FRNIUSIM• FEE $35.00
57
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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.
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17 LL ff 4- 6 3C) w/l
BUSINESS NAME ek;AJ? IFEICUSOI PHONE (1Q-56�-
117q
PROPERTY OWNER
PROPERTY ADDRESS
MAILING ADDRESS
TYPE OF RESIDENCE(
TYPE OF BUSINESS
BRIEF DESCRIPTION
PHONE C-�Cca u-
tiple, mobil home, etc.)
BUSYNESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSANI
LIST NAME OF PERSONS.EMPLOYED (114-1
• SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE ( EXCLUDE GARAGE) h�On
LOCATION AND SQUARE FOOTAGE OF AREA
( MF BUSINESS ACTIVIT)ji���PN� HOME
EXAMPLE, "BEDROO5 .F.")
DESCRIPTION OF MACHIRY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPE ION " At S N
I E READ UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HO ' O CUPA ON IS ALLOWED ( CONDITIONS ATTACHED ) .
PLICANT SIGNATURE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
OWNER/AGENT SIGNATURE DATE
IMPORTANT: FALSE OR MISLEADING INFORf TION 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 -and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
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