WHITNEYy�.
CITY OF. LA OUINTA
NOME OCCUPATION PERMIT
APPLICATION
7e-106 Celle Eels
P.O. Box 1601
Le Quints. CA 92
(610)661-2216
Read 'each condition listed on tte attachment to this form to see if the
proposed activity can comply with the City's Home Occupation Regulations.
(TYPE OR PRINT IN INK)
APPLICANT'S NAME f2 Z l C.
— / PHONE._ /,
PROPERTY OWNER 1, PHONE
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS yIl'%�I/�G ' /
BRIEF DESCRI ION OF OW THE BUSINESS WILL OPERATE %i/i>�/� ��i���
�F<
NUMI:ER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED Z- -�
SQUARE FOOTAGE OF USABLE FLOOR ,AR A IN ®
HOUSE (EXCLUDE GARAGE) ��_2_ N STAMP' 1'
LOCATION AND SQUARE FOOTAGE OF AREA OF QrrYQFIAQUINTA
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM --125 SQUARE FEET") SEP 12 1991
DESCRIPTION OF MIAC INER�t , • LQUIPMEI. , AND SII I D HE BUSINESS
OPERATION �/Y/✓1J i-/.�1'�- BY
---------------
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS PL15WED (CONDI NS ACHED).
APPLICANT SIGNATURE jJ 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.
BU ING i SAFETY DEPARTME
APPROVED BY 117 f DATE g1L1 CONDITIONS AftACHED '.
DENTED BY DATE
1991 BUSINESS LICENSE APPLICATION FORM
[11 1199i
BUS. YrI C . NO.
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mak,
*APPROVED INITIALS DATE
*llENIED INITIALS DATE
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lV/
I. IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO
2. Business Name:
3. BusinessAddress:_";-2-� ;s U, 4. Mailing Address:
L
5. Business Phone:( 61Z )
6. Owned By: CORPORATION PARTNERSHIPNDIVIDUAL
If Corporation or Partnership: Tax I.D.#
8. 'If Individual Owner: Social Security #
.9. Name of Owner (2q2L Zt�-Wi 'j tiF— c-- Title: �lIJRJ�'—
or Officers
10. Type of . Business
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 Establisheq0bu
s�s8pL09i20-9158.00 10
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
issu_p- to pre and arm i,full force and effect.-
• Signature Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253