Firma, Jackson, & Waxlax•
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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
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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
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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
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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
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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
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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
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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
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3,176.62