PhillipsP.O. Box 1504
_ La Quinta, CA 92253
(=� q (619) 564-2246
CITY OF LA QUINTA
�FTMe.,�„ OME OCCUPATION APPLICATION
1
Read each con ti listed on the attachment to this form to see if the
proposed acti ity ca comply with the City's Home Occupation Regulations.
` p PHONE �Y' 71 Z
APPLICANT'S NAME � \ �1/��L\ S
PROPERTY OWNER
C ftr--¢-
PHONE
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS F I QVZ44-k`
BRIEF D IP ON OF HQW THE USINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS D
LIST NAMES OF PERSONS EMPLOYED v,� rt- �v`. _ �k� Ts
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.")
VALIDATI
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BE
BUSINESS OPERATION / /1,01J-. ,, , d
OCT 2 9 1993
USED IN
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
APPLICANT SIGNATURE
-1 r- 9 3
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.
----------------------------------------------
Building and Safety Department
APPROVED BY DATE
DENIED BYL-
J
z DATE(
//,0"iec-- 'C"E
CONDITIONS ATTACHED
•
4 ........ .......... U v LIC� NO��l
...... ........
93 BBUSINESS.BUSINESS.ENSON.FORM
*APPROVED DATE.DATE
tT;
*DENIED
IN
SURAPROOF OF WCIRKERS:-Coi4PE!NSATIdit,'S,URA REQUIRED ........
&7 "1
APPROVED BY BUILDING &' SAFETY ..';DEPARTMENT
7 �S,
1.
2.
3.
5.
6.
7.
IS THIS BUS1NESS.LOCATED`fA'V
iYES
Business Name:.
v
11AA-- S i3,v J�ng Address:
Business
Business Phone':'
1" IV.
INDIVIDUAL
Owned By: ',,CORPORATION
,Or P. Of. Tax
If Corporation
8. If Individual
9.
10.
11.
12.
Name 'of owner
Or Officers
Type of VUsljilwo D
fit!
SBE - Resale -Nuw5de:
W1WTN
�,,WIVHI "
ED", .1 -IT
BUSINESS LOCATI,
Building
A. Estimated -GrOS-s'BdiiWd&:.Rd4
NO
oei,.Not Apply To
ewt= Businesses Only:
$
d
-""iblishe
�A` ''I" Businesses:
B.- Previous Year-GrOss-Red
eipts; Fa
********GOOD ONLY FOR'jANUARY 199 DE0EMBER3lj1993
I HEREBY CERTIFY that -a-1,1 rthe --inf ormat-iohjsu00j:-ied '--.by me is correct and
7 1 Government have been
-State,,',Or,,,-,-Xedera
es -.required bi,':�h4".,.."C'o'u".n't"*""
any licens �A � . — 5*
issue and -are 'in.-full;--Iorce
'0 yo
/h -
z
Signature,,
Submit Form TO.:
-CITY OF.,LA,QPINTA.
BUSINESS,LICENSE`-DIYISION
78-4,95. Caille 'Tampico
La Quinhtd,' 'cj- X92263'
Da
69