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Tveit� 1w4�w 19M BUSINESS LICENSE APPLICATION FORM Send Completed Form To: C="_'Y OF LA QUINTA BUSINESS LICENSE DIVISION P.O. Box 1504 La-Quinta, CA '92253 ,v- BUS. LIC. NO. 111111111111 I'll 1111 78 Prior to the Issuance of a Business License Number, Businesses Located In a Home Are Required to Have A Certificate of Use and Occupancy, Obtainable through the City's Planning Department. 1. Business Name: J)d 5E�eT 2. Business Address: 7 ?- 780 d4z-� C'y�c`o''� G`r ©ul"24, & Fzz5'3 3. Mailing Address: 4. Business Phone: ( ) S. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL • 6. If Corporation or Partnership: Tax I.D. # ;�3- DS 3-7 2i 7. If Individual Owner: Social Security # 4% 2 " d - 5 /4.10 8. Name of Owner or Officers and Title: 7' -ow,vc'C 9. Type of Business: f1anES,!W 5& -,",V146- 10. & -,",✓« 10. *SBE Resale Number: 11. BUSINESS LOC.= %THIN TBS CITY OF LA QJINTA (That Are Not Building. Contractors): A. Estimated Gross Business Receipts; for New Businesses Only: $SDoo B. Previous Year Gross Receipts For Established Businesses: $ • 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 and are in full force and effect. Signature DIVIV45e- Title Date M '� � � A• � ,? Y ill i / ,_ '} t. f. CITY OF LA OUINTA ��78 106 Calls Estado P.O: Box 1604 HOME OCCUPATION PERMIT I L. oulnta. CA+' 9226 (818)684-2248 APPLICATION Read each condition listed on the attachment to this form to see if the proposedactivity cancomply with -the -City,s Home Occupation Regulations------- ---------------------------- (TYPE OR PRINT IN INK) APPLICANT'S NAME 7_#0t14'5A•✓E/T PHONE 5�4-OS7S OmAS Ile. 40W" L� T✓E'r PHONE PROPERTY OWNER 1 PROPERTY ADDRESS 77-780 C LLE eN�ucv✓ TYPE OF RESIDENCE (single, multiple, mobile home, etc.) SiivGtE TYPE OF BUSINESS h6IMC A4364 C'omoart Se.e✓/46 - - BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE NUMBER OF PERSONS INVOLVED IN BUSINESS CAIt LIST NAMES OF PERSONS EMPLOYED SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE) 1800 01 CUINTA AMP AT LOCATION AND SQUARE FOOTAGE OF AREA OF • N 0 V 2 3 1992 BUSINESS ACTIVITY IN HOME (EXAMPLE, "BEDROOM - 125 SQUARE FEET-) ' pea - 14,5 SQ. Ft: tVDESCRIPTION OF MACHINERY, EQUIPMF1iT, AND SUo11159E BUSINESS OPERATION �G UT ,ti /)1UDE I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME OCCUPATION IS ALLOWED (CONDITIONS ATTACHED). -9Z APPLICANT SIGNATURE VA1L //, IF APPLICANT IS. OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNETi 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. -------------------- PLANNING i DEVELOPMENT APPROVED BY DATE CONDITIONS ATTACHED DENIED BY DATE CODE ENFORCEMENT 1 APPROVED SYP DATE �` CONDITIONS ATTACHED DENIED BY DATE MR/FORMJH.004 REVISED 08/89