LARSONT16 t=kl q-- (J-;-- SA
CITY OF LA .OUINTA,
I II'III VIII IIII II'I �
78
78-105 Calle Estado
P.O. Box 1504
HOME .00CUPATION PERMIT La Oulnta, CA 97253
(819)584-2248
APPLICATION=
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)
APPLI CANT' S NAME h S / /l /T Q ~- PHONE
PROPERTY OWNER J/i S / I�' '� �T O ��(' PHONE 6
PROPERTY ADDRESS /i
TYPE OF RESIDENCE (single, multiple, m bnile hgme,'etc.) a:_4
r. O10,
TYPE OF BUSINESS
HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE F OOR AREA IN
HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE -FOOTAGE -
QUARE FOOTAGE_ OF' AREA OF
BUSINESS ACTIVITY IN HOME (EXAMPLE,..
"BEDROOM -/125 SQUARE FEET")
DESCRIPTION OF MACHINERY,
OPERATION Cal
P 4Li
VALIDAOVK 88461 05-0-89 35.0010
AND SUPPLIES•BEI"NG USED IN THE BUSINESS
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS LN,D
LOWED (COITIONS ATTACHED). ,17
ADPLICAXT" SI
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.
P\LA,NNING b' DEVELOPMENT
y APPROVED. Bl� DATE 11 CONDITIONS ATTACHED
DENIED BY DATE
----------------------- - -- - -----------------------
CODE ENFORCEMENT
APPROVED BY DATE CONDITIONS
ATTACHED
DENIED'.`". BY DATE
MR/FORMJH.004
REVISED 08/89
71
FOR OFFICIAL
M N T
USE ONLY
1Y
-
:4---