CABANG64
�U OF'
LA 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 PHONE
PROPERTY OWNER PHONE - /
PROPERTY ADDRESS
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) V L
TYPE OF BUSINESS1��9ru-�/S
BRIEF DESCRIPTION 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)
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.")
DESCRIPTION OF MACHINERY, EQUI MENT, SU
BUSINESS OPERATION Mi -.eLw A -P7 D� _ ;
Ai ' <cT,
• c
r
t 1•1k I $ fJ 11l
nv
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
01
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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.
---------------
40- . -----------
Buil in and Safety D rtment
APPROVED BY g 7/DATE /� �✓BIZ CONDITIONS ATTACHED
DENIED BY DATE
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ria 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: �� r
Business License Applicant:
• Date:
0
•
•
r�M OF TMw�
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: �l� �7�yv"v-
Business License Applicant: e -'e /�
Date:
4
1992 BUSINESS LICENSE APPLICATION FORM
BUS. LIC. NO.
......PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
*APPROVED !/ INITIALS 15 DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATE A�_YO R HOME: YES NO
2. Business Name: /4 NN
3. Business Address: 4. Mai ing Address : -
5. Business Phone:(_)
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security #
• 9. Name of Owner Q �'L C7i`�� Title:
Or Officers
10. Type of Business:
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:
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.
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253