HARDING1I
r 11111179
IIII IIIb
BUS. LIC. NO.
BUSINES' LICENSE APPLICATION FORM
*APPROVED BY
C� * DATE
......PROO OF WORKERS COMPENSATION INSURANCE IS REQUIRED.......
IS THIS BUSINESS LOCATED AT YOUR HOME: YES 11 NO
Business Name: j4XaLD/1i14, -S � 16lAJ AA)n
3. Business Address: _SV -a,30. A►/. jo�,LA(--0 4. Mailing Address:
C,4S2- Y`3
5. Business Phone : () S'( c
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8 . If Individual Owner: Social Security #y s p - // - p y
9. Name Of Owner �/�,Y1� /�/�/�//c,�� Title: V 04,�V't%
Or Officers
.10. Type of-. Business •
11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES_ 1111-14 NO
12. SBE Resale Number: A1//,L
13. 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 Established Businesses:,
i
********GOOD ONLY FOR JANUARY 1 1994 THRU DECEMBER 31,1994*******
I HEREBY CERTIFY that all the information supplied by me is. correct and
any licenses require County, State or Federal Government have been
sued to an rein fullby the force and effect.
:ure
Title
.4h;1✓
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE.DIVISION
Date
•
1
Is
T4hf 4 4a Ira
78-495 CALLE TAMPICO — LA QUINTA; CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
Every employer who applies for any license or a renewal of any
license for a business issued pursuant to Section 37101 of the
Government Code or Section 7284 of the Revenue and Taxation Code
shall complete and sign a declaration that states the following:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of -perjury, one of the following
declaration:.
I have and will maintain a certificate of consent to self -
insure for worker's compensation, as provided by Section 3700 for
the duration of any business activities conducted for which this
license is issued.
I have and will maintain worker's compensation insurance, as
required by Section 3700 for the duration of any business
activities conducted for which this license is issued.
My worker's compensation insurance carrier and policy number:
Carrier:
Policy Number:
A "COPY" OF THE POLICY SHOWING THE AMOUNT OF COVERAGE AND
EXPIRATION DATE FOR WORKMEN'S COMPENSATION IS REQUIRED.TO PROCESS
THIS APPLICATION.
L/' I certify that in the performance of any business activities
for which this license is,iss.ued I shall not employ any person in
any manner so as to become subject to the worker's compnsation
laws of California, and agree that if I should become su;ject to
the worker's compensation provisions gf,Section A700t / /
Date: �j } - �� (� �� Applicant:
WARNING: Failure to secure workma 's :compen'sdtion coV-exAge is
unlawful, and shall subject an employ to criminal penalties and
civic fines up to $100,000. In addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
Code, interest, and attorney's fees.
bus.fac
MAILING ADDRESS - P.O. BOX 1.504 - LA QUINTA, CALIFORNIA 92253 •
I-
C
FEE $35.00
I ,
TIUIV/ 41 4 aui4a,
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La
HOME OCCUPATION PERMIT
c,
Quint CA 922.
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 & JA) V--5 Ll lJl HONE -/ !► 3
PROPERTY OWNER 1 "( 5__F i2 PHONE
PROPERTY ADDRESS id Vi.LASc.�,
MAILING ADDRESS
TYPE OF RESIDENCE (single, multiple, mobil 'home, etc.) �;;,�•��
TYPE OF BUSINESS r�rj/y.1 �hif��✓
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE.. 778,4✓£ t ►'�
cosrvmf►z Nun�� �•N� �°�i��=cRvr1 M�N�fZ �u:•�>✓ � �/f�dl S .' '
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED /✓ 14
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE ( EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA i L•.I`
OF BUSINESS ACTIVITY IN HOME
( EXAMPLE , "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION -,5K'1L sif•y - LLv� L 5 L6<' £w �ji� Ib'! ��
IVE READ, DERS AND AND AGREE WITH THE CONDITIONS BY WHICH A
HO OCCUPATI IS �D ONDITIONS ATTACHED).
J _Iu -s' y
�APPLICA T;SIGNATURE DATE
IF XPPLICANT IS OTHER T]" PROPERTY -OWNER, AUTHORIZATION OF OWNER
AGENT IS 7QUI77 c l L/
/.2-I /-qt1
OWN / Ate_ S I GSE DATE
IM_PORTANT: 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 n and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
4 /f
, 'fig+•
..rl14-95 01; 56 PV FROM MASTERS BLDG, Chi,
aklasters Building Co--
'ro: Mr. Don Wtielchel
City or LaQ iinta
Re: 54230 Velasco
Deal- Mr. Whelche!
TO
6197777011
602
} 25870 Six Mile Roar!
Redford, Michigan 482,10
(313) 535-3333
ianuary 4, 1995
I am the owner of the above -captioned property in the city of
LaQuinta. Mr. Jim Harding is my tenant. it is with my permission
that he operate a handyman biistness out of my home.
If you have any questionts', please contact are at 313-535-3333.
Sincerely,
64—
,t ries P.-Elster
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01-04-95 01:56 I'M FROM MASTERS BLIN GO. TO 6197777011
,Alft
ASTERS BUILDING COMPANY
FAX COVER S)iLQT
16.A e
FAX #:
l t
COMPANY: � 1 '�'' ' � ?�} iJ in
INFO ENCLOSED:
a
r• �
FROM: % •�-� _
MASTERS BUIL[ IM" COMPA*JY
DATE:
NO. OF PACKS
PLVS COVER SHEET
PO1
25870 SIX MILE ROAD
REDFORD, MICHIGAN 48240
PHONE: (313) 535-3333