LUBBEN�Lc��,,J� r I I�IIII IIT IIII IIII 78-105 Calle Estado
12 P.O. Box 1504
La Quinta, CA 92253
CITY OF LA QUINTA (619) 564-2246
`yoFTt+�°� HOME OCCUPATION APPLICATION
•
Read each condition listed on the attachment to this form to see if the ��2
proposed activity can comply with the City's Home Occupation Regulations,/
APPLICANT'S NAME tcs�/�t{C (`� 1 c y �' C -_,J PHONE
PROPERTY OWNER7�L C PHONE
PROPERTY ADDRESS _�L
TYPE OF RESIDENCE single multiple, mobile home, etc.)
TYPE OF BUSINESS
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE (r)p FSS
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED .— — I= an weIV
SQUARE FOOTAGE OF USABLE FLOOR AREA IN PAID L35
-00
HOUSE ( EXCLUDE GARAGE) 41 'L, ca r MMMOM 1- STAMP
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LOCATION AND SQUARE FOOTAGE OF AREA OF DEC 3 11991
BUSINESS ACTIVITY IN HOME (EXAMPLE, >
"BEDROOM - 125 S.F.") �(J, �
BY
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPA �/I ALLOWED (CONDITIONS ATTACHED).
• 605182 its 6336 12--31.-91
114. TOT OL 1 ;3 3.00
APP ICANT 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.
Building and Safety Department
4— APPROVED BY DATE I CONDITIONS ATTACHED
DENIED BY DATE
•
0
BUS—LIC. NO.
.1991 BUSINESS LICENSE APPLICATION FORM
*APPROVED INITIALS DATE
*DENIED "-3� INITIALS DATE
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES
2. Business Name: � � � �G� F7- 1� I STR1U -t-0 ri-- S'
3 . Business Address:_S-4;/ , S"4;/ (off Sr 4. Mailing Address: li_-
25�
5. Business Phone:(
6. Owned By: CORPORATION PARTNERSHIP VIDUA
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # U
9. Name of Owner (�,�� U 15 t� Title: Co
Or Officers
10. Type of Business: j,%/ JL L, 27'G (c= C
11. SBE Resale Number: S
12. BUSINESS'LOCATED WITHIN THE CITY OF.LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$ 67r
B. Previous Year Gross Receipts For Established Businesses:
********GOOA ONLY FOR JANUARY 1,1991 THRU DECEMBER 31,1991*******
I HEREBY CERTIFY that all the information supplied by me is correct and
any lic stslquired by the County, State or Federal Government have been
issue e d are in full force and effect..
ure Title
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
Dat