Belknap1. Business Name:
111111 IIIII 1111 IIII
75
BUS. LIC. NO.
BUSINESS LICENSE APPLICATION FORM
Send Completed Form To:
CITY OF LA QUINTA /� 'S'000
BUSINESS LICENSE DIVISION
P.O. Box 1504. �J
La Quinta, CA 92253
2. Business Address:
e_ Z v
3. Mailing Address: C). nay_� 02Lt
4. Business Phone: of
5. Owned By: CbRPORATION PARTNERSHIP vfNDIVIDUAL
• 6. If Corporation or Partnership: Tax I.D.#
7. If Individual Owner: Social Security # (p 3 O$- 36 924
8. Name of Owner or Officers and Title: W')? A/h 0 60ahl
9. SBE Resale Number:
10. Number of Decals Needed:
11. CONTRACTORS ONLY:
r
A. Type of Contractor:
B. Classification:
C. State License Number:
CONTRACTORS - GENERAL $100.00 Per Year or $50.00 Semi-annual
CONTRACTORS - SUB $ 50.00 Per Year or $25.00 Semi-annual
CONTRACTORS ARE ON A CALENDAR YEAR BASIS ONLY; ANNUAL FROM JANUARY 1ST
THROUGH DECEMBER 31ST. SEMI-ANNUAL FROM JANUARY 1ST THROUGH JUNE 30TH; OR
JULY 1st THROUGH DECEMBER 31ST.
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.
0-0p- q3
SiUature Title Date
C
CITY OF LA QUINTA (619) 564-2246
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 w s PHONE(�Lo/V,,56 <( o? 2g&
PROPERTY OWNER �-Jrnw r , i
PROPERTY ADDRESS
TYPE OF RESIDENCE (single,
TYPE OF BUSINESS
PHONE�0-6)-Ye// o2cav/
ltiple, mobile home, etc.) -.Iah�
t
BRIEF DESCRIPTION OF HOW THE WINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LISTNAMES OF PERSONS EMPLOYED --tT
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.") S 00 IS, 4=1
STAMP l�
FEB 2 41993 3-0 0 /
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPBY
LIE THE
BUSINESS OPERATION ---
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
Si
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
'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.
Buildin nd Safety Department
APPROVED BY DATE .2--.9- Sri 93 CONDITIONS ATTACHED%L^-
DENIED BY DATE