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CITY OF LA OUINTA
HOME OCCUPATION PERMIT
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.
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(TYPE OR PRINT IN INK) p(,y
APPLI CANT' S NAME -DeBgR Arr'567 ArrV D L R� 1 ? P1ONE �IO / 39
PROPERTY OWNER Sa Ay` i PuB is PHO r
n
PROPERTY ADDRESS 1,A
TYPE OF RESIDENCE (single,, multiple, mobile home, etc.)
CA—
TYPE OF BUSINESSO:i--��0� 1j
BRIEF %DESCRIPTION OF JiOW'TH€ ��; BUSIKESS WILL OPERATE roo-ke- S W) QD�'ilad
78-106 Call* Estado
P.O. Box 1604
La Oulnta. CA 822!
(619)661-2248
J J°
NUMBER OF PERSONS IN'✓OLVED IN BUSINESS
LIST NAMES OF PERSONS FMtLOYED
I-)
SQUARE FOOTAGE OF USABLE FLOOR�1$bA INTyaP
HOUSE ( EXCLUDE GARAGE) .--,
LOCATION AND SQUARE FOOTAGE OF AREA'df JUL
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 SQUARE FEET")
. DESCRIPTION O MACH NERY, EQU P T, D SU PLIES B$IN SED I aTHH ,BUSINESS
OP RATION �� ``
t�
I HAVE READ yy�� UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION R ALLOWED (CONPT'AIO1fS ATTACHED). J
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 attached page
shall be grounds for revocation of permit.
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BUILD iG i SAFETY DEPAR NT
APPROVED BY DATE �CONDITIONS ATTACHED
DENIED BY DATE
I IIIIII IIII IIII IIII
07 _i
r
rBUS. PAC. NO.
�F .vim
4
OF TNS•
1991 BUSINESS LICENSE APPLICATION Fq@Q5i82 i0 4i90 09-03-91 i0
v CASH i TOTAL 1 18.00
PA I D SEP03 1991
*APPROVED INITIALS DATE
*DENIED INIfiIALS DATE
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YESNO
2. Business Name:
3. Business Address: ( 4. Mailing Address: . l�l
5. Business Phone:( AS p (9--3-91
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL S t^ (0
If. Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security #_,��
•9. Name. of OwneTitle:
Or Officers
10. Type of Business: '�:;.tj.e S
11. SBE Resale Number:
12. BUSINESS LOCATED WITHIN THE.CITY OF LA,QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts
00ov
$ ��� rood —
for New Businesses Only:
B. Previous Year Gross"Receipts For Established Businesses:
$
I HEREBY CERTIFY that all the information supplied by me is correct and
anyenses required by the County, State or Federal Government have been
i�su Alto„me an4/1a-�,p In full force and effect.• /
Signat
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
9/'3 0/�-