HABIRC _.. 39 II
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FEE $35.00
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, -La Quinta, CA 92253
- J
HOME OCCUPATION PERMIT
Read each condition listed on the attachment to this. form to see if
the proposed activity can comply with the" -City's Home Occupation
Regulations.
BUSINESS NAME A4_4 01 PHONE S7t �''l5 C7 7
PROPERTY OWNER t PHQNE f
PROPERTY ADDRESS Gt. o L
MAILING ADDRESS Six cn�—
TYPE OF RESIDENCE si multiple; mobil home, etc.)
TYPE OF BUSINESS Clo, V -c/ -c L) r'&,—
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED •$-
SQUARE FOOTAGE OF USABLE FLOOR A
IN HOUSE ( EXCLUDE GARAGE) l Y OO 5�'
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME 2 G
(EXAMPLE, "BEDROOM -125 S.F.") S/
DESCRIPTION OF MACHINERX, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION
I HAVE READ, DE STAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME 0 A LOWED CONDITIONS ATTACHED).
P NT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS 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
BuilZina and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
L I!
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RECEIPT City of La Ouinta, 78-495 Calle Tampico, P. 0. Box 1504 La Ouinta CA 92253
DATE 19 /G,' NO:. ,
RECEIVED FROM _ f '� '
ADDRESS
DOLLARS
���►L1LLi—/.��
AMT. OF
DUE
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.
BUSINESS NAME �611 PHONE j iy 7
PROPERTY OWNER _� +^-- PH
QNE
PROPERTY ADDRESS j1
MAILING ADDRESS w i
TYPE OF RESIDENCE si multiple, mobil home, etc.)
TYPE OF BUSINESS
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED -&-
SQUARE FOOTAGE OF USABLE FLOOR A A
• IN HOUSE (EXCLUDE' GARAGE) ( Yt OO
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
.(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY` , EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION ��vv
I HAVE READ, DE STAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME 0 A LOWED CONDITIONS ATTACHED).
P NT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS 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 Department
APPROVED DENIED CONDITIONS ATTACHED
�L
a
i
4 BUS..LIC. NO.
1994 BUSINESS LICENSE APPLICAT-I,ON`: FARM
Send Completed -Form To:
CITY OF LA QUINTA **********************
BUSINESS LICENSE DIVISION *APROVED BY
78-495 Calle Tampico * DATE
La Quinta, CA 92253 ************* ***** **
PROOF OF WORKERS COMPENSATION.INSURANCE IS REQUIRED
1. Business Name: �Zh h Fn
Ok--- A970VC G
2. Business Address: 9_- w ? L Cc
ZT
3. Mailing Address: �Z-- �� S' a6 �� �Z)
4. Business Phone:�<vCr- /90 %
5. Owned By: CORPORATION PARTNERSHIP I IVID
6. If Corporation or Partnersh1p: Tax I.D.#
7. If Individual Owner: Social Security # rS-� 3 3 — 9 p9 J
8 . Name of Owner or Officers and Title:
9. SBEResale Number:
10. Number of Decals Needed: 1
11. CONTRACTORS ONLY: COPY OF STATE CONTRACTORS LICENSE IS REQUIRED
A'. Type of Contractor: 6-1,.n t
B. Classification:
C. State License Number:
• CONTRACTORS - GENERAL $100.00 Perar or $50.00 SemA_--aMnUSILA
CONTRACTORS - SUB $ 50.00 Per ear or 5. Semi-annual