WILEYLJ
CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
78-105 Calle Estado
P.O: Box 1504
La Quinta, CA 92253
(619) 564-2246
79
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
PROPERTY OWNER
PROPERTY ADDRESS
TYPE OF RESIDENCE
TYPE OF BUSINESS
mobile home,
v
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
is
HOUSE (.EXCLUDE GARAGE) 1 =L
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.") F
DESCRIPTION OF MACHINER , EQUIP- ANI
BUSINESS OPERATION IC1►'ki t,1. (`i1: �'m(5 SM- A d
VALIDATION STAMP
005182 10 2657 0-16-92 4
10 CASH i TOTAL 1 35.00
ES BEING USED IN THE
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS AT Arurni
IF APPLICANT IS OTHER THAN
REQUIRED. PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
SIGN
IMPORTANT: False or misleading information shall be
grounds
your Home Occupation; failure to comply with conditions listedoondtheing
attached page shall be grounds for revocation of permit
Buuiildi�n wand Sa_Y Department
!/
APPROVED BY �, DATE
DENIED BY DATE
CONDITIONS ATTACHED ,L�
•
----�... ....r-_.___----.e,,,�,�,�,.,,�
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CITY OF LA OUINTA �Glit,�Gv "I
CL
iUSINESS LICENSE APPLICATION FORM
005182 10 2555 10-09-92
BUS. LIC. 100 i 15.00
10 CASH i TOTAL 1 15.00
i AMOUNT TENDERED 15.00
CHANGE .00
THANK; YOU
BUS. LIC. NO.
i0.************************************************
INITIALS DATE
INITIALS DATE
LOCATED AT YOUR HOME: YESNO_
I �vl L5 �ti !L�iz,l��l.�.S
F36
2NCk_4-4. Mailing Address:-).,
ddress ).
45-
5. Business Phone:(
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#I C' p
8. If Individual Owner: Social Security #
• 9. Name of Owner, L11 Title:
Or Officers
10. Type of Business: 4LE
11.. SBE.Resale Number: �I
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only*
$ 1�
B.. Previous Year Gross Receipts For Established Businesses:
X13?u0y''S'�}�, ii; -t;=
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER X31,*****
I HEREBY CERTIFY that all the information supplied by me is correct and
any licenses required by the County, State or*Federal Government have been
tissued to me and are in full force and effect. , I
0 Signat re .. Title
Submit Form To:
CITY OF LA UINTA
BUSINESS LICENSE DIVISION
P.O. Box .1504
La Quinta, CA 92253��%
Date