SANTIAGO (2)•
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/Z CITY OF LA QUINTA
HOME OCCUPATION APPLICATION
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253
(619) 564-2246
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.
APPLICANT'S NAME PHONE
PROPERTY OWNER �D/d/R�Q �uPHONE
PROPERTY ADDRESS 5-1 — S'7 NA vfa 22a
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
f�l TYPE OF BUSINESS
•
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS 1
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA IN PAID $35.00
HOUSE (.EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF F
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.") 2?6-D R 00N(
DESCRIPTION OF MACHINERY,
BUSINESS OPERATION
ALIDATIDN"STAMP ;U -7—
S E P 0.3 1992 tX */—a /-S
BUILDING AND SAFETY DEPT.
i.
AND S -i-- $�EING USED IN THE
V
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
Si
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
REQUIRED.
OWNER/AGENT SIGN
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 Safes De a ent
APPROVED BY &E DATE Y
DENIED BY DATE
CONDITIONS ATTACHED
•
BUS.
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1992 BUSINESS LICENSE APPLICATION FORM
LIC. NO.
******************************************************************
*APPROVED 41� INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO�_
2. Business Name: V, 7-14 .S4 t27 -11J e
3. Business Address:/-5�.2 �/�//A�jPd 4/.G✓ Mailing Address: P.O ed -X -S y'
22
5. Business Phone:(
6. Owned By: CORPORATION PARTNERSHIPDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # -5 7-3
9. Name of Owner %� 7-/-1 S/VNT/A6- d Title:
Or Officers
10. Type of Business: S rlE X F TS
11. SBE Resale Number: c:s + ET i0... 9 9 — 1 Z-7 7 -7
12. 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 1,1992 THRU DECEMBER 31,1992*******
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 in full force and effect.
Signature Title Date
• Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box .1504
La Quinta, CA 92253
Design 8 Production: Mark Palmer Design. 619.346.0772