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FLOWERSYII"IIIIIIII'I'lII'i 78-105 Calle Estado �q P.O. Box 1504 La Quinta, CA 92253 CITY OF LA QUINTA (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 NAME ` /C-/ 1044 e,. > PHONE SLO 2/ z 7 PROPERTY OWNER 2-��J /J��,�/� 5 PHONE PROPERTY ADDRESS 3 7�� TYPE OF RESIDENCE (single, multiple, mobile home, etc.) Slyc Xe- TYPE ,c TYPE OF BUSINESS BRIEF DESCR ION OF H W THE BUSIN SS WI NUMBER OF PERSONS INVOLVED IN BUSINESS LIST NAMES OF PERSONS EMPLOYED ; SQUARE FOOTAGE OF USABLE FLOOR AREA IN 40HOUSE (EXCLUDE GARAGE) Z ?,00 5j-- LOCATION j=LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME EXAMPLE . "BEDROOM - 125 S.F.") O PAID $35.00 VALTDAMMITYSTAMP . MAR 2.1992 BUILDING AND SAFETY DEPT. DESCRIPTION OF MACHINIRY, EQUIPMENT, AND�UPIPLIES BEING.USED.IN THE BUSINESS OPERATION AFiyS &Ie,, I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME OCCUPATION IS ALLOWED (CONDITIONS ATTACHED). Z_ APPLICANT SIGNATURE 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 • attachedpageshall -be-grounds -for -revocation_of -permit- - - ------------------ Bull/,ngand Safety Department c� APPROVED BY DATE_ J _ CONDITIONS ATTACHED DENIED BY DATE • �W BUS. LIC. N0. 1992 BUSINESS LICENSE APPLICATION FORM ......PROOF OF WORK COMPENSATION INSURANCE IS REQUIRED........ *APPROVED '~ INITIALS DATE' off. *DENIED INITIALS DATE ****************************************************************** 1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO 2. Business Name: ��,•� �/ / S S 3. Business Address: 4. Mailing Address: 5. Business Phone:( —�/ 9f Z % 6. Owned By: CORPORATION PARTNERSHIP I ID 7. If Corporation or Partnership: Tax I.D.# 8. If Individual Owner: Social Security # L� Ivl'// g, • 9. Name of Owner Yi•[/aC/OGvr� Title:_©div ��-- 7 Or Officers 10. Type .of Business: 1/_�,� /i3O 47 ¢Lr021e-5- 11. -S 11. SBE,Resale Number: 12. BUSINESS .LOCATED -WITHIN THE CITY .,Of �LA QUINTA (Does•.Not Apply To Contractors)Building .j . ;a A. Estimated Gross Business Receipts for,New Businesses Only: B. Previous Year Gross Receipts For.Establish9d 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 required by the County, State or.Federal Government have been issued te• me and.are in -full force and effect. • Sig ature Title ate Submit Form To: CITY OF LA QUINTA BUSINESS LICENSE DIVISION P.O. Box 1504 La Quinta, CA 92253 • I certify what in the performance of work for which this City of La Quinta business license is issued I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California. Note: If after signing the certificate, you hire any employee, you become subject to the workers' compensation provisions of the California Labor Code, and you. must -immediately comply with the provisions of Section 3700 or your license immediately becomes revoked. 11 Business Name: Business License Applicant: (.Iyrn Z/ A1fy C Date: - s�, Z-3: /9 tl 1 V