Clausen & Mihajson•
C,
I��I�I 1111111111111
CITY OF LA QUINT
18-105 Celle Es/ed•
P.O. sox 1504
L• Qu1nro,CA. 92253
,(OW $64-11,66
564-2246 PLANNING DIVISION c:�� 6/67
ead each condition listed on the reverside aid eo this form to see f
the proposed activity can comply with the City's Home Occupation
Regulations. $35.00 fee
27C5250 7— G- AIDS
TYPE OR PRINT IN INK
E Cl -.14
APPLICANT'S NAME
PHONE -66- 'S-71
PROPERTY OWNER
PHONE
PROPERTY ADDRESS
`�i�IStreet��
(City)
(State)
(Zip)
Type of residence(Single,
!Multiple,
mobile home,
etc.)
Type of business
Dkief description of,how Phe business will operate
n2 S
Number of persons involved in business
List names of persons employed
Square footage of usable floor rea in
house (exclude garage) �TiO cSij�
Location and square footage of area of
5 16 business activity in home (example:
1 bedr ; 125 square feet)
Validation Stamp
005182 10 1927 09-15--88 0
3.0 CASH i TOTAL 1 35.00
Description of machin , equipment, and supplies being used in the
•busine� ration
I have rea an� nders nd and agr ith the conditions by which a
home,pccqpation is (lowed (Conditions on reverse side).
APPLICANT SIGNATURE DD TE
If Applicant 1s other thanro
p party owner, authorisation of owner or agent
required. f
OWNER OR AGENT SIGNATURE DATE
IMPORTANT: False or misleading information shall be grounds for denying
your Home Occupation, or failure to comply with conditions listed on
reverse shall be grounds for revocation of permit.
1 f • • f • • f R f • f
•APPROVED Initials /S'- Date
CONDITIONS A77A
DENIED initials Date
LQHOMOCC.PRT