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Firma, Jackson, & Waxlax• I IIIIII VIII IIII IIII 21 T4hf 4 4a a" 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7050 FAX (619) 777-7011 APPLICATION FOR Fee3$ 5.00 HOME OCCUPATION OF A BUSINESS Read each condition listed on the attachment to this form to see if the proposed activity complies with the City's Home Occupation Regulations. APPLICANT NAMES (List all owners, partners and/or corporation officers) Q PROPERTY ADDRESS J = /-V-Q MVWJAz, 0�0A2- PHONEE6 =?o73 BUSINESS NAME PROPERTY OWNER�s W�'x MAILING ADDRESS (if different from business address) lb 9-pX 7 S Iv► , rA g2,2--�3 TYPE OF RESIDENC singl , multiple, mobile home, etc.) TYPE OF BUSINESS SDPTW r— BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE NUMBER OF PERSONS INVOLVED IN BUSINESS OCT 2 2 1997 LIST NAMES OF PERSONS EMPLOYED s F-� AC1-CaD �f TY 0�� �9'�� SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (exclude garage) LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (example, "bedroom - 125 sq. Ft.) S2 57-Ff • DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS OPERATION tp-PT64. FWD -P4&. VR-14'rtf—,y7AX MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 a I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME OCCUPATION IS ALLOWED (conditions attached). Date to h 4 j 7 Applicant's Signature IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR RENTAL/LEASING AGENT IS REQUIRED. Owner/Agent Signature Agent Company Name Date Date Agent/Owner Contact Phone # iMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING YOUR HOME OCCUPATION; FAILURE TO COMPLY WITH THE CONDITIONS LISTED ON THE ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMIT. BUILDING & SAFETY DEPARTMENT/CODE COMPLIANCE DIVISION is �G APPROVED �D 23 DENIED SPECIAL CONDITIONS ATTACHED BY: 1. D. # S —8� DATE a 2 3 9 • countera HOME OCCUPATION 0. CONDITIONS AND CRITERIA ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS AND REQUIREMENTS: No one other than the resident of the dwelling shall be employed on the premises in the conduct of the Home Occupation. 2. The Home Occupation shall be conducted entirely within the enclosed area of the main building & shall not occupy more than 25 percent of the total area of the structure. 3. A Home Occupation shall not be conducted within an .accessory structure. There may be storage of equipment or supplies in an accessory structure. Garage space may be used for the conduct of a Home Occupation only when it does not interfere with the use of such space for the off-street parking of vehicles required by Chapter 9.160 of the Zoning Ordinance. 4. There shall be no outdoor storage of equipment, machinery, supplies, materials, or merchandise. There shall be no sales activity, either wholesale or retail, except mail order sales, nor shall there be the maintenance of an office open'to the general public. 6. There shall be no supply of hazardous materials stored on the premises at any given time (i.e. pool, chlorine, paint thinner, etc.) Unless the hazardous materials are stored in a manner approved by the State Fire Marshall or any other regulating agency. •7. There shall be no dispatching of persons or equipment to or from the subject property, including the use of vehicles which operate to and, from the premises. 8. No vehicles or trailers except those normally incidental to residential use shall be parked at the residence at any time. 9. There shall be no use of any mechanical equipment, appliance, or motor outside of the enclosed building or which generated noise detectable from outside the building in which it is located that is related to the business. 10. There shall be no signs or other devices identifying or advertising the home occupation. 11. In no way shall the appearance of the building or lot be so altered, or the home occupation be so conducted, that the lot or building may be reasonably recognized as serving a non-residential use (either by color, materials, construction, lighting, sounds, vibrations, etc.) 12. No Home Occupation shall create a nuisance by reason of noise, odor, dust, vibration, fumes, smoke, electrical interference, traffic, or other causes. 13. The use shall meet reasonable special conditions as established and made of record in the Home Occupation Permit, as may be deemed necessary to carry out the intent of this Section. 