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BUS. LIC. NO.
1994 BUSINESS LICENSE APPLICATION FORM
*APPROVED BY
DATE . l�_ 9S *
......PROOF OF WORKERS COMPENSATION INSURANCE*IS*REQUIRED .ry..F****##***
1. IS THIS BUSINESS LOCATED AT YOUR HOME: . YES_ NO
2. Business Name: _ -Jo- `r7 5 pvs'r/N 17
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3. Business Address: 4. Mailing Address: 5114__e� F
�f 3 (,X ), / In w C� �� ,C�, �iiK f� J
5. Business Phone:( 6 �1 3" 42L `f
6. Owned By: CORPORATION PARTNERSHIP
�IDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # 566 35 6 d 5
9. Name o f Owner _�p� tom --Lo 2 F, t--
— Title:- Title: � G
Or Officers
10. Type of-, Business: PO 027 -!OU 6 �p5 S v�PG
11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO
12. SHE Resale Number: R C 9(o Zy2
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:
i
#`*"*•**GOOD ONLY FOR JANUARY 1 1994 THRU DECEMBER 31 1994
� � *tr,trw*
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 to me and are 'n full force and effect.
Sig ture Title
Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
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NA r_79
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FEE $35.00 I II'lll IIII' IIII IIII
33
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 To 6'-5 Spoe7-I✓! PHONE 36D /g)_
PROPERTY OWNER To (3 L.OPf-y PHONE 36o t22 y
PROPERTY ADDRESS 44-37-0 W i 11yW C i rc F2 `1' - �i Jtn rig
MAILING ADDRESS 15 -iME
TYPE OF RESIDENCE (single, multiple, mobil home, etc.) 5ay6cxz_ HomL
TYPE OF BUSINESS SPoast-i�16 �5 fioo�5 rt SuPP�y
BRIEF DESCRIPTION OF HOW THE BUSIN SS WILL OPERATE
5Po /nlc50SU POc F� 6TN i/✓C c/7'�oc>�S
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED e
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) 16oO Sr_
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME DRO o o,-, / 3D S �-
(EXAMPLE, BEDROOM -125 S.F. )
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION CO kpoTee—,
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPATIQN IS AIAOWED (CONDITIONS ATTACHED). _ , ,
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.
• Buil-----and Safety De attment__________________________________
APPROVED DENIED CONDITIONS ATTACHED
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