GIBSONX/
35.00 Jill, III, III,
FEE
$ 68
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT
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.
BUSINESS NAME. Gibson Pool & Spa PHONE ( 619) 564(1511
PROPERTY OWNER -Brian A. Gibson PHONE (61A) 564-f15A1
PROPERTY ADDRESS. .414'025 Aupnirla VPlgczcn
MAILING ADDRESS
TYPE OF RESIDENCE (sin�le�_ multiple, mobil home, etc.) Sial,
TYPE OF BUSINESS Pool & S„a rrofeGGinnal care
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
FTnmp 11RP mailanrl�h�y}® VPhicic to sprvice ;Ae� Cera
NUMBER OF PERSONS INVOLVED IN BUSINESS My self nn1jz
LIST NAME OF PERSONS EMPLOYED xxxxxxxxxxxx
SQUARE FOOTAGE OF USABLE FLOOR AREA
• IN HOUSE (EXCLUDE GARAGE) .120 SF apx. 64sf. used for Business
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.") 64 s.f. used in home
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION Pnnl Cham chinrino oct... np 11c,RRTTC7�Fc unc�c
NETS and other like pool care Equipment_
I HAVE READ, UNND;RSTAND, AND AGREE WITH THE CONDITIONS BY WHICH.A
HOMF,,j0)ffCUP.ATI S ALLOWED (CONDITIONS ATTACHED).
Brian Gibsnn 1-9-c
LICANT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS 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
Build-InBuild-Ina and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
s�
VOW
4
BUS. LIC. NO.
1995 BUSINESS LICENSE APPLICATION FORM
*APPROVED BY*
* DATE f —I f l -a
****************************
PROOF OF WORKERS COMPENSATION INSURANCE IS REOtUIIED PRIOR TO ISS ANCE
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES XXXXX NO
2. Business Name: Gibson Pool and Spa
3. Business Address:54025 Avenida Velasco 4. Mailing Address: same
T.a nuinta Ca- 92291 same
5. Business Phone:. ( 619 ) 564-0591
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: TAX I.D.#
8. If Individual Owner: Social Security #125 52, 9.-I55
9. Name of Owner Brian Gibson
Title: Owner.
Or Officers
00. Type of Business: P
Spa nrn Pcgin+,nT rarer
11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO
12. SBEResale Number:
13. BUSINESS LOCATED WITHIN THE CITY OF --LA QUINTA (Does Not Apply To g
Contractors): • .
A. Estimated Gross Business Recei is fQ--new Business` 21�yy:$ 25,000 ;995
B. Previous Year Gross Receipts for Established Busines es: --�
***********GOOD ONLY FOR JANUARY 1, 1995 THRU DECEMBER 31, 1995** *******
I HEREBY CERTIFY that all the information supplied by me is corr.ct and any
licenses required by the County, State or Federal Government have been issued
to me apo are i4,1-41,Vforce and effect.
ignature
e
Send Completed Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
P. 0. Box 1504
La Quinta, CA 92253
to