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04
CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
Read each condition listed on the attachment to this form to see if the
proposed activity can comply with the City's Home Occupation Regulations.
APPLICANT'S NAME i16t/,PY S A-79VE/DE PHONE Soy- aoffe
PROPERTY
OWNER
cSAM&�_
PHONE
PROPERTY
ADDRESS
q7-145
0ifuE
TYPE OF RESIDENCE ( single, multiple, mobile home, etc.) MA -141(y
TYPE OF BUSINESS WIAIXW C6Wjet06-
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE 6U/ei ZW e16WIV6-
S A4osr u,GhPir .&AdE gZ/rsio e
OC: #j"E. .0� �Accs
PC��/UlcO �T t/�NE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED AlMr
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE ('EXCLUDE GARAGE) IMO
• LOCATION AND SQUARE FOOTAGE OF.AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S . F . " ) /� .� i"eAl
DESCRIPTION OF MACHINERY, E
BUSINESS OPERATION 7-457e45;
VALIWOW.W STAMP.
CITY OF LA QUINTA
FEB 2 01992
BUILDING AND SAFETY DEPT.
IPMENT, AND SUPPLI
9AOE . 7-A0e- JeP/Te
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
01
SIGNATURE
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.
•-------------
Buildin -and Safety Department
APPROVED BY DATE o20 'Q2 CONDITIONS ATTACHED
DENIED BY DATE
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X1992 BUSINESS LICENSE APPLICATION FORM
......PROOF F WORKERS COMPENSATION INS RANCE IS REQUIRED........
************ ************************* **************************
*APPROVED INITIALS DATE 2-,26 _9*Z
*DENIED INITIALS DATE
************************************** ***************************
IS THIS BUSINEL LOCATED AT YOUR HO YES NO
t
Business N me:` �i�i1//ls CU//VQ Apt//.ter
Business A ress : W-1,25 Mailing Address: P0.6VK
Business Phone:( Aw— -Wfo
Owned By: CORPORATION PARTNERSHIPINDIVIDU
If Corporatio dor Partnership: Tax I.D.#
If IndividuaOwner: .Sociall# Security
-�9- /70 - '70 If -5-
Name of Owne
S: �LE/11�t1e: �'UitJF�
Or Officers
Type of Bus i ess : elvwme % &Lrgv/fir
SBE Resale mr: N /f 1
f ,� 1
BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. E timated Gross Business6eeipts for New Businesses Only:
--ftj 1'\
Str4oVAM
B. Previous iYear Gross Receipt For Established Businesses:
********GOOD1. ONLY FOR JANUARY 1,199? THRU DECEMBER 31,1992*******
I HEREBY CERTIF that all the information supplied by
any licenses re uired by the County, State or Federal
issued to me and are in full force and 9ffL-:rct.
S. oullytx-
• Signature
Submit
CITY OF I
BUSINESS LICI
P.O. Bol
La Quinta,
e
To:
QUINTA
ISE DIVISION
1504
CA 92253
me is correct and
Government have been
Date