PELESS13 �TY OF LAQtANT
HOME OCCUPATION PERMIT
APPLICATION
70-05 Cells ists#s
P.O. SOX 1504
Ls QulnN,CA. 92203
,($)4) 564-1846
664-2246 PLANNING DIVISION)X60 6/67
Read each condition listed on the reverside side of this form to see 17
the proposed activity can comply with the City's Nome Occupation
Regulations. $35.00 fee
E OR PRINT IN INK
APPLICANT'S NAME 119 -Md -S P's �F_i"s' PHONE SGS /e-3?
PROPERTY OWNER.? flY•� �� E/mss' PHONE re� y- Ar, 3
PROPERTY ADDRESS r,? - 3ks� 28P -r=20-/
(Street)
Gdi - C►�ii. �.fA r` 9z2 -r3
(City) (State) (tip)
Type of residence (Single, Multiple, mobile home, etc.)
Type of business C/aAPA77—
Brief description of how the business will operate 1?vr1,4.114ss
Number of persons involved in business
-List names of persons employed AIOAI
__Square footage of usable floor area in -
house (exclude garage) AJf00 Validation Stamp
Location and square footage of area of pp5f82 0 i 264 U18-88 i0
business activity in home (example: 10 CAH TOTAL 1 35.00
bedrooms; 125 square feet)
el' s9
Description of machinery, equipment, and supplies being used in the
business operation F KT�.�{to.z 7 �/�'�'«��'►
I have read and understand and agree with the conditions by which a
home *cc ation is allowed (Conditions on reverse side).
/L
APDL ANT SIGNATURE DATE
If Applicant ins other than property owner, authorization of owner or agent
required.
OWNER OR 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.
• ff • f f f R f
� APPROVED �y� '� Initials
CONDITIONS ATTACHED
DENIED ..'Initials
LQHOMOCC.PRT
Date
Date