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• FEE $35.00
CITY OF LA QUINTA
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 a (n 1.1 Vs - I,l)o � �S PHONE C �1q � t' S��P
PROPERTY OWNER L l PHONE
PROPERTY ADDRESS RJ 0 SQ ro U IM -A,
MAILING ADDRESS O Q
TYPE OF RESIDENCE ( Ingle ultiple, mobil home, etc.)
TYPE OF BUSINESS e
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL PERATE LjS
mi ci. Md .Z s es
NUM ER OF PERSONS INVOLVED IN BUSINESS
LIST NAME 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, EQUMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION r-�e0PfU Mcc Cq(. o « 7u0(, 1yrter, (,)r(Ia.CW
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME\0¢ONnI��OWED (CONDITIONS ATTACHED) •
LICANT SIGNATURE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
OWNMAGENT `SIGNATURE
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR
DENYING' YOUR HOME OCCUPATIO,N;. FAILURE TO COMPLY WITH CONDITIONS
LISTED ON TH ATTACHED PAGE-a`SHALL BE GROUNDS FOR REVOCATION OF
PERMIT.
Bui d =- ===-Safety De artment__________________________________
AP ROVED DENIED CONDITIONS ATTACHED
lc-
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4 4a
HUS. LIC. NO.
1994 BUSINESS LICENSE APPLICATION FORM
************** ** * ****
*APPROVED BY
* DATE
********************** ***
......PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES X NO
2. Business Name: LQu(a 0nss)TL)PP6-W0(6 Scies
3. Business Address: 4. Mailing.Address:
5. Business Phone:(-( )
6. Owned By: CORPORATION PARTNERSHIP �IUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security .# l (^909 5
9. Name of Owner (� Zl �. (�S Title: 0U- 141
• Or Officers
10. Type of Business: In hone` pL24,�scjjfs'
11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO
12. SBE Resale Number:
13. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
av
B. Previous Year Gross Receipts For Established Businesses:
$ 0
********GOOD ONLY FOR JANUARY 1 1994 THRU DECEMBER, 31,1994*******
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
issped to me and are in full force and effect.
Signat
tle
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
La Quinta. CA 92291
Date