MORTENSON/ II'lllllllllllllllll i P8010Boxa1504Estado
V\10 7s --_ La Quinta, CA 92253
�- (619) 564-2246
CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
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 V I.CKI MO RT �E_N cSO IV . PHONE 3 (56
PROPERTY OWNER 71 �� Fir Y / Cki mO R T_;E1V Sd I \ PHONE Y16 -svtal
PROPERTY ADDRESS
TYPE OF RESIDENCE ( single, multiple, mobile home, etc.) S / NfG 1--E. FA I L\(
TYPE OF BUSINESS SI NGLF_S NEWS L. E_Tt_ W I`C4 PEKSOIJAL- 11 -IS
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE 1 N FO k t'►" ATI 0 i\) v
VLA P�21� �_ OR rn A -I L. I9_) ILL. 6E_ / N PL(T )N M Ca , ";E k: (-A ? Lo 5 -
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA IN
•HOUSE ( EXCLUDE GARAGE) % �%� S. �•
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,.
"BEDROOM - 125 S.F.") �F_ - Ito S-,
DESCRIPTION OF MACHINERY,
BUSINESS OPERATION 0 0 0)
V CITY OF LA QUINTAL0 CZ,~ o�-
FEB 2619925lj��
3
BUILDING AND SAFETY DEPT.
FPPLIES_Bt&U- Wa-U_cXM - 1 L THE.
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
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.
Buildinq and Safety Department
APPROVED BYJDATE -J' "� CONDITIONS ATTACHED
DENIED BY DATE
•
•
0
S r
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 provisions of the
California Labor Code, and you must immediately comply with the
provisions of Section 3700 or your license immediately becomes
revoked.
Business Name: U-Sn / J CO 1,,J ` KCI (Ctt�T N CE Eflcou_/l i ze2
Business License Applicant:y K 1 YLO R-ILN SO iV
Date: .� - 2— 9?
OWN
•
BUS. LIC."NO.
1992 BUSINESS LICENSE APPLICATION FORM.
....PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED...::-�'
*APPROVED �" INITIALS DATE'
*DENIED INITIALS ''DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES �Z ;�'NO
2. Business Name: _ .C14SU N C.On( ��{p Cf A -PIC& F-61Co' LkFi i E
3. Business Address:4. Mailing Address:
5. Business Phone:(
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I . D . # D � / 5 SL.k � u
8. If Individual Owner: Social Security #
9. Name of Owner Title:
Or Officers '•y SLK( YYLOk-T`LP,1 SO �.•: U
10. Type of Business: S(tJG LES 4F -OS L'F_TTEfl W1:T-4
11. SBE , Resale ,Number: n •Y, Y, ..-. *,�,:; _
12. BUSINESS LOCATED -WITHIN :THE •CITY •OF JA 4UINTA .(.Does Not Apply To x
Building Contractors) : _ �; - s ;•_ r ,: ,_ , ,_
A. Estimated Gross Business Receipts for7New•Businesses Only:
$ 1O100c)O. 60
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
issued to me and are in full force and effect.
• Sign ture Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
` P.O. Box 1504
La Quinta, CA 92253