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78-495 CALLE TAMPICO - LA QUINTA,
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CALIFORNIA 92253 - (619) 777-7050
FAX (619) 777-7011
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APPLICATION FOR I I1
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Fee$35.00 HOME OCCUPATION OF A BUSINESS
SEP p, 19961
Read each condition listed on the attachment to this form to see if the pro ed activi-f—y
complies with the City's Home Occupation Regulations.
APPLICANT NAMES (List all owners, partners and/or corporation officers) -S f+� 5M
PROPERTY ADDRESS561790 N3 Efa t DA MVk-Oi3fO PHONE 6_20q D1_04o-
BUSINESS NAME S +--� S � k_V-1-A-
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PROPERTY OWNER ? I G
MAILING ADDRESS (if different from business address)
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) .5% Q 4::. Lt
TYP
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TYP E OF BUSINESS SaCl 040 01E ffA-4jo k'u-ni (zkFu_--S 4 SHCI-�u_ds
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE �:) ( Q
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.;-.NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED S 4PILA-) ti S NA t -71+
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (exclude 9,-taqe,)
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY 114. nmr-, 1,03mm pie,
"bedroom - 125 sq. Ft.) 100
D�--�.OAIPTIOI
OPERATION.
� blz MACHINERY, -,EQUIPMENT, AND SUPPLIES BEING
MAILING ADDRESS K0.-�,BOX 1504 A QU:NTA, CALIFORNIA 9225.-1
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (conditions attached). ;
• Date 941,2 ,2
Applic nt's Signature
IF APPLICANT IS OTHER THAN PROPERTY .OWNER,
RENTAL/L ASING AGE T IS REQUIRED.
2 W. ®R
caner/Agent Signature
AUTHORIZATION OF OWNER. OR
Date
Date
Agent Company Name 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.
APPR VE DENIED SPECIAL CONDITIONS ATTACHED
BY: I . D. # DATE
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HOME OCCUPATION
CONDITIONS AND CRITERIA
ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS AND REQUIREMENTS:
1. 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.
5. 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.
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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: "1 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 complete and 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:
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: 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.
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Certificate .No: 9330
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State of California
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;. Department of Justice
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CERTIFICATE OF ELIGIBILITY ' .
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Issued to:
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Shawn Kevin Smith .
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This is to certify that the Department of Justice has completed its records check. As of the date of
issue, there is nothing that would prohibit the above named individual from acquiring or
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possessing firearms.
This certificate is not valid for more than one year from the date of issue.
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Date of Issue: June. 13, 1996 Expiration Date: June 13, 1997
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Signature of Issuing Officer:Rim
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DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED
CALIFORNIA STATE BOARD OF EQUALIZATION
SELLER'S PERMIT
ACCOUNTNUMBER
10/1/1996 SR EHC 99962847
SHAWN KEVIN SMITH
53790 AVENIDA MADERO
L LA QUINTA, CA 92253 J
IS HEREBY AUTHORIZED PURSUANT TO SALES AND USE TAX LAW
TO ENGAGE IN THE BUSINESS OF SELLING TANGIBLE PERSONAL
PROPERTY AT THE ABOVE LOCATION
BT -44244 -LZ REV. 12 (8-95)
THIS PERMIT DOES NOT
AUTHORZE THE HQIDER
Til ENGAGE IN ANY
BUSINESS CONTRARY TO
LAWS REGULATING THAT
BUSINESS OR TO
POSSESS OR OPERATE
ANY ILLEGAL DEVICE
Not valid at any other address
THIS PERMIT IS VALID UNTIL REVOKED OR CANCELED BUT IS NOT TRANSFERABLE IF YOU SELL YOUR BUSINE88,
OR DROP OUT OF A PARTNERSHIP, NOTIFY US OR YOU COULD BE RESPONSIBLE FOR SALES AND USE TAXES
OWED BY THE NEW OPERATOR OF THE BUSINESS.
NOTICE TO TAXPAYERS
INFORMATION FURNISHED TO THE BOARD OF EQUALIZATION
The Information Practices Act of 1977 requires this agency to provide the followingg notice to individual taxpayers who are asked by
the State Board of Equalization to supply inforrmatiorl:
The principal purpose for which the requested information will be used is to administer the Ca6lDrria Sales and Use Tax Laws,
Special Taxes Laws, or Timber Yield Taos Laws. This includes the determination and wWcbon of the correct amount of tax.
As an individual taxpayer, you have the right of am= to persons inlDrnation about you in records maintained by the Board of
Equalization. Please contact your local Board office listed in the while ;epee for assistance.. B the local Board office is unable:to
provide the information sought, you may also contact the Registration Unit in Sacramento at (916) 324.2397.
