KELLYu y?�@78-105 Calle Estado
2
®��� P.O. Box 1504
La Quinta, CA 92253
z
b a CITY OF LA QUINTA (619) 564-2246
HOME OCCUPATION APPLICATION 07 1111 IIII
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 YN%0.,ry c- LA 2 C' .I w
PROPERTY OWNER -Sa n
PROPERTY ADDRESS
r
PHONE(1019) GL�Q 1
PHONE.
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) S;r,1e-
Qj
TYPE OF BUSINESS bled; to,-i o r',
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE la
NUMBER OF PERSONS INVOLVED IN BUSINESS I
LIST NAMES OF PERSONS EMPLOYED hxa.r W,=.
SQUARE FOOTAGE OF USABLE FLOOR AREA IN cffyosi
PAID$35,00
HOUSE (EXCLUDE GARAGE) lalol VALIDATI0
• LOCATION AND SQUARE FOOTAGE OF AREA OF JUN 2 31992 n
�N
BUSINESS ACTIVITY IN HOME (EXAMPLE, BUILDING AND SA
"BEDROOM - 125 S.F.") D
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION Ln SX e Last,%r Zo,-1- YY', v.-Aey
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
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.
Buildin and Safety Departpent
`s
AP_PROUED BY �- DATE / CONDITIONS ATTACHED
DENIED BY DATE
1992 BUSINESS LICENSE APPLICATION FORM
BUS. LIC. NO.
......PROOF OF WORKERS COMPENSATION INSURANCE IS�D.�5.-3-9? 211. 00 i�#
*************************************** ******** ** * * **
*APPROVED INITIALS $_ 1 DATE G -`Z3" 7-,
*DENIED INITIALS DATE
******************************************************************
1.
IS THIS BUSINESS LOCATED AT YOUR HOME:
YES ✓
NO
2.
Business Name: -�e 5 er
CO- rrs e-�r
( �4 c�
3.
Business Address: -?S(E ���,�,��,r4 .
Mailing Address:
aC'i2,��� oda,
5.
Business Phone:( l�� °� ) ►� ,, y_
6.
Owned By: CORPORATION PARTNERSHIP NDIVIDUAL'
(S0\e. Pk0Ke; 4 r
7.
If Corporation or Partnership: Tax I.D.# 3 3 -�op�
8.
If Individual Owner: Social Security #
f"
v
- 7 oc
109.
Name of Owner
c2-2-3--
�� Title: S
0(e, V ro r
Or Officers
10. Type of Business: Nedtnoo
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:
$ �aS ,0c n
B. Previous Year Gross Receipts For Established Businesses:
$ 9IP" .
********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.
Sit7nature Title' Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box 1504
La Quinta, CA 92253