HENDRICKS (2)•
HOME OCClUPAT
APPLICATION
CITY OF LA QWNT
74405 Call* t.t•d.
P.O. Box 1504
�. Qulnts,CA. 92M
(619) 564-1:*6
664-2246 PLANNING DIVISION +40. 6/07
Read each condition listed on the revers e side of this form to see If
the proposed activity can comply with the City's Home Occupation
Regulations. $35.00 fee
TYPE OR PRINT IN INK
APPLICANT'S NAME E D EI S PHONE
PROPERTY OWNER i "; 1 (o
PROPERTY ADDRESS. iN
.LA Opi-olf-A (Street
(City) (State) (Sip)
Type of residence !Single Multiple, mobile home, etc.)
Type of business PmL
Brief description of how the business will operate /,// r A
CF- OF 00L MA l E oa
L -s o Lo
(lumber of persons involved in business
1
List names of persons employed (Y) i r h A L 0e is 1; Cis
•
Square footage of usable f o r area in�/+//++
house (exclude garage) /�'S.t C�r�C E Validation Stamp
Location and square footage of area of
business activity in home (example: 1005MASM i64ZTAB-115-9035.00 14
fan bedrooms; � square feet) 5244� -,kEA
Description of machinery, equipment, and supplies being used in the
business operation �O L5� 13Sf-,� Na'� �IACu, �M KED n(o(`i/16L E Oc )I
I have read and understand and agree with the conditions by which a
home occupation is allowed (Conditions on reverse side).
G l9'� 8 -lam Ro
Ct : �' :J� LN (lUI�J 1Y A APPLICANT SIGNATURE DATE
0l.ANhiNi, & DGVELOPn+.FPS? DEPT
If Applicant is other than property owner, authorisation of owner or agent.
required.
0 & B-�S-9c7
04TNERR AGENT SIGNATURE DATE
IMPORTANT: False or misleading information shall be grounds for denying
your Home Occupation, or failure to comply with conditions listed on
reverse shall be grounds for revocation of permit.
f f f } f f ! } •
• v APPROVED Initials �Z Date
CONDITIONS A CHED
Initials Date
DENIED
LQHOMOCC.PRT
I llllll VIII IIII I'll
39