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GIROUX4V a" P.O. Box 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92247 COMMUNITY SAFETY DIVISION (760) 77 7-7 05 0 FAX (760) 777-701 1 HOME OCCUPATION PERMIT Permit Number: 08-000024.42. Please read each condition listed on the attachment in this packet to see if the proposed activity complies with the City's Home Occupation Regulations. Applicant name(s): (List all owners, partners, and/or corporation officers) JASON GIROUX Property address: 52045 AVENIDA CARRANZA Phone: (760) 309-2195 /D q Mailing address: P O BOX 581 0 Property owner: MAY 0� ?OQ Type of business:. Window Coverings c� qN �AQU B Brief description of how the business will operate: �oFPTrq Square footage of usable floor area in house (exclude garage) 1250 Location and square footage of area of business activity'in home (Example: Bedroom — 125 sq ft.) Bedroom/Nook, 160 Description of machinery, equipment, and supplies being used in the business operation: I HAV;E� AD, UD RSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME OCCUPATION IS LOWED. (Conditions Attached) ` 2 ®8 AP _ICANT SIGNATURE DATE If applicant is other than the property owner, authorization of owner or rental/leasing agent is required. Your inspection•has been scheduled for Home Occupation Inspection between'Mon 5/5 @ 9am-9:30am. Your inspector will be Michael Morris., --------------------------------- ----------- INSPE OR USE ONLY ---------------------------------------------------- 2 APPROVED ❑ DENIED Inspector Signature Date . CE HP 04/25/2008.FRI 12:30 FAX FEE $70.00 P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Z002/006 _ (760)777-7000 FAX (760) 777-7101 APPLICATION FOR HOME OCCUPATION OF A BUSINESS INSPECTION DATE: Please read each condition listed on the attachment in this packet to see if the proposed activity complies with the City's Home Occupation Regulations. APPLICANT NAMES: (List all owners, partners, and/or corporation officers PROPERTY ADDRESS: 6_Z �'` ��`� 616 PHONE: -11-U/� MAILING ADDRESS: V ©� X� `�Sl �'4 9ZZ (TF DIFFERENT FROM ABOVE) PROPERTY OWNER TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): TYPE OF BUSINESS: KJ?f1100L10- . BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: 7:2� LMe fWVWZ,57:4 Ta C f-�ru�� �1r . Y rs r� > �• � 27 /5 +L/L_ NUMBER OF PERSONS INVOLVED IN BUSINESS: SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): tk -56Z LOCATION AND SQUARE FOOTAGE AREA OF BUSINESS ACTIVI'T'Y IN HOME (EX. BEDROOM.- 125 EDROOM-125 SQ FT.): 4 - DESCRIPTION O MARY, EQUIPMENT, AND S PLIES BEING USED IN THE BUS S OPERATION: ��l+�l���. VE READ, NDERSTAND, AND AGREE WITH THE CONDMONS BY WHICH A CCUPATIO ALLOWED. (CONDITIONS ATTACHED). ' ANT'S SIGNA V1 15ATW IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER. OR RENTAL/LEASING AGENT IS REQUIRED. jM W 04/25/2008 FRI 12:31 FAX • OWNER/AG SIGNA ATE 'AbENT COMPANY NAME CONTACT PK.# ATE IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING YOUR HOME OCCUPATION; FAILURE TO COMPLY wrm THE CONDITIONS LISTED ON THE ATTACHED PAGE SHALL. BE GROUNDS FOR REVOCATION OF PERMIT. BUILDING AND SAFETY.DEPARTMENTMODE COMPLIANCE DIVISION: APPROVED DENIED SPECIAL CONDITIONS OFFICER I.D. # DATE 4 IA 003/006 04/25/2008 FRI 12:31 FAX PLEASE READ! Please contact your Homeowner's Association prior to paying for your Home Occupation Permit. Your Homeowner's Association may restrict or prohibit home based businesses. • I HAVE READ AND UNDERSTAND THIS Z004/006 04/25/2008 FRI 12:31 FAX WORKER'S COMPENSATION If your company has employees, a copy of the Workman's Compensation Policy must accompany the -business license application, indicating dates of coverage and dollar. amount. This proof of coverage must be received before t1mbusiness license can be processed. If you do not have employees, please check the last section on this page: "I Certify that......" If your business is being operated from your home in La Quinta, a Home Occupation Permit is required before a business license is issued. If you have any questions,'please contact the Code Compliance Division at 777-7050 Every employer who applies for any license or 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: I hereby affirm under penalty of perjury, one of the following declarations: 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 Com tion Insuranceas . pensa � , 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: Expires: A COPY OF SAID POLICY OR CERTIFICATE OF CONSENT SHOWING THE AMOUNT OF COVERAG EXPIRATION DATE FOR WORKEWS COMPENSATION IS REQUIRED TO .-PROCESS 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 become subject to th rker's compensation provisions. of Section 3700, I will provide the City with a or certificate copy within ten (10) days of the change m requirements. APP1;1C4NT SIGNATURE f DATE WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties -and civil fines up to $100,000. In addition to the cost of compensation, damages, interest, and attorney's fees may be assessed to you as provided in Section 3706 ,of the Labor Code. 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