Baker (2)` 1 i .''// I Illill Illll llll I'll
70
FEE $35.00
- CITY OF LA QUINTA
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78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT
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.
BUSINESS NAME 9LA L OcC S -f PHONE
PROPERTY OWNER h << PHONE 1
PROPERTY ADDRESS Si - 92-.T IV2Vc..lrro C�c? 9�2 Z 5'7
MAILING ADDRESS l( -
TYPE OF RESIDENCE (4&jp
multiple, mobi� honA, etc.)
TYPE OF BUSINESS G
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
nuizzn lir rr.tcJu"a 117vu"vc.L 117 muQj- Qaa
LIST NAME OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) L -L50
LOCATION AND SQUARE FOOTAGE OF AREA DK%C YZ°.�.vk �f �L{� Y�
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY EQUI MENT, AND UPPLIE'S/BEING USED IN THE
BUSINESS OPERATION &eu& lyw Nr��..4—/-/ _ Skl� y
I HAVE READ, VNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
ROM C T N S ALLOWED (CONDITIONS ATTACHED).
APPLICANT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS 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 Safetv Depatment
APPROVED K DENIED CONDITIONS ATTACHED
COST *E?�D tiNl leT--
CUl;LST E-Ou rpT - !'L4C3UC V iL ws TaOQ/+U�--
D "'`�" atllHiw yams
1994 BUSINESS LICENSE APPLICATION FORM
BUS. LIC. NO.
Arlo
Send Completed Form To:
CITY OF LA QUINTA **********************
BUSINESS -LICENSE DIVISION *APROVED BY
78-495 Calle Tampico * DATE
La Quinta, CA 92253 1 ********************
PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED
1. Business Name:
2. Business Address:
3. Mailing Address: S3 - �ZS' �1'c� vG �� ;�-� C-6
4. Business Phone:
5. 'Owned By: CORPORATION PARTNERSHIPINDIVIDUAL
6. If Corporation or Partnership: Tax �-
7. If.Individual Owner: Social Security 97 S
8. Name of Owner or Officers .and Title. � � � � a
9. SBEResale Number:.
10. Number of Decals Needed:
11. CONTRACTORS ONLY: COPY OF'STATE CONTRACTORS LICENSE IS REQUIRED
A. Type of Contractor:
B. Classification:
C. State License Number: 297�r;l
CONTRACTORS - GENERAL $100.00 Per Yea�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 IST THROUGH JUNE
30TH; OR JULY IST 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
(Arz dIto mf -)and are in full force. and effect.
Signature
Title
Date
I