ANARIEA I I'llll III'I'lll II II
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FEE $35.00
CITY OF LA QUINTA
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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 L
PROPERTY OWNER
PROPERTY ADDRESS
MAILING ADDRESS
TYPE OF RESIDENCE
TYPE OF BUSINESS
NUMBER OF PERSONS INVOLVED IN SUUINE
LIST NAME OF PERSONS EMPLOYED qZn4W
SQUARE FOOTAGE OF USABLE FLOOR ARE
IN HOUSE (EXCLUDE GARAGE) );S St Pt.
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
SbN -Oqb&
DESCRIPTION OF MACHINERY EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION -r en C)N/e-
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUIONS_ALWEJI_ (CONDITIONS ATTACHED)
APPLIZANO SIGNATTJRE DATE
IF APPLICANT IS OTHER THAN_PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
"1-- - -
OWNER/AGENT SI�N�i�!'ZJRE DATE
IMPORTANT: FALSE OR MISJaEADING 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.
Buildi :and Safety Department
PPROVED DENIED CONDITIONS ATTACHE_
W411 -
•
i
1.
2.
cedy 4 4(Q Q94(a
ASaLOIC.
NO.
1994 BUSINESS LICENSE APPLICATION FORM
****************** ********
*APPROVED BY
* DATE
************** ****** ***
......PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
IS THIS BUSINESS LOCATED AT YOUR HOME: YES_ NO
Business Name:_ nk �'7111h►�
3. Business Address : 3 3 S.S tic-�_ io 4. Mailing Address:
�I�� r lift CY UA�r(` �.23
5. Business Phone:( )
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL "
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security
9. Name of Owner T -0,4y
,
f�-(e Title: A-.1/JHL
Or Officers
10. Type of Business : rL(,&flDd (001,0h-zJY
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:
$_i,oN)
B. Previous j'Yyeaarr Gross Receipts For Established Businesses:
$ C/
********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
iss to me a e in full force and effect.
-o,-Jl 8 XvG y
igna ure
Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
La Quinta, CA 92253
ate