CLARKI IIIIII Iilll I'll IIII li
80
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.
APPLICANT'S NAME L1&8ZQ ,VJ7?j. --- PHONE ! 7S
PROPERTY OWNER E- PHONE
PROPERTY ADDRESS Q
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS
BRIEF USCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE ,FLOOR AREA IN
- HOUSE ( EXCLUDE GARAGE) IQ no !'6 >r -
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,./
"BEDROOM - 125--S-.F.") �, . f - Ori
DESCRIPTION OF MACHINERY., /�EQUIPMENT,
BUSINESS OPERATION .�.cJ, 4 <`h
i
VALIU) STAMP. A'��,
.
CITY OF LA O(11NTA
MAR 2 71992 �Ai V
--0 AMID SAFETY D _; S
SUPPL USED IN E
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I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED SCONDITIONS ATTACHED).
• � CSC
APPLICANT IGNATURE FA -7
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
attachedpageshall_ be_ grounds -for _revocation -of _permit_
------------------ _-_--- --____
BMlding and Safety De artment N
APPROVED BY DATE CONDITIONS ATTACHED
DENIED BY DATE
� a i
r�V OF
NON -EMPLOYER CERTIFICATE
I certify what in the performance of work for which this City of La
Quinta business license is issued I shall not employ any person in
any manner so as to become subject to the workers' compensation
laws of California.
Note: If after signing the certificate, you hire any employee, you
become subject- to the workers' compensation provision's of the
California Labor Code, and you must immediately comply with the
provisions of Section 3700 or your license immediately becomes
revoked.
Business Name: nks'Aio
Business Li ense Applicant:
• Date:
0