KIEDROWSKIG
05
CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
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 PO.IV A L D 1. PHONE
PROPERTY OWNER S' ffl" E PHONE
PROPERTY ADDRESS 7 S SS A V, o� r/M O, 6. o Ce U /1via., to•
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) S 1 N G L E
TYPE OF BUSINESS
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE (-,t
6 r-Flr6
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED v
CR1'
SQUARE FOOTAGE OF USABLE FLOOR AREA IN OFiA4i IXT
• HOUSE (EXCLUDE GARAGE) /f D O VAL ION -STAMP
- . 1992
LOCATION AND SQUARE FOOTAGE OF AREA OF ®BUUIN(; 199
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.") l ;L U
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE .
BUSINESS OPERATION X10 A10
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
PLICANT 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
attached page shall be grounds for revocation of permit.
Building and Safety De artmentY n
APPROVED BDATE /"� CONDITIONS ATTACHED
DENIED BY DATE
1.
C&&f 4 4 Q"..
BUS. LIC. NO.
1992 BUSINESS LICENSE APPLICATION FORM
- A V14 - Inn l
..PROOF OF W9.RKERS COMPENSATION INSURANCE IS REQUIRED........
************** ******************** ******************* *********
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO
10'c6
2. Business Name: // U %V/C <57 g�y �
3. Business Address: ��55��,G� 11 (J l -T O
4 Mailing Address: %9s'ss 14
rl c11 -;11M0
L Cy11WTFI, Gf� q2z 5'3 �A 62v S.3
5. Business Phone:( Z-
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.# F7
8. If Individual Owner: Social Security # J"a 2 `- 4{4-/ q''/S-"
•9. Name of Owner 1r'/eP 2cacvS/c-j Title:
Or Officers
10. Type .of Business: n Fj� 5y /vAl p c--
11.
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:
$Oo 0
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
issue to me and are in Aull force and effect.
Signature" Title " `Dat
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
BUSINESS LOCATED IN THE CITY OF LA QUINTA ONLY
GROSS RECEIPTS
RANGE
CLASS 1
CLASS 2
CLASS 3
0
- 25,000
$ 15.00
$ 18.00
$ 21.00
25,001
- 50,000
25.00
30.00
36.00
50;001
- 100,000
30.00
36:00
43.00
100,001
- 250,000
46.0,0
55.00
66.00
250,001
- 500,000
76.00
90.00
108.00
500,001
- 750,000
114.00
135.00
162.00
750,001
- 1,000;Q00
150.00
180.00
216.00
1,000,001
- 2,000,000:
400.00
500.00
600.00
2,000,001
- 3,000,000
500.00
625.00
750.00
3,000,001
- 4,000,000
600.00
750.00
900.00
4,000,001
- 5,000,000
700.00
875.00
1,050.00
5,000,001
- 10,000,000
1,000.00
1,250.00
1,500.00
10,000,001
- and up.
1;500.00
1,875.00
2,250.00
CLASS 1 Automobile Repair and Services; Laundry, Dry Cleaning &
Garment Services; Manufacturing; petail &,Wholesale
Trade.
CLASS 2 Amusement & Recreation Services, including Motion
Pictures; Architectural Services; Automotive Sales;
Barbers & Hairstylists; Beauty Shops; Engineering
Services; Landscape & Horticultural Services; Operators
Renters,& Lessors of Commercial Property; Services to
Buildings; and all other persons engaged in business
not specifically listed elsewhere.
CLASS 3 Accounting, Auditing & Bookkeeping Services; Financial
Services; Insurance Brokers & Services; Legal Services;
Management & Public Relations Services; Medical &
Health Services; Real Estate Agents, Brokers, Managers
& Services.
V
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LJ
I
NON -EMPLOYER CERTIFICATE
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.
s
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.
Business Name:
Business License Applicant:
Date:
a
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