POOLE (4)CITY OF LA OUINTA
HOME OCCUPATION PERMIT /
r l
APPLICATION
78-105 Call* Estado
P.O. Box 1504
La Qulnta. CA 82253
(619)564-2218
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.
-----------------------------
(TYPE OR PRINT IN INK)
APPLICANT'S NAME bNMAV 1 YA04IL&I PHONE S
PROPERTY OWNER/Q4P"-:SA" e -1- dNDfeA W -46/e, PHONE
PROPERTY ADDRESS 7 al% b S'A CTL/.A teD KP,4 D
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) SiA)&le-
TYPE OF BUSINESS 5eKL)- e � � LID/JSu-li4L 3t
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE :T- jp'00l PV- D/LK6 bac �
NUMBER OF PERSONS INVOLVED IN BUSINESS I
LIST NAMES OF PERSONS EMPLOYED 1�),SQU
HOUSEE(EXCCLUDE GARAGOTAGE OF E) BLE LSO SEA IN �1� ldff
bb UU M W 2 -1 1.77 P
LOCATION AND SQUARE FOOTAGE OF AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE, AW&Vn wT.
"BEDROOM - 125 SQUAR FEET") & Tk1 BY
• DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES B ING USED IN THE BUSINESS
OP RATION i Al@ — `6
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
APPLICANT S19PATURE 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.
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
BUILD NG i SAFETY DEPAR
APPROVED BY DATE�7 `z r- 1?/CONDITIONS ATTACHED
DENIED BY DATE
is
/ I IIIIII II'll II'I IIII
17
If
i
w.�
p
,, x`�WILL�g1Y1 T. POOLE
MOREA ►`►LKER POOLE '
' s Esso sq o (s, 9) 564-I M8 ^ 42
CA 92253 o�
ME
r !
oI'611fornla26
• �4 h� I�@%Sta:B •72'S11'Nighwat 1 _' �: i , ,, �v�".� ^'3`n i1 � ���'�a�5'rS?�+
Bank P:o.:.eox.ao29
i Palm Dvaoit, CA $2?617o,29
" `'t '/i`�t� ��.oO � w1�/1��Y �'(_) K{j�- /r� Aly •tl �t� �4�' Lt�.�y�1�7`raLl ;f �� { r M }. k.
xcum wrcrsrnrc-tEPourONr .,. s, d.1.3 ,;L ;• .x;. t•:: 3¢h{yi ,�� t ��n ���hhR"' y .�•�,r4�ecti x f y��� 4.�r
4,�'•1 . Qt .t_rw.,�'-+fir .,d.a�. : �kr � .. Lt,.� :�s � n M. - «
•