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78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 - (619) 777-7050
FAX (619) 777-7011
APPLICATION FOR
Fee $35.00 HOME OCCUPATION OF A BUSINESS
Read each condition listed on the attachment to this form to see if the proposed activity
complies with the City's Home Occupation Regulations.
APPLICANT ',TAMES ( fit aiII owners, partngrs and/or corporation officers)
PROPERTY ADDRESS Q�V� CK,V Imo, PHONE -7 6�
BUSINESS NAME
PROPERTY OWNER
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IN
• MAILING ADDRESS (if different from business address)
TYPE OF RESIDENCE (single, multiple, mobile home, t5j JC
` An
TYPE OF BUSINESS�-
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS SEP 3 U 1997
LIST NAMES OF PERSONS EMPLOYED
cl-ry
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (exclude garage)
LOCATION AND .SQUARE F OTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (example,
"bedroom - 125 sq. Ft.)'
DESCRIPTION OF MAqHINERY,. E IPMENT, AND SUPP(� I,ES BEING USED IN THE BUSINESS
OPERATION�1n T�l�nr�(7NQ,
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION.IS AL WED (conditions attached).
C� v Date �Q
Ap licant's Signature
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
Date
Owner/Agent Signature
Date
Agent Company Name Agent/Owner Contact Phone #
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING
YOUR HOME OCCUPATION; FAILURE TO COMPLY WITH THE CONDITIONS LISTED ON THE
ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMIT.
• . v APPROVED
BY:
countera
DENIED SPECIAL CONDITIONS ATTACHED
I.D.# � DATE