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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 vb 3�i� 96