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CITY OF LA QUINTA R4R p3
78-495 Calle Tampico, P. O.Box 1504, La Quinta,ey 92253 9
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 S % 7'S PHONE 36&-f 5�l
PROPERTY OWNER LL /UES PHONE
PROPERTY ADDRESS 7 O EST
MAILING ADDRESS L7 QUiAJTA,7,15
TYPE OF RESIDENCE (single, multiple, mobil home, etc.)-Tj1V6(—r-
TYPE OF BUSINESS -DAPr MlICNIAIE kI LGA161NG
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
�ao�K€�P!Nls /47- d-�OML A411th 08iE /A) At-
:1- OF PERSONS INVOLVED I BUSINESS i
LIST NAME OF PERSONS EMPLOYED /VO/VIf
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) - —0
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN �
HOME/��f>,
( EXAMPLE , "BEDROOM -125 S.F.")
ed yyt�(}<c`t sir
DESCRIPTION OF MACHINERY E UIPMENT, AND UPPLIES BEING UUSED IN THE
BUSINESS OPERATION 1R r U111421 6 MtO//16-s
I HAVE READ,RS D, AND AGREE WITH THE CONDITIONS BY WHICH A
KOK QC ' P ^ . ,-.,.,LCWED ( ONDITIONS ATTACHED ) .
GNATURE
a-/�,
DATE
IF APPLICANT SIS 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.
Hui din and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
1 .
4
1.
IS THIS BUSINESS LOCATED AT YOUR HOME: YES
2.
Business Name: �5�i'` w
�U a ni
3 .
Business Address : 8- 35 �'ot� es(A I/l.& r" 6i Q
y4. Mailin Address. 9�5
C,4 9z`zS 3 /
5..
Business Phone: ado—, plS
6.
Owned By: CORPORATION. PARTNERSHIP
INDIVIDUAL
7.
If Corporation or Partnership: TAX I .D. #
8.
If Individual Owner:. Social Security #
`
9.
Name of Owner M i Lty TokJiFS
Title: PA L� JEA
Or Officers
,
�0 .
Type of Business :Kif' ` EW,61 �6
11.
IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY
HEALTH PERMIT:
YES NO
12..
SBEResale 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:
B: PreviousJOAfF
aGross Receipts
$
for Established Business s:
***********GOOD.ONLY FOR JANUARY 1, 1995 THRU DECEMBER 31, 1995**********
I HEREBY CERTIFY that all the information supplied by me is correct and any
licenses r red by the County, State or Federal Government have been issued
to me an gar full force and effect.
A.
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Title
Send Completed Form To:
CITY OF LA QUINTA.
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
P. 0. Box 1504
La Quinta, CA 92253
Date