DUNCAN•
412oCITY OF LA OUINTA
HOME OCCUPATION PERMIT
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.
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(TYPE OR PRINT IN INK)
78-106 Calle Estado
P.O. Box 1604
La Oulnta. CA 92263
(6/9)664-22411
APPLICANT'S NAME ` 904 aWa_4
PROPERTY OWNER .��J L/5an �',� z4M_ /1
PROPERTY ADDRESS ��y ,// !�i[' /�
,9_C�Q
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS
BRIEF DESCRIPTION OF HOW THE B SINESS WILL OPERATE
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 HOME (EXAMPLE,
"BEDROOM - 125 SQUARE FEET")
DESCRIPTION OF MACHIN,:RY, Eqj IPMENT, AND
• OPERATION '��(�f9/� I9r IY1ZC'C'1
PHONE 1�61,T 64-5020
PHONE
•
• AMP
APR •
1991
Ir
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
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.
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BUILDING i SAFETY DEPARTM N
APPROVED BY A JVW 54 , DATE 7 CONDITIONS ATTACHED ,
DENIED BY DATE
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