PenaLj
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P.O. Box
.. Box1504
62 La Quinta, CA 92253
Q
LA OF i�
CITY UINTA (619) 564-2246 (�
HOME OCCUPATION APPLICATION
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.
----------------------------- -------------------------------------------
APPLICANT'S NAMEAPHONE -664-490,5
PROPERTY OWNER PHONE
PROPERTY ADDRESS 5 I- G 10 AIC -N I IPA N ww-o
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) t,*
TYPE
TYPE OF BUSINESS CzQSAXL:7iN6
BRIEF DESCRIPT;QN��H�OW T �BUS;N�v WI�L�,, OPERATE
TALC 1 ��
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED JD6,
{ -
SQUARE FOOTAGE OF USABLE FLOOR AREA IN _
HOUSE; (EXCLUDE GARAGE) 100 VALIDATION STAMP
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOM (EXAMPLE,
"BEDROOM - 125 S . F . " ) (; t4
DESCRIPTION OF MACHINERY EQUJTMENT AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION LOOM lrE
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
'/-7 1 qz
AP`PL11CANT SZORATURE IDATE
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.
Building and Safety De rVment
APPROVED B SYDATE CONDITIONS ATTACHED
DENIED BY DATE
1.
TAf 4 4Q"-
1992 BUSINESS LICENSE APPLICATION FORM
BUS. LIC. NO.
**************** ****************** ************************* ***
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
IS THIS BUSINESS LOCATED AT YOUR HOME: YES v NO
2. Business Name: U ill
G PrTC-S
3. Business Address: 4. Mailing Address:
5i -quo kKnm NwakRo, �Q
5. Business Phone:(
6. Owned By: CORPORATION PARTNERSHIP NDIVIDUAL
7. If Corporation or Partnership: Tax I.D.# �I
8. If Individual Owner: Social Security # 555 CU 1'7,59--
• 9. Name of Owner Title:
Or Officers
10. Type of Business: C�IJSl1lM IJ �r9 x? e.T /Q/2_�}U /U
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 Businesses Only:
$ Inn()
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 requ ed by the County, State or Federal Government have been
issued a and a in full force and effect.
11 — '/-1 lco'
l�
ture T:
• v Submit Form To:
CITY -OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box .1504
La Quinta, CA 92253
to