Pelletier (2)11111111111 IIII IIII02
CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
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.
APPLI CANT' S NAME
SA -so^
PHONE J � 44-(o 76 'f
PROPERTY OWNER '6ClCe
t SUSat\
Pe llefi er
PHONE 564A --67044
PROPERTY ADDRESS 5q255
Heccero,
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) Sj(1�r-2r
TYPE OF BUSINESS VA ous 1✓ &e o, 6% q
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE Wjjl CeCf-QU�e CaAh OA -
NUMBER OF PERSONS INVOLVED IN BUSINESS l
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE) J-750
•LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.") %1
T L 35.00
VALIDATION -STAMP
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION -8-
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
LICANT SIGNA
DATE
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.
---------------
ui din and Safety Department
APPROVED BY DATE CONDITIONS ATTACHED
DENIED BY DATE