BARRERAl Illlll lilll Illi I'll
03
. 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.
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APPLICANT' S NAME Rvrl-v ' ` UG. /rereG , PHONE 5'kV-vl'.3 /F
PROPERTY OWNER
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
n .i
TYPE OF BUSINESS
BRIEF``/A ESCRIPTI OF �iOW THE�USINEJSS WILL OPERATE 6115e' o
Cl//S A A �/ /YL,-iyr.9a (r /I/K2- Sii rPt
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE)
• LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOM (FCAMPLE,
"BEDROOM - 125 S.F.") ,
DESCRIPTION OF MACHINARY,
BUSINESS OPERATION /u,
AND SUPPLIF.
AG�i` a
rRy�ASTAMP� P-.-
APR 151992
DING
E
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
DATE
IF APPLICANT I'S 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.
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• B ing and Safety DepartVent
APPROVED BY ff DATE CONDITIONS ATTACHED
DENIED BY DATE
P
PAID APR O 6 1992
4 4agba
BUS. LIC. NO
1992 BUSINESS LICENSE APPLICATION FORM 7
1. Business Name:
2.
3.
Business Address:
Mailing Address:
Send Completed Form To: (�
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION `r\�
P.O. Box 1504
'La Quinta, CA 92253 �I
2 2 S --3'-
4.
s
4. Business Phone:
5. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
6. If Corporation or Partnership: Tax I.D.# _ b
7. If Individual Owner: Social Security #
08. Name of Owner or Officers and Title:
9. SBE Resale Number:
10. Number of Decals Needed: oo ic, , F SEI" n T�()Tf� 6- i ` 50. 0
11. CONTRACTORS ONLY:
A. Type of Contractor:
B. Classification:
C. State License Number:
CONTRACTORS - GENERAL $100 0'd P X Year or $50.00 Semi-annual
CONTRACTORS - SUB $-5U-.-90 Per Ye or $25.00 Semi-annual
CONTRACTORS ARE ON A CALENDAR YEAR BASIS ONLY; ANNUAL FROM JANUARY 1ST
THROUGH DECEMBER.3IST. SEMI-ANNUAL FROM JANUARY 1ST THROUGH JUNE 30TH; OR
JULY 1st THROUGH DECEMBER 31ST,
I HEREBY CERTIFY that all the information supplied by me is correct and .
ny licenses required by the County, State or Federal Government have been
issued to me a
7 are in full force and effect.
Ax� 6(_� 6ez1___7_z . 4�'— a — '5;� '�')
Signature VTitle L Date