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CITY OF LA �rb
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 F -N
PROPERTY OWNER
PROPERTY ADDRESS
MAILING ADDRESS
TYPE OF RESIDENCE
TYPE OF BUSINESS
BRIEF DESCRIPTION
NUMBER OF PERSONS INVOLVED IN B�SINESS r
LIST NAME OF PERSONS EMPLOYED 06-na c>
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUI
BUSINESS OPERATION��uT!wN
AREA
l.�3 ���1^9H
[ENT. AND SUPPLIES BEING U� 9E
V
I HAV R,4AD, UNDERSTAND, AND AGREE WITH THE"CONDITIONS BT WHICH A
HOME CC -F&TION I ALLOWED ,(_CONDITIONS ATTACHED) .
APPLICANT SIGNATURE
/—/-7
DATE
IF APPLICANT IS 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.
Bu'ld' and Safet Department
APPROVED DENIED CONDITIONS ATTACHED
I .
BUS. LIC. NO.
1994 BUSINESS LICENSE APPLICATION FORM
*APPROVED BY
* DATE
...... PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
IS THIS BUSINESS LOCATED AT YOUR HOME: YES. NO
�- o e
2. Business Name:-
3.
ame:3. Business Address: L/L/1,5-0 Q,j-Q 4. Mailing Address:
5. Business Phone: O
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Securit # Z
y sy3-�I�-ZB
9. Name of Owner Title:
Or Officers
T
010. Type of Business:
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:
v�
$_��a oo
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 anda
any lice required -;by the Coun y, State or Federal Go 1 rnment:-'have been
issue to me anti are 'n full force -and of ect.
Title
Submit Form To:
4- .. -CITi OF LA QUINTA
_. BUSINESS LICENSE DIVISION
.78-495 Calle Tampico
La Quinta, CA 92253
Date