14. Listed below are special conditions which shall be considered a part of the conditions and criteria directly related to this application and permit. • 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 the business license can be processed. your company has employees, a copy of the workman's If you do not have employees, please check the last line on the first 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 used. If you have any questions, please contact the Code Compliance Division at 777-7050. 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 comoletand sign a declaration that states the following: WORKER'S COMPENSATION DECLARATION 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 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: P4s .FvN 0 Policy Number: A "COPY' OF SAID POLICY OR CERTIFICATE OF CONSENT SHOWING THE AMOUNT OF COVERAGE AND EXPIRATION DATE FOR WORKER'S COMPENSATION IS REQUIRED TO PROCESS THIS 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 the worker's compensation provisions of Section 3700, 1 will provide the City with a policy or certificate copy within ten (10) days of the change in requirements. Date: �T�9� Applicant: 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. 0 C OCT 16 '97 12:23PM SCIF RIVERSIDE POLICY STATE COMPENSATION INSURANCE FUND Dear Applicant: P.1/9 IN REPLY ArPrR TO: Thank you for contacting us regarding your workers' compensation: insurance needs. Per our conversation of iv—i4 - 41 we wilU need the following application completed. Along with the completed application, we will need additional material in order to expedite your request for coverage. ,Please provide copies of the following information with the attached forms: ?� Business License Fictitious Business Name Statement Contractor's License Public Utilities Commission License Partnership Agreement w Articles of incorporation _x!:7 Domestic Stock Certificates Dec Page of Medical Insurance Remarks: , fit /� Purchase Agreement/Escrow Papers SB 198 (Written Safety Program) Five -Year Policy History (45 days current) on the letterhead of your agent or carrier to include - coverage dates, premium paid, number and type of claims paid, incurred costs and status of each claim. Once we have received the information indicated above, along with the completed application, we Can process your request for insurance, If you should have any additional questions, please feel free to contact us at (909) 656-8300. Sincerely, O r .s? .RiveWde Customer Service Representative 6301 Day SU'w1 • RiverSide, CA 92507.0942 (309) 656.8300 Policy Fax (909) 656-6359 Claims Fax (909) 653-1597 Mailino Address: P.C. Box 5025 • Riverside, CA 92517.5025 0 c; 0 SofTime Inc. List of Corporate Officers President: Vice President: Treasurer: Secretary: Rick Firman Stephen Jackson Jeff Jackson Kenneth Waxlax Phone: 714369-5179 FAX: 714-369-5180 E-mail: www.corp@soffime.com 1 10/21/97 • • Sof Time Inc. soF-rfMe Slid •mss, Inc Employee Contact October 21, 1997 Employee Brian Pollak Jeffery N Jackson Jo G Jacobsen Kenneth B Waxlax ` Michael J Stone Pam S Nieto Peter Schuller Rick Firman Sean Colgan Stephen Jackson Phone: 714369-5179 FAX: 714-369-5180 E-mail: www.corp@softime.com Sof Time Inc. Share Holders NAME NUMBER OF SHARES Jeffrey Jackson 31,770 54-920 Avenida Diaz. La Quinta, CA 92253 Kenneth Waxlax 54-920 Diaz La Quinta, CA 92253 Stephen Jackson P.O.. Box 190 La Honda, CA 94020 • Richard Firman 121 Calle del Pacifico San Clemente, CA 92670 John & Megan Shapiro 3 Sherbrooke Park Purchase, NY 10577 James Carey 14 Willow Road Riverside, CT 06878 Joseph Delaney III C/O 1585 Brondany New York, NY 10036 • 31,770 31,770 11,767 3,530 1,765 1,765 Phone: 714369-5179 FAX: 714-369-5180 E-mail: wwwcorp@softime.com Share Holders Page 2 NAME NUMBER OF SHARES Richard & Alice Shelton 1,765 11 White Woods Lane Westport, CT 06880 Keith L. Grzecka 1,765 14 Clancy Drive Northport, NY 11768 Richard A. Smith 2,541.30 145 Central Park West 19C New York, NY 10023 Nancy Kim Caffery 952.99 40-964 Sonata Court Palm Desert, CA 92260 • Michael & D. Elizabeth Craven 1,588.31 2240 SW Stephenson Portland, OR 97219 Robert & Mary Daltry 1,588.31 1405 SW Country Commons Lake Oswego, OR 97034 Patrick J.W. Allen 953 71 Old Readingsburg Road Califon, NJ 07830 Christopher C. Thompson 2,700 209 Springwater Lane I�qw Canaan, CT 06840 (rC. Bloomberg 1,905.97 'Niedermeyer 5,082.59 0 � � r • Share Holders Page 3 NAME NUMBER OF SHARES Robert H. Despirito 794 John C. Coleman, Jr. 635.32 2211 First Ave. Napa, CA 94558 JJr,fTrey Jackson 51-450 Carranza La Quinta, CA 92253 n LJ 0 3,176.62