE (EXCLUDE GARAGE) 50 Sq. ?
LOCATION AND SQUARE FOOTAGE OF AREA "
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME CCUPATI N 1,4 ALLOWED (CONDITIONS ATTACHED).
APPLICANT SIG TURE DATE
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.
------------------ ------------------------------------
yBilai and Safety De artment
APPROVED DENIED CONDITIONS ATTACHED
•
•
4
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, C\k-1192
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
PROPERTY OWNER VQv
PROPERTY ADDRESS
MAILING ADDRESS
TYPE OF RESIDENCE
TYPE OF BUSINESS
BRIEF DESCRIPTION OF
PHONE
multiple,
, etc.)
S WILL OPERATE
NUMBER OF PERSONS -)INVOLVED IN BUSINESS �4C
LIST NAME OF PERSONS EMPLOYED ' —�--
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE ( EXCLUDE GARAGE) ..
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEIN USED IN THE
BUSINESS OPERATION (1n�r�q_CLC..I. \ °A�n �f�a ����: n-�-m� %�c.i ri)nA ,
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME,QCCUPAINN I,k ALLOWED (CONDITIONS ATTACHED).
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.
BuijAinq and Safety Department
APPROVED DENIED
5
CONDITIONS.ATTACHED
't,
•
RECEIPT CitY of La Quints, 78 - 105 Calle Estado, / P. O. Box 1504, La Quints CA 92253
���/Rf /ED FROM , 19 / NO.�� �b
AD�SS
the proposed activity can c:�,►rte j
Regulations.
BUSINESS NAME
PROPERTY OWNER _
PROPERTY ADDRESS
MAILING ADDRESS
TYPE OF RESIDENCE ain le multiple,
TYPE OF BUSINESS
BRIEF DESCRI�ION OF HOW B IN S
101\r,S--
�(,:iIC—Q.. nn rc-;,� Vc--r-^4- :-
scW'196NE Sl Dq--ZU04
_ PHONE
I
Ci' CJS'
iobil home, etc.)
WILL OPERATE
NlRd-BER OF PERSONS-3INVOLVED IN BUSINESS
IJT NAME OF PERSONS EMPLOYED —�
ARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE ( EXCLUDE GARAGE) , ?
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
Tilht 4 4aaulikrw
11111111111111111111
40
BUS. LIC.. NO.
1994 BUSINESS LICENSE APPLICATION FORM
*APPROVED BY /
* DATE 1
...... PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
1.
IS THIS BUSINESS LOCATED
AT YOUR -HOME: YES
t,� NO
2.
Business
Name•1.
3.
Business
Address:��--(�;�-{ � �� 4`, Mailing
Address:_�)�p�l�ss
5.
Business
Phone: ( (L_ � )
` �,y --a0Cj
6.
Owned By:
CORPORATION
PARTNERSHIP
INDIVIDU `
7. If Corporation or Partnership: Tax I.D.#
92
If Individual Owner: Social Security # ' . j-�jy_0 2 -7g
Name of Owner s-i�l��l Title:��
F� LON)
Or Officers
Type of Business: P t\
11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO
12. SBE Resale Number:
13. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$ 'kU)coG
B. Previous Year Gross Receipts For Established Businesses:
********GOOD ONLY FOR JANUARY 1,1994 THRU DECEMBER 31,1994*******
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.
Signature
Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
La Quinta, CA 92253