JARROTCITY OF LA OUINTA
HOME OCCUPATION PERMIT
APPLICATION
70-105 Call* Ectad
P.O. Box 1504
Le Oulnla. CA 022
(010)664-2240
Read each condition listed on tt.e attachment to this form to see if the
proposed activity' can comply with the City's Home Occupation Regulations.
(TYPE OR PRINT IN INK) \
APPLI CANT'S NAME �-�f\ \�O `L�-, \ �7 PHONEl +1 91 /(0
PROPERTY OWNER DQ�O�C1/�l1 A y�V��J�(/L C I - (� PHONE I b 0
L-.&.- PROPERTY ADDRESS [ �/ r `Ft�I �1L v���� I � CA- a aas3
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) lUla! ei
TYPE OF BUSINESS �Q�i"\\V�C� I a\A V V\�,/ 1_
BRIEF DESCRIPTION OF HOW•THE BUSINESS WIL),-OPERATE S-�R1 C-T�-� L�e �V1aY\.Q—
NUMBER OF PERSONS INVOLVED IN BUSINESS I:A R
LIST NAMES OF PERSONS EMPLOYED CA" L- t) ) V A -91910-1C
SQUARE FOOTAGE OF USABLE FLOOR ARE IN pp
HOUSE (EXCLUDE GARAGE) 0-.. O .4
LOCATION AND SQUARE FOOTAGE OF ARE1f.OF
BUSINESS ACTIVITY IN HOME (EXAMPLE ,
"BEDROOM - 125 SQUARE FEET") 1D_ O�
is
OLenp
DESCRIPTION OF MACHINERY, EQU PMENT A
OPERATION 0 QY'S0-% CCMA 0
VALIDATION STAM
SEP p 4 1991
BUILDING
ES BEI INESS
READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY
WHICH
r
g19c
A HOME
IF APPLICANT IS OTHER THAN ROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
REQUI
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.
F1
BUILDIAG i SAFETY DEPART!
APPROVED BYAJI. DATE / CONDITIONS ATTACHED '.•
T
DENIED BY DATE
• I IIIIII VIII IIII IIII
77
• BUS. FtI C . NO.
1991 BUSINESS LICENSE APPLICATION FORM
V�
S" 11 1 19911
*APPROVED INITIALS DATE
*DENIED INITIALS DATE
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1.
IS THIS BUSINESS LOCATED AT YOUR HOME:
YES�r NO
2.
Business Name: CC���v 2 �V�S
Iy�Q.y�C9�py�cL`
3.
Business Address:19-,!�3(7 IMPfR%(boLb6he 4.
Mailing Address: 1 o,kW-Q-
1,�
5 .
Business Phone:(
6.
Owned By: CORPORATION PARTNERSHIP CNDIVIDU;Z
i.
If Corporation or Partnership: Tax I.D.#
S.
•
if Individual owner: Social. Security #
I a- (P
9.
Name of Owner CI�'E�0 p �i��-��0�
Title : f ec �Q V\ -
Or Officers
10.
Type of Business:.
11.
SBE Resale Number:
12. BUSINESS LOCATED_WITHIN.THE..CITY OF LA.QUINTA (Does Not Apply To
Building Coritractors):
A. Estimated Gross Business Receipts for New Businesses Only:
B. Previous Year Gross Receipts For Established Busine11sses:1
$ i005ip�sN0,4&4 9i if -9 36.00 i0
I HEREBY CERTIFY that all the information supplied by me is correct and
a licenses required by the County, State or Federal Government have been
M;4
and are in full force and effect."
p,
&1A,4" er S. ! '(,
• Signature 11 Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253