CRANFORD0
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BUS. LIC. NO.
1994 BUSINESS LICENSE APPLICATION FORM
*APPROVED BY,(�,
* DATE
•*****.********/#*ter*wwir,ir**
...... PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
75-495 Calle Tampico.
1'.
IS THIS BUSINESS LOCATED AT YOUR HOME: YES xx NO
2.
Business Name: A Professional Conference Call
3.
Business Address: 78670 Highway 1'
_7£i6 5 v;>>Pta n,- 4. Mailing Address:suite 112
La Quinta CA 92253 La Quinta Ca 9225:
5.
Business Phone:( 619 ) 360-8317
6.
Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7.
If Corporation or Partnership: Tax I.D.#
S.
If Individual Owner: Social Security # 564-57-0645
9.
Name of Owner Matthew Cranford Title: President
•
Or Officers Ivonne Cranford Vice President
10.
Type of - Business: Teleconferencing Service
11.
IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO XX
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:
B. Previous Year Gross Receipts For Established Businesses:
S
********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
issued
required by the County, State or Federal Government have been
to m and
are in full fo and effect.
Signature
Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
75-495 Calle Tampico.
S
�\ FEE $35.00 IIIIIIIIIIIIIIIIIIII
51
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 Co"f;C-L" i CALL, PHONE 619- 34,0-Ff15 %
PROPERTY OWNER MA-TTkew Ce.r.Nyoa.> PHONE
PROPERTY ADDRESS 79'4oss Pe- . L.4, 3
MAILING ADDRESS .tSxmr
TYPE OF RESIDENCEsingle, muitiple, mobil home, etc.)
TYPE OF BUSINESS -rC�eC-0#-JC-64t.AS-ac+'`'l
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS 2
LIST NAME OF PERSONS EMPLOYED (-S)
SQUARE FOOTAGE OF USABLE FLOOR AREA -
• IN HOUSE ( EXCLUDE GARAGE) 1<-0 ( (���¢ Y..+ )
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
I HAVE READ, UNDERSTAND, AND AGR WITH THE CONDITIONS BY WHICH A
HOME OCCUPAT S Aj�U 0 TIONS ATTACHED).
A P CANT -9IGWATU 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.
• BuildiFn1 and Safety Department
APPROVED DENIED. CONDITIONS ATTACHED
Cj
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T4ht 4 4a Qu&M
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
Every employer who applies for any license or a renewal of any
license for a business issued pursuant to Section 37101 of the
Government Code or Section 7284 of the Revenue and Taxation Code
shall complete and sign a declaration that states the following:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury, one of the following
declaration:
I have -and will maintain a certificate of consent to self-.
insure for worker's compensation, as provided by Section 3700 for
the duration of any business activities conducted for which this
license is issued.
I have and will maintain worker's compensation insurance, as
required by Section 3700 for the duration of any business
activities conducted for which this license is issued.
• My worker's compensation insurance carrier and policy number:
•
Carrier:
Policy Number:
A "COPY" OF THE POLICY SHOWING THE AMOUNT OF COVERAGE AND
EXPIRATION DATE FOR WORKMEN'S COMPENSATION IS REQUIRED TO PROCESS
THIS APPLICATION.
/ I certify that in the performance of any business activities
for which this license is issued I shall not employ any person in
any manner so as to become subject to the worker's compensation
laws of California, and agree that if I should b come subject t
the worker's. compensation provisions of Sectio 700.
Date: h—�--� Applicant:
WARNING: Failure to secure workman's compensation coverage is
unlawful, and shall subject an employer to criminal penalties and
civic fines up to $100,000. In addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
Code, interest, and attorney's fees.
bus.fac
L•
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253