GOUTHER• /'/��,�/� ' t t�lltl fl'I� IIII t'��
BUS. LIC. NO
t- 1992 BUSINESS LICENSE APPLICATION FORM
C. ` �v`��7 Send Completed Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
*La Quinta, CA 92253
1. Business Name:
1
2. Business Address:
3. Mailing Address:- /� a , 6X - �G
-✓iG'
4. Business Phone: ( �c/moi' ) to �/^3 S �D
5. Owned By: CORPORATIONS PARTNERSHIP INDIVIDUAL
6. If Corporation or Partnership: Tax I.D.#
*7. If Individual Owner: Social Security #
8. Name of Owner or Officers and Title:
9. SBE Resale Number:
10. Number of Decals Needed: 2 00518) io 9973 05-21-92
i0 CASH i TOTAL 1. 100,00
11. CONTRACTORS ONLY:
A. Type of Contractor : n c r-�,
B. Classification: /3
C. State License Number:
CONTRACTORS - GENERAL 100.0'0er Year or $50.00 Semi-annual
CONTRACTORS - SUB $ 50.00 Per Year or $25.00 Semi-annual
i
CONTRACTORS ARE ON A CALENDAR YEAR BASIS ONLY; ANNUAL FROM JANUARY 1ST
THROUGH DECEMBER 31ST. SEMI-ANNUAL FROM JANUARY IST THROUGH JUNE 30TH; OR
JULY 1st THROUGH DECEMBER 31ST.
HEREBY CERTIFY t at al he infor tion supplied by me is correct and .
enses re red b State or Federal Government have been
ssue ConrA a re nn f fy
effect.
c?. -e 5W2--
Sigiia/ttire Title r/ Date
R
CITY O1= LA QUINTAr
005182 10 9972 05-21-92 i0
MISC• 1 35.00
0013400034050
10 CASH i TOTAL 1 35.00
i AMOUNT TENDERED 35.00
CHANGE .00
THANK YOU
4%
CITY OF LA OUINTA
I
005182 10 9973 05-21-92 i0
'US. LIC. 2463 1 i0O.00
iO CASH i TOTAL i 100.00
i AMOUNT TENDERED 100.00
CHANGE .00
THANK YOU
•
•
•
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
>- (619) 564-2246
CITY OF LA QUINTA
f M of TMw`. 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 H me Occupation Regulations.
--------------------------------------------- ------ --------------------
}.
APPLICANT'' S NAME '. e����� �' �-� YL5( PHONE 5 -/ :3S�y
PROPERTY OWNERPHONE
PROPERTY ADDRESS 5-3 -70-S'
o f o
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS C��i► C_�/� /L ��� /�'
BRI�EfF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
droll
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA IN PAID $35.00
HOUSE ( EXCLUDE GARAGE) / 6 4�fo
OLOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.") 4,�o Se ir-r
VALIDATION_ STAMP
MAY 2 Q 1992
BUILDING AND SAFETY&Yt
BUSINESSZOPERATIONHZDESCRIPTON OF NE`��E4UZ j.g� ,•...� ING,PMENT, AND U �ES �JSED INoINo THE
I HAVE READ, UND R TAND, GREE WITH THE CONDITIONS BY WHICH A5 HOME ip
C ION I AL ED (CO ITI N TTACHED) . 0 H8' L'G S2TRTAti ' 35 a 00
L CANT SIGNA UR DACE
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.
---------------
0- .
Buildinq and Safety Departxpent
APPROVED BY CV DATE/r& 11 JF
S ��
DENIED BY DATE
CONDITIONS ATTACHED