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69
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.
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APPLICANT'S NAME &A L cap n PHONE 56q -&O 90
PROPERTY OWNER
PHONE
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile
home, etc.) n19� 11
TYPE OF BUSINESS Q r in1 h G'
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL
OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
/
LIST NAMES OF PERSONS EMPLOYED i--..
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
HOUSE (EXCLUDE GARAGE)
VALp STAMP ..
CITY OF LA QUINTA ���c••//
LOCATION AND SQUARE FOOTAGE OF AREA OF
`
BUSINESS ACTIVITY IN HOME (EXAMPLE,
JUL 0 21992
"BEDROOM - 125 S . F . " )
BUILDING AND SAFETY DEPT.
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIESY E
BUSINESS OPERATION C � PM ,cMAt W --V c, //>�.F—/7 `r0-1��tz / ,/�v`r sce�
•.
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
r
APPLICANT'9IGNATURE 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.
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Building and Safety Department
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1992 BUSINESS LICENSE APPLICATION FORM
BUS. LIC. NO.
/3 7/.
..PROOF OF WO COMPENSATION IN URANCE IS REQUIRED........
*APPROVED l`' INITIALS DATE
*DENIED INITIALS DATE
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1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES_ NO
2. Business Name:- 00 rd �2 n ( K)
3. Business Address :5Ir7S ,4 • Mailing Address: &
5. Business Phone:( S �/ _ioO�� S�'Si 101x1 1-�.5-92 i4
18.00
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL -
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # 6q- 74 `7 -2 7 55
Name of Owner V� Oc N Title: —Cl) C1) `1 60. r -
Or Officers
10. Type of Business: �G�:rd le-yx I L1 G,
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
B. Previous Year Gross Receipts For Established Businesses:
********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
iss to me and rein full force -and effect.
Signatur Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253