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LASALLE11111111111111111111 32 FEE $70.00 LA QUINTA, CALIFORNIA 92253 FAX (760) 777/-/7101 APPLICATION FOR HOME OCCUPATION OF A BUSINESS / (-- A//-7 3 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 M R-ckS 44 PROPERTY ADDRESS: �-S PHONE: MAILING ADDRESS: ��` � (IF DIFFERENTF OM ABOVE)�� PROPERTY OWNER: TYPE OF RESIDENC((SINGL , MULTIPLE, MOBILE HOME, ETC.): TYPE OF BUSINESS: • BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: D'�l% ,✓�%'``'�`�--�. NUMBER OF PERSONS INVOLVED IN BUSINESS: fes\ j SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): l/ 0 LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - 125 SQ FT.):� DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS OPERATION: . I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HO D. (CONDITIONS ATTACHED). