SAGAWA01
Of wwav I I"III VIII IIII IIII
BUS. LIC. NO
/ 4-
1996 BUSINESS LICENSE APPLICATION FORM
APPROVED BY iDATE
PROOF OF WORKERS COMPENSATION INSURANCE IS REQU D PRIOR TO ISSUANCE
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES '� NO
2. Business Name: . IAI I O' 'CT 0
3. Business Address: [ $� I I S t?�.tJt S 4. Mailing Address s�
5. Business Phone: (o l ��
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: TAX I.D. # UZ/1
8. If Individual Owner: Social Security#
9. Name of Owner �f ' G' Title:
S,46 -AWA -
or Officers / �p
• 10. Type of Business: � / " � F K fon ��P Is A "-T-O �
_11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO X
12. SBEResale Number:
13. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To Building Contractors):
A. Estimated Gross Business Receipts for New Business Only:
$ 1-5 bs
B. Previous Year Gross Receipts for Established Businesses:
$ if
******************GOOD ONLY FOR JANUARY 1, 1996 THRU DECEMBER 31,1996***************
I HEREBY CERTIFY !hat all the' information supplied by me is correct and any licenses required by the County, State
or Federal Government have been issued tome and are in full force.and effect:"-
`
�-
OSignature 6r Title
Send Completed Form To:
CITY OF LA QUINTA
r BUSINESS LICENSE DIVISION
78495 Calle Tampico
• x P.O. Box 1504
La Quinta, CA 92253
Date
AA
jqK
ce,
FEE $35.00
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT
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.
BUSINESS NAME %N
PROPERTY OWNER R - T, S'tlT,
PROPERTY ADDRESS
MAILING ADDRESS
TYPE OF RESIDENCE ( ng
TYPE OF BUSINESS /N7FRia
BRIEF DESCRIPTION OF HOW
PHONE
PHONE ! dl 9 ) 5-6 fe - 66.f
40A17A. CA 912 �3
multiple, mobil home-, etc.)
,. � _ - . .
BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED
• SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE ( EXCLUDE GARAGE) 2" S, ,= "
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.") $ aDR0 0 M—14.0,S.F "
(TA RA CT R - 6 0.
DESCRIPTION OF MACHINERY, EQUIPMENTAND SUPPLIES BEING USED IN THE
BUSINESS OPERATION 7FL Fi4X CD, !/TDR+ ldORejLOSSFSOiQ,
ASS/6A) BPS/c
I HAVE.READ, UNDERSTAND, AND -AGREE WITH THE CONDITIONS BY WHICH A__
HOME 0 CUPATIO IS ALLOWED ( CONDITIONS ATTACHED) . _.� �, I �_
�� - - -
LICANT aIGNATURE
t • f♦ ♦ry .r
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORZZ TION OF OifNERL
OR AGENT IS REQUIRED. r
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.
Bxildinq and SatetZ Department
c APPRO D DENIED CONDITIONS ATTACHED
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3�i� 96