The Board officials responsible for maintaining this information. am Sales and Use Taos, Deputy Director. Sales and Use Tax.
Department, 450 N Street, MIC -4,% Sacramento, CA 95814, telephone (916) 445-1441; Excise Tax, Fuel Tax and Environmental .
Fee Tax, Deputy Director, Special Taxse and Operations Deparimen% 450 N Street, MI1=1, Saaame % CA 95814, telephone:
(916) 445-9356; Timber Yield Tax. Deputy Director, Property Taxes Department, 450 N Street, MIC:63, Sacramento, CA 95814,
telephone (916) 445-1516. If the Deputy Director is unable b provide the information sought you may also contact the Information
Security Office in Sac ranw to, telepllorro (916) 324-1927.
The California Reverim and. Teratism Cade,, Parts 1, 1.5 and 1.6 (Stale Sales and Use Tax). 2 (Motor Vehicle Fuel Tax), 3 (Use
Fuel Tax), 7 (Taxi on, Insurers),.. 13 (Ciperletle and Tobacco Products Taxy 14 (Alcoholic Beverage Tax), 18.5 (Timber Yield Tax), 19:.
(Energy Resources -Surcharge). 20 (Emergericy Telephone Users Surcharge), 22 (Hazardous Substances Tax Law), 23 (Sotid`-
Waste Disposal Sites"Cbwiup I and Maintenance Fee Law), 24 (Oil Spill Respona% Prevention and Administration Fees), and 25:
(Underground Slorage Taif iMalntenence Fee Law), and Part 31 (Diesel Fuel Tax); Government Code, Tette 7.3; Chapter. 6 (Tis
Recycling Feey; Publid Resources Code; Div. 30, Part 7, Chapler 4 (Oil Recycling Fee); Health and Safety Code, Div. 1, Part 1,
Chapter 2. Article 4.6 (Childhood Lead Poisoning Prevention Fee); and Chapter 1 of the Public Utilities Code (Hazardous Spin
Prevention Fee) require persom meeting certain requirements to file applications; for registration, app icatiorls for Permits or licensee,
and tax rectums or reports in such form as prescribed by the State Board of Equalization. .
It is mandatory that you furnish all of the required information requested by applications for regiatratiorT. appkaticne for permits or
licensee, tax raturns and other related data. Failure to provide all of the required informabon requested by an application for a permit
or license could result in your not being issued a permit or license. In addition, the law provides penalties for failure to file a return,
failure tD furnish specific information required, Wm to supply information required by law or regulations, or for AaTastung fraudulent
information.
Pursuant to California law, the information appea ft on the face of any permit or license issued by the Board is a public tecorld.
Information you fumish to this agency may be used for the purpose of collecting any outstanding tax liability and may be given to
federal, state, and local govemment agencies as authorized by law.
COPIn4MMIMM ORIGINALS 9-19-96 �,�
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DEPARTMENT OF THE TREASURY - BUREAU OF ALCOHOL, TOBACCO AND FIREARMS --
LICENSE (18 U.S.C. Chapter 44)
In accordance with the provisions -66i -Title' I, Gun Control Act of 1968, and the regulations, Issued
thereunder (27 CFR Part 178), you are licensed to engage in the business specified in this license,
within the limitations of Chapter 44, Title 18, United States Code, and the regulations issued thereunder,
until the expiration date shown. See "WARNINGS" and "NOTICE" on reverse.
CHIEF, F 8 E LICENSING CENTER NUMBER 9-33-033-01-9K-40506
DIRECT ATFNDE BATF, P * 0• BOX 2994f
_ NUMBER
CORRESPONDENCE
TO ATLANTA# GA 30301•-2994:
EXPIRATION •
OCTOBER 1• 1999
NAMELICENSED PREMISES: 5379{!. MA6ERO '
SMITHS SHAWN K LA.01)INTAi CA 92253
WK0F 01 — DEALER IN FIREARMS OTHER THAN DESTRUCTIVE DEVICES
LICENSE
LICENSING CENTER � .
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PURCHASING CERTIFICATION LICENSEE: MAILING ADORESS
I certify that this is a true copy of a license SMITH• • SHAWN K
Issued t me to n a the bu ess specified. 53790 i MADERO
LA DUINTAv CA
(S NATURE OF LICENSEE) 92253
The licensee named herein shall use a reproduction
of this license to assist a transferor of firearms to
verify the Identity and the licensed status of the
licensee as provided in 27 CFR Part 178. The
sl nature on each reproduction must be an
ORIGINAL signature.
ATF FORM 8 (5310.11) (6/91) PREVIOUS EDITION IS OBSOLETE
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