HERNANDEZ (2)pgp10Boxa1504Estado
A ,(� 57 La Quinta, CA 92253
CITY OF LA QUINTA (619) 564-2246
• . HOME OCCUPATION APPLICATION
Read each\,cone tion listed on the attachment to this form to see if the
proposed activity can comply with the City's Home Occupation Regulations.
APPLI CANT' S NAME PHONE
PROPERTY OWNER PHONE
PROPERTY ADDRESS
TYPE OF RESIDENCE( (single, multiple, moniie home, etc.)
It
TYPE OF BUSINESS
BRIEF DESCRIPTION 01�Y/ROW THE BUSINESS/ifILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES.OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE.FLOOR AREA IN`"
4
HOUSE (EXCLUDE GARAGE) V RTA.4P.
LOCATION AND SQUARE FOOTAGE OF AREA OF MAR 2 61992 a �'
BUSINESS ACTIVITY IN HOME -(EXAMPLE,
"BEDROOM - 125 S.F.") 8MBINO AND WMY DON
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES E
BUSINESS _OPERATION D/r./ f� „er r , i A4 - :f_ i e" .�Q�.�9n ,"
I HAVE READ, UNDERSTAND,`AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED, (CONDITIONS ATTACHED).
r
ICANT SI
— -c /. —
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.
u'1 in and SafetyDe a ment
APPROVED BY DAT CONDITIONS ATTACHED
DENIED BY DATE
I
0
•
•
u�
•
Z �u �
x
s
syOfTMw`•
NON -EMPLOYER CERTIFICATE
I certify what in the performance of work for which this City of La
Quinta business license is issued I shall not employ any person in
any manner so as to become subject to the workers' compensation
laws of California.
Note: If after signing the certificate, you hire any employee, you
become subject to the. workers' compensation provisions of the
California Labor Code, and you must immediately comply with the
provisions of Section 3700 or your license immediately becomes
revoked.
1 7 Business Name:
Business Liceie Applicant:,
Date: