ROWECA
M OF TNS
CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
Read each condition listed on the
proposed activity can comply with
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---------------------------------
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
14
attachment to this form to see if the
the City's Home Occupation Regulations.
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C�q>
APPLICANT'S NAME �KalJ�l_ .purr PHONE St. • Z�`i �_
1,19
PROPERTY OWNER u� �. ZZo fie--- PHONE S(A -DJo9 :7
PROPERTY ADDRESS Sj- 195yek� 5c.a L - k:�2.
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) SiNGLZ
TYPE OF BUSINESS
BRIEF DESCRIPTION
OF HOW
THE BUSINESS
WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESSQo1i
LIST NAMES OF PERSONS EMPLOYED pq
SQUARE FOOTAGE OF USABLE FLOOR AREA IN CRYOFLAOUWTA
OUSE ( EXCLUDE GARAGE) "ac7 VALIDA<TZO? - STAMP .
�F tt ti 41992
*CATION AND SQUARE FOOTAGE OF AREA OF BUILDHVG MD $q�En, D
BUSINESS ACTIVITY IN HOME (EXAMPLE,.
"BEDROOM - 125 S.F.") 2S BY
DESCRIPTION OF MACHINERY, EQUIP T, AND SUPPLIES BEING USED•IN TL
BUSINESS OPERATION ;>4Ve_ cAr�- lele._� s (:P Q
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITION,%o�Y8.��C98�pg*M ,-g-,
1
000
OCCUPA�ON IS ALLOWE�CONDITIONS ATTACHED) . 10 CASH i T SAL 1 35.
i
_— V
APPLICANT SIGN
ra
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.
Bui� and Safety Department
APPROVED BY DATE CONDITIONS ATTACHED
DENIED BY DATE
• 1
�. BUS. LIC. NO.
1992 BUSINESS LICENSE APPLICATION FORM
......PROOF OF W RKERS COMPENSATION INSURANCE IS REQUIRED ... ...
*APPROVED INITIALS DATE (,
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME:
2. Business Name:
lee -100\ s
YES_ NO
3.
Business
Address: S4- k95
ye�cSCO 4. Mailing
Address:
SAvti�
5.
Business
Phone:
6.
Owned By:
CORPORATION
PARTNERSHIP
INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # 9 0 �
Name of Owner ���.` ,�0� {� Title: C)
Or Officers C -
10. Type of Business: �pc�` I
11. SBE Resale Number:
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors) : 005182 10 7888 02-24-92 i0
i0 CASH i TOTAL i i8.00
A. Estimated Gross Business Receipts for New Businesses Only
B. Previous Year Gross Receipts For Established Businesse 0
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*** ***
I HEREBY CERTIFY that all the information supplied by me is correct and
any/,"nses required by the County, State or Federal Government have been
issued o me and are in full force and effect.
6.'10-, - y c
Signature
Title-
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
Date