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BUS. LIC. NO.
1992 BUSINESS LICENSE APPLICATION FORM��'�"`�' v G
************* ** ************************* ********* * **********
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*APPROVED INITIALS DATE Z—/e-.9�
*DENIED INITIALS DATE
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO
2.
Business
Name:flv��C�"�S
3.
Business
Address :
S,+ -4c5
V A �a 4 . Mailing'�'68is ,Tlh 1,1 15.00 ' 4
t_ p. \ LA .
5. Business Phone':(
6. Owned By: CORPORATION
PARTNERSHIP , INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8.
09.
If Individual Owner: Social Security #
Sr.z} - 3S - 8.1 rI
Name of Owner E�—I--ISE-0 G. �l_l�A ,J�- Title:
Or Officers .
10. Type of Business: (Z- P,L-
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:
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
issued to me and are in full force and effect.
mil
Signature
Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box.1504
La Quinta, CA 92253
' Date
16
•
l O— 1 V J t.41 iC L.�cau V
=� (� P.O. Box 1504
La Quinta, CA 92253
/ CITY OF LA QUINTA (619) 564-2246
Of n ��` 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 Home Occupation Regulations.
Ok7EW rl,4 5 AAA 11
APPLICANT'S NAME IXC ISEO C , Q L! V4 .Tie. PHONE 5_6
PROPERTY OWNER 6S A Hc) PHONE 0 4ME)
PROPERTY ADDRESS 54- 110S_ AVE7 I W VAL-L EJO 1
TYPE OF RESIDENCE single -multiple, mobile home, etc.)
TYPE OF BUSINESS 5e 1 1AJ 6- A Pko ptIC7- %d AQ 57 -& It WTS
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE _rAeQAJ &- OPbZ"
NUMBER OF PERSONS INVOLVED IN BUSINESS a —, fU.S3l A)P £ ��
LIST NAMES OF PERSONS EMPLOYED E,4/567D -/ OeT�Ti r4 D CI ✓ 19-
SQUARE
4
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.")
VALI AI UMSTAMP
CITY OF U QUINTA
JUN 12 1992
BUILDING AND SAFETY DEPT.
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIESBYB=r_ USED TN THF.
BUSINESS OPERATION P /y (Amp U TeV12—
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATICA IS ALLOWED (CONDITIONS ATTACHED).
(- 12, 2
APPLICANT SIGNATURE DATE
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 SafetyDep�a.,rrttment
�
�� APPROVED BY LJ2DATE 2 CONDITIONS ATTACHED
DENIED- BY DATE