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i „inY n,3 1996
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 , ” )0 's 1*cfflxre_PHONE -41T- 771-11741
PROPERTY OWNER QV cra n S eC..14 y PHONE
PROPERTY ADDRESS :C-2_774- Ofye •
MAILING ADDRESS
TYPE OF RESIDENCE ( ngle, multiple, mobil home, etc.)
TYPE OF BUSINESS _,5+ic SS �t
MIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE /
brt vA �u-k1� f0 ko- (7U�`ry t�
NUMBER OF PERSONS INVOLVED IN BUSINESS J
LIST NAME OF PERSONS EMPLOYED Ccj
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE ( EXCLUDE GARAGE)!.L.L`
• LOCATION AND SQUARE FOOTAGE -OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F. ") /ao rf fQ�-f
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION At cs.-c
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME O,CCUPATION IS ALLOYED C DITIONS ATTACHED) /6 q
APPLICANT SWRATURE nw".e
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.
-------------------------------------------
B"Idina and Safety Department
4Z 24 APPROVED DENIED CONDITIONS ATTACHED
r
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78-495 CALLE TAMPICO — LA OUINTA, 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
EXPIRA
THIS A
kGE AND
PROCESS
I certify that in the performance of any business activities
or which this.license is issued I shall not employ any person in
any manner so as to 'become subject to the worker's c ensation
laws of California, and agree that if I should be me su4je to
the worker's compensation provisions of Section 37
Date:
/�/C� Applicant:- �• ''
._e i�
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
MAILING ADDRESS - P.O. BOX 1504 - LA .OUINTA, CALIFORNIA 92253
APN :
774-141-002
Use: SINGLE RESIDENCE
Phone : (619)564-5028
Owners:
VILLEGAS,GERARD B &
SANDRA D
Pg-Grd: 224 -B3/879 -D3
Site
53776 AVENIDA MONTEZUMA*LA QUINTA CA
92253
Census: 0451.048
Mail
53776 AVENIDA MONTEZUMA*LA QUINTA CA
92253
Zoning: R1
FloodP:
Legal
LOT 22 BLK
196 MB 019/033 SANTA CARMELITA AT VALE Map: MB -019-033
0Tr/Lot/Bl:
00000-00/L-0022/196
Assd
$67,548
TRA
020062 SaleDt:
11/01/82
SaleAm: $59,000
Land
$11,774
Tax
$1,049.70 Doc # :
189460
1st Td: $58,750
PerImp:
820
Sta/Ex:
CUR / Y Lender:
TITLE COMP Addl:
Ownshp:
JOINT
TaxYr
95-96 Title
PrevDt:
Last Trans W/O $:
$/SgFt:
$47.28
PrevAm:
Yr Blt:
1982
SgFeet:
1,248 OutImp:
GarSgF: 320
BedBth:
3/2.0
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
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