ALVARANOC11V OF LA OUINIA
HOME OCCUPATION PERMIT
APPLICATION
78-106 Call* E•
P.O. SOX 1604
to Ou(nt•, CA
(619)664-2246
Pead each cor.d3taon Jested on tt.e-•attachment to this form to see if the
prop
0 e activity can comply with the City's Home Occupation Regulations-
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(TYPE OR PRINT 1N INK)
APPLICANT'S HAIME .5Axt S ' i r J 14 1R A do PHONE �y y�O�0
PROPERTY OWNER �44 1�v S 1,142 4 C" PHONE 6 y- y6 / O
PROPERTY ADDRESS
TYPE OF RESIDENCE Isingle, multiple, mobile home, etc.)
TYPE OF BUSINESS '-r)?ee il�lA;�I�Pf-R*l hAzc✓A�%NA
BR F DESCRIPTION 0rOw /2
� THE BUSINESS WILL OPERATE PP
r,&"e kse 4f- /CPS lc%.•c e o "44
NUM.fER OF PERSONS INVOLVED IN BUS�INESS Z
LIST NAMES OF PERSONS EMPLOYED IIA C lex s'u do , -4 1201,A- A .` [' 41 CJv
rnw WO.W
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE) IV78 S. 0'-. YALIDATION STAMP
IACATION AND SQUARE FOOTAGE OF AREA OF JAN 31.992
BUSINESS ACTIVITY IN HOME (EXAMPLE,
-BEDROOM - 125 SQUARE FEET) BUILUWG AND SAFETY D
• DESCRIPTION �SMACHIN ERY, Po UeIPMEta. AND SUPPLIES NG VS N THE
WE
OPERATION h A•w . r
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS SY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED)-
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•
IF APPLICANT It OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OwDIER OR AGENT
REQUIRED.
OWNER/AGENT SIGNATURE DATE
IKPAR'kvT: False or misleading information shall be grounds for denying your
Nome Occupation; failure to comply with conditions listed on the attached page
shall be grounds for revocation of permit.
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APPROVED BY DATE CONDITIONS ATTACHED
DEN:ED BY DATE
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BUS. LIC. NO.
1992 BUSINESS LICENSE APPLICATION FORM �� t
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO
2. Business Name: G�AQ- TQ e c die
3. Business Address: 4. Mailing Address: /9 0.A)X G ��
5. Business Phone:( ..5-6
6. Owned By: CORPORATION (PARTNERSHIP INDIVIDUAL
7. •If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security #
9. Name of Owner 1 n r9 C14) Title:
Or Officers
10. Type of Business: `fie
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:
$ _ d( ci Uri
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 required by the County, State or Federal Government have been
issued to �/� me and are in full force and effect.
!C V C- ' % - - y z___
Signature Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253