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• FEE $35.00
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CITY OF LA QUINTA \
Calle Tampico, P. O.Box 1504, La Quinta; �A 9y2'253----
HOME OCCUPATION PERMIT
Read each condition listed on the attachment to this fo --see ifs
the proposed activity can comply with the City's Ho m cupation'
Regulations. �,
BUSINESS NAME L PHONE
PROPERTY OWNER s PHONE
PROPERTY ADDRESS SY79Sys-i4i a ku jo
MAILING ADDRESS S
TYPE OF RESIDENCE ngl multiple, mobi home, etc.)
TYPE OF BUSINESS
BRIEF d PESCRIPTION OF HOW THE BUSINESS WILL OPERATE
— -
NUMB OF PERSONS INVOLVED IN BU INESS
LIST NAME OF PERSONS EMPLOYED a.g�xi'a A] K, 0. w a -
SQUARE FOOTAGE OF USABLE FLOOR AREA
• IN HOUSE ( EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME t i v� a10`�e ar l 1
(EXAMPLE, "BEDROOM -125 S.F.") lie a wm4% W1 - 4, be °,0KN
i n k /LQfds-e—
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCG ON IS ALLOWED (CONDITIONS ATTACHED).
APPLICANT SIGMA DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
Sa4M �
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.
• Buil n and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
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DEPARTMENT OF
ce,
STATE OF CALIFORNIA
NOTICE
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All
INQUIRIES MAY BEWCTED TO:
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LICENSEE SHALL NOTIF�r" THE
BOARD/BUREAU OFANY C,HAN-
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GES AFFECTING THE STATUS
OF THIS DOCUMENT. INCLUDE
ra,:�°y`:< ,• ., -
LICENSE NUMBER ON ALL
CORRESPONDENCE.
Vii* 8„1 `,? A
RECEIPT
VALIDUNT/L:1? 6/3X3! 97
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Audit No.: 333630
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SIGNATURE:
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Receipt No.: 1711 n ^
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CA x 2253
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I X3 5 1_':YFJ AT '=2 ,T,l�f': Y I?c: S1:�T1Lsv
License No. 7—F01'1598
Post in Public View
41
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