JACOBSEN/kA-
cv,414P
• 60
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 LRJ- Wkolesale + Below PHONE AD - SSS6S
PROPERTY OWNER List. 4- Toel Ta.colaseA PHONE -2, LD - Zt. (.9
PROPERTY ADDRESS 7jPcjp-p Son�S�a I,Jo�v
MAILING ADDRESS L0. 5.3
TYPE OF RESIDENCE sin 1 multiple, mobil home, etc.)
TYPE OF BUSINESS Remavke_-k► a Closeot,+ Wt2rcJ and i se,
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
"
LIST NAME OF PERSONS EMPLOYED self'
• SQUARE FOOTAGE OF USABLE FLOOR AREA,«
166� Cf{o�we�
I1 Sq ff'
IN HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND
SUPPLIES BEING USED IN THE
BUSINESS OPERATION C0v*1j2L&i•ev-, Fa -Y, JRohe
I HAVE READ, UNDERSTAND, AND AGREE WITH
THE CONDITIONS BY WHICH A
HOME O ALL WED (CONDITIONS ATTACHED).
Z�TION.
10-7-9�
APPLICANT S NATURE
DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGEN ZS REQUIRED.
Q .
10-7-%Y
�
OWNER/ GENT 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.
40 Buia inq and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
r0 [
0
•
�.
S
1994 BUSINESS LICENSE APPLICATION FORM
o i•APPROVED
DATE
THt //
...... PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
dett- �7.2
q CV
�r
r aa/Q y
BUS. LIC. NO.
B � Y •
* f'v •
1.
IS THIS BUSINESS LOCATED AT
YOUR HOME: YES
v/ NO
2.
Business
Name: LRT LJ
ALE
3.
Business
Address.: ?89).0 Son
-s+ inlay 4 . Mailing
Address:
Lau��t�
C,4 42.253
5.
Business
Phone:( 101=
6.
Owned By:
CORPORATION
PARTNERSHIP
IVIDUA
7. If Corporation or Partnership: Tax I.D.#
B. If Individual Owner: Social Security # 41)_ - 7-69t)3reoL
9. Name of Owner L 15& i� , Sg �Title:
_A Rear -cP
Or Officers
10. Type of -.Business: _GM.rLej;nQ close-o'At ►r,erc�aAciise,
11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
• , YES NO
12. SBE Resale Number: - S R N C
13. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$ S, 000,
B. Previous Year Gross Receipts. For Established Businesses:
********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
issued tome and are in full force and effect.
reser a�ivg_. 10-7-q
Signatur Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION