WilliamsCITY OF lA OUINTA
NOME OCCUPATION P
APPLICATION
a-106 Cada Ea
i
. •os 1604
la ulnla. CA 1
`f (61 )664-2246
Read each condition listed on ttc attachment to. this torp to see if the
IIIIIII'I"III'lII'I proposed activity can comply with the City's Nome Occupation Regulations.
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41 lZypE OR PRINT IN INK) 00 `7" �g {%y ri€ 'f-'% '360-- //1Z3
APPLI CANT' S NAME 1AC % G (1119-l%S PHONE
PROPERTY OWNER /1/�%- �C4i �✓ `> �tf (/� � � i [ G %/� /!% S ��OtJE �-y�� 3 � � 9i
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile home. etc.) P�
TYPE OF BUSINESS ') p�'.i fi d aer 5 S/ id )641 SIA"
BR EF
DESCRIPTION OF N THE BUSINESS MILL OPERATE C0 CIV -1-$ LcJIC C_
a a
'NUM -ER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED A/1 Gf/ / c 4 % l i '^I �S
SQUARE FOOTAGE OF USABLE FLOOR AREA Cny(1F(p(xJ(�1�jA�
HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF in& OF MAR 2 4'..1992.
!US/NESS ACTIVITY IN NOME 1 AMPLE.
"BEDROOM - 125 SQUARE FEET") lJe-w
n -F- d)C.,$L� '- /.5'd S 9 •jppyyju nim.C/
• DESCRIPTION OF RACK Ell tQUIPKENT. AND SUPP1. SINESS
OPERATION %Uyh6p�.(7"E�' �'i�/I✓.Y�is/�. �o�f ;,
J �
I HAVE READ. UNDERSTAND, AND AGREE'" MIT" THE CONDITIONS 1Y WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACKED).
IF APPLICANT IS OTHER THAN `PROPERTY OWNER. AUTHORISATION OF OWNER OR AGENT
REQUIRED.-`
IMPORTAAIT: False or misleading information shall be grounds for denying your
Horne Occupation; failure to comply with conditions listed on the attached page
shall be grounds for revocation of permit.
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ILDI iG a SATM DLPAR
APPROVED CONDITIONS ATTACHED
DEN: ED BY DATE
•
Tlwf 4 4.Q"-
1992 BUSINESS LICENSE APPLICATION FORM
BUS. LLIC. NO.
J r�� "-2
......PROOF OF WO ERS COMPENSATION INSURANCE IS REQUIRED........
*APPROVED INITIALS DATE**************
*DENIED INITIALS ppm&T4 RR .., 0,1-192
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES 1/ NO
2. Business Name:
d ('40
y1(
3. Business Address ::�Ie, 4. Mailing Address
5. Business Phone:(. l 9 ) (P 0 —
6. Owned By: CORPORATION PARTNERSHIP DIVIDU
7. If Corporation or Partnership: Tax I.D.#
8 . If Individual Owner: Social Security # QQV 7 -- V2
Name of Owner /IA&Lf Title:
Or Officers
10. Type of Business:
11. SBE Resale Number:
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$
°0
OOd DO07�,
B. Previous Year Gross Receipts For Established Businesses:
14
1.00
12
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******
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
issued to me and arp in full force and effect.
3 Da
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253
-1-1