BRODTW
•
CITY OF LA GUINTA
HOME OCCUPATION PERMIT
APPLICATION
78-106 Calla Ealed
P.O. Box 1604
La Oulnla, CA 922
(819)664-2216
Read each condition listed on tte attachment to this form to see if the
proposed activity can comply with the City's Home Occupation Regulations.
(TYPE OR PRINT 1N INK) 13 n
APPLI CANT'S NAME \'y LArQ (L \u \ PHONEc� 10 �V
OPERTY OWNERa/G PHONE ��S%/O
PROPERTY ADDRESS- l— V I%-
TYPE OF RESIDENCE ( single, multiple, mobile home, etc.) (t�%� r, e.
TYPE OF BUSINESS 'P �� T R \ I T
L l
B IEF DESCRIPTION OF HOW T)iE BUSINESS MILL OPERATE ���'�i �ACJ1n,e S2J'V�L25
2�Si G1t, c tts ` C� i�cS f� tOrJ ..e w.er\r-r,.
NUMPER OF PERSONS INVOLVED IN BUSINESS A T
LIST NAMES OF PERSONS EMPLOYED �—�� R—
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE) VAL�TIQji 6ST�
LOCATION AND SQUARE FOOTAGE...OF AREA OF
SE
11 v
BUSINESS ACTIVITY IN HOME (EXAMPLE,.
"BEDROOM - 125 SQUARE FEET") BUILDING AND SAFE •
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION C�3 .tel �ui�c9 5 d7;b Wi`ntfi e✓CiajT)
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED). I I
IF APPLICANT IIS OTHER THAN PROPERTY OWNER, A/UTH'ORIZATION OF OWNER OR AGENT
REQU}RED
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.
BUILDING i SAFETY DEPARTMENT
X_ APPROVED BY �_ DATE I� I CONDITIONS ATTACHED •.•
DENIED BY DATE
6
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• I !�
u"-14 . 6(4� BUS. LIC. NO.
o0 70;/
1992 BUSINESS LICENSE APPLICATION FORM
......PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
*APPROVED INITIALS G DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES �/' NO
2. Business Name: '\i k t�nj �rol)"( acYy��� s
3. Business Address: s� ��Syt11e�4s� Mailing Address:-
5.
ddress:5. Business Phone:( o;Zb
6. Owned By: CORPORATION PARTNERSHIP DIVIDUAL
7. If Corporation or Partnership: Tax I.D.# tit-
8.
it--
8. If Individual Owner: Social Security #
•9. Name of Owner 'y �-�� f 0 DT Title:
Or Officers
10. Type of Business:,
11. SBE Resale Number:
12. 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:
A
$ = 00 b
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******
I HEREBY CERTIFY that all the information supplied by me is correct and
any licenses required by the County, State or Federal Government have been
issued to me ar in full force and effect.
Signature Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
0 -
0
NON -EMPLOYER CERTIFICATE
I certify what in the performance of work for which this City of La
Quinta business license is issued I shall not employ any person in
any manner so as to become subject to the workers' compensation
laws of California.
Note: If after signing the certificate, you hire any employee, you
become subject- to the workers' compensation provisions of the
California Labor Code, and you must immediately comply with the
provisions of Section 3700 or your license immediately becomes
revoked.
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Business Name. � ` o� �V'dOT
Business License Applicant: Ul,+o✓
Date: