BROOKSU� HOME
CITY OF LA OUINTA
OCCUPATION PERMIT
78-105 Calls Estado
P,O.:Bon '1504
L;a lOutnti. CA 92253
(8asi)6.Q1=2248
APPLICATION
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 IN INK)�i.6�XSG (6kco S-(.1 lc a
APPLICANT'S NAME Oa`i"S PHONEC62)-s(O"zi
PROPERTY OWNER PHONE 't, hNyn`Tc
PROPERTY ADDRESS SS
TYPE OF RESIDENCE single, multiple, mobile home, etq.)
TYPE OF BUSINESS �SL®.QrL
BRIEF DESCRIPTION OF H W THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSIlNESS {�
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE
EF AREA IN
HOUSE GARAGE) \,-o VA`W"QUWA
LOCATION AND SQUARE FOOTAGE OF AREA OF FEB 2 2 1991
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 SQUARE FEET") \2_<Z
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPL EING USE N H B SINESS
OPERAbTI�N� � a
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
APPLICANT SI URE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
REQUIRED.
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 i SAFETY DEPARTM OT
APPROVED B S DATE 3- 5- 9 1 CONDITIONS ATTACHED _tljk
DENIED BY DATE
E