SMITHi
63
. CITY ,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� yf"- �� - i, .� 71 PHONE �� i �) % 7 / e, ":.3/ ")
PROPERTY OWNER Gee PHONE
PROPERTY ADDRESS �; .y,. -11(1C, --,-,S
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) �.
TYPE OF BUSINESS,-�T.
BRIEF DESCRIPTION OF -HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS /
LIST NAMES OF PERSONS EMPLOYEDQ n -k
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.")
VALIDATION -STAMP i
005182 82 CASH 31 TOTAL 41 9, 35 00
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
APPLICANT SIGNATURE
IF APPLICANT IS OTHER THAN PROPERTY OWNER,
REQUIRED. 7
/
OWNER/AGENT SIGNATURE
rI
AUTHORIZATION OF OWNER OR AGENT
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 -------------------
Building and Safety Department
APPROVED BY DATE CONDITIONS ATTACHED
DENIED BY DATE