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CITY OF LA OUINTA
HOME OCCUPATION PERMIT
APPLICATION
78-105 Celle Estado
P.O. Box 1504
Le Oulnta. CA 922.1
(619)564-2248
Read each condition listed on tt.e attachment to this form to see if the
proposed activity can comply with the City's Home Occupation Regulations.
---------------------------------
(TYPE OR PRINT IN INK)
APPLICANT'S NAME
PROPERTY OWNER
PROPERTY ADDRESS
TYPE OF RESIDENCE Isingle, multiple, mobile home, etc.)
TYPE OF BUSINESS
BRIEF DES
o
NUMBER OF PERSONS INVOLVED IN BUSINESS C
LIST NAMES OF PERSONS EMPLOYED A0,9'/
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDR00 - 125 SQUAB F ET")
DESCRIPTION OF Y CHIN Y, EQUIPMENT,
OPERATION
PHONEIZ-5ZV/ol 7,
JUL I -19W
AND SUPPLIES BEING USED IN THE BUSINESS
I HAVE READ,
UNDERSTAND, AND AGREE WITH THE
CONDITIONS BY WHICH A HOME
OCCUPAT ON IS
ALL ED .1 CONDITIONS ATTACHED).
ICAN7 SIGNATU
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.
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BUILDI!G i SAFETY DEPARDANT
VX APPROVED BY JA S DATE CONDITIONS ATTACHED .
DENIED BY DATE
� I I'llll III'I IIII II II
15
'% T4Wf 4 4Q"
BUS. LIC. NO.
1991 3uslNEss LICENSE APPLICATION FORM
Send Completed Form To:
CITY OF LA QUINTA \(1
BUSINESS LICENSE DIVISION \J -
�ty P.O. Box 1504 ` ,' i` '� �.i JUL
La Quinta, CA 92253
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. Busines
s Name : � � c�� > -, / -i► u.S%?�''I ��I>'ri��-
2. Business Address:
3. Mailing Address:- 7 1
4. Business Phone: 4/ /j )�
S. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
6. If Corporation or Partnership: Tax I.D. #
7. If Individual Owner: Social Security #
9
10
Na: -ie of Owner or Officers and Title: 11"6x;:�,7zz lllc
5l ,+ �i(�-ji'S
Type of Business
SEF; Resale Number:
11. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (That Are Not Building
Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
s—
.�G�, � 005iS,,1 4i' :hJ
1 i(?- f.;r15'FI i. 'IC)1,Ai... J. 30.00
B. Previous Year Gross Receipts For Established Businesses:
36
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.
5'ec
Signature Title Date