Round (3)B. Previous Year Gross Receipts for Established Businesses:
$ / yS! o -'o
***********GOOD ONLY FOR JANUARY 1, 1995 THRU DECEMBER 31, 1995**********
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 a e f force and effect.
Signature
•
Title Date
Send Completed Form To:
CITY OF LA QUINTA.
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
P. 0. Box 1504
La Quinta, CA 92253
5.
Business Phone: ( 6/f ) 77/_?S/y
6.
Owned By: CORPORATION PARTNERSHIP
INDIVIDUAL
7.
If Corporation or Partnership: TAX I.D.# 9 7/y
8.
If Individual Owner: Social Security #
9.
Name of Owner /i1ie.e.!ryE7
Title:
Or Officers
10.
Type of Business: sy,,o�1►z.2 aor- ,� /�
�,�/ti•►%�
11.
IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY
HEALTH PERMIT:
YES N0.
12.
SBEResale 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:
$ / yS! o -'o
***********GOOD ONLY FOR JANUARY 1, 1995 THRU DECEMBER 31, 1995**********
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 a e f force and effect.
Signature
•
Title Date
Send Completed Form To:
CITY OF LA QUINTA.
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
P. 0. Box 1504
La Quinta, CA 92253
FEE $35.00
- L
CITY OF LA QUINTA i
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£So�?ct /moi/cAoSysTfi•+S,
Z—PHONE
PROPERTY OWNER G. -,y m /2ou,va
PHONE S.9ssf
PROPERTY ADDRESS
r , I.a
9zz
MAILING ADDRESS
TYPE OF RESIDENCE
( single, multiple,
mobil home, etc.
.,iri /t �'o„a
TYPE OF BUSINESS
BRIEF DESCRIPTION
OF HOW THE BUSINESS
WILL OPERATE
Dl.ivfe Pg,, B ciC� 1
a�Y3i .C3�SF Sfi4l7G`f1 rf
�2gfo� £1 /1 F,n c/t'✓ � %�,-:4.E� S�.� Ta iN/fi /aQ
NUMBER OF PERSONS
INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED �� /
Ooc.,riq,y'7t
7W
SQUARE FOOTAGE OF
USABLE FLOOR AREA
C'/rsa5
IN HOUSE (EXCLUDE GARAGE) Z/,6 6
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 �o,.,� ��.e ,�,4?r, e'u//r,e, 7`f
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPATS�IS (CONDITIONS ATTACHED) . ��31/9.r-
APPLICANT SIGNATURE
DA
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.
-------------------------
Buildinq and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
N
Return check to requestor
Name / Title of person requesting check
Department individual is associated with:
+J jlVail check
Date check required by:
b
Check payable to:
CO
Amount: $
—am e (Vendor o.
-.41 '/QUO% Account Number: ® I— 000 —
(Address)
- Cj �.'5
Check description and invoice number:
int` �1
Describe emergency in detail:
•
FEE $35.00
�tty nC �i'QuiHfw
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 R£so,�et/l�ica2csysTf.•+s,
PHONE
G/9' 7�/-
PROPERTY OWNER 1,—g -V PHONE 6;0ovz
PROPERTY ADDRESS .TS - S' 9zzjz-?
MAILING ADDRESS 15�,"-S-
TYPE OF RESIDENCE (single, multiple, mobil home, etc.)
TYPE OF BUSINESS Z o~,,—rrz - S,snojr
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
O& -1A -s4 �GLr �/�1 agS� Q�QcS£ S'fi4/ZCHtS 1.,29
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) 7-1.1,e
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 -ey, 1,rx, 7'� /rP �on.1 � 1-axec
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPAT��I �(CONDITIONS ATTACHED) . If -13
APPLICANT SIGNATURE DA'
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.
Building and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
4
In
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.
XI 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 become subject to
the worker's compensation provisions of Section 370
Date: sh/ �J'J Applicant :
WARNING: Failure to secure workman's compensation coverage is
unlawful, and shall subject an employer to criminal penalties and
civic fines up to $100,000. In addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
Code', interest, and attorney's fees.
bus.fac
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 �a�.
1.
4 BUS. LIC. NO.
1995 BUSINESS LICENSE APPLICATION FORM
****************************
*APPROVED BY
* DATE
****************************
PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED PRIOR TO ISSUANCE
IS THIS BUSINESS LOCATED AT YOUR HOME: YES X Nn
2. Business Name: Z-.5'40�r'r "OWIcCRosy�r�"r o
3. Business Address: S -r - S'd4'/ �'i�Gac� Fes,, 4. Mailing Address: s �
5. Business Phone: -;7
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: TAX I . D . # �.$�' 3 �a 9 ?/ y
8. If Individual Owner: Social Security #
9. Name of Owner �fSd c2�'� fliice,�ygTt�rTitle: ��1Ffim1•�
Or Officers
Type of Business:
11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO
12. SBEResale 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:
***********GOOD ONLY FOR JANUARY 1, 1995 THRU DECEMBER 31, 1995**********
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 mefull force and effect.
7;�
Signature Title Date
Send Completed Form To:
CITY OF LA QUINTA.
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
P. 0. Box 1504
La Quinta, CA 92253
y"
BUSINESS. -LOCATED IN,. THE CITY *OF*'. LAI _QUINTA ONLY
GROSS RECEIPTS
RANGE
CLASS 1
CLASS'2
CLASS 3
0
- 25,000
$ 15.00
qcira
$ 21.00
25,001
- 50,000
25.00
;;30..00
36.00
50,001
- 100,000
30.00
3.6000
43.00
100,001
- 250,000
46.00
55.00
66.00
250,Q01
- -500,000
76.00
;90.00
108.00
500,001
- :.750,000
114.00
x,1.3:5.0.0
162.00
750:;,0.01
- ` 1 Q0.0;, 000-
150.0'0
:: k"8`0.00
216.00
1,000"'001
� 2,000,000
.400:00
500>`00
600.00
2 ; O.OQ,,001
- 3,000,000
500.00
6.25.:.00
750.00
3.,,000, 001
- 4,000,000
600.00
750..00
900.00
4.,,000,001
- 5,000,000
700.00
8'75:00
1,050.00
5,000,001
- 1Q, 00.0, 000
1, 000.001,.2501:'0.0
1,500.00
10,000:,001
- and up
'.;1,500.00
1.; 87 S. 00
2,250.00
CLASS 1 Automobile Repair and•.Services;.Laundry,,'Dry Cleaning &
Garment Services;, -Manufacturing; Retail.& Wholesale
Trade.
CLASS 2 Amusement & Recr"eation Services, including Motion
Pictures; Architectural Services;.Automotive Sales;
Barbers & Hairstylists; Beauty Shops; Engineering
Services; Landscape & Horticultural Services; Operators
Renters & Lessors of Commercial Prop.rty; Services to
Buildings; and all other persons engaged in business
not specifically listed elsewhere.
CLA_.S�S 3 Accounting, Auditing &: Bookkeeping;Serv.ccs; Financial
Services";.. Insurance Brokers & Servi.ces.; -;Legal Services;
Management &-.Public Relations Serviee•s Medical &
Health. Services; Reale Estate Agents,:{Brokers., Managers
& Services.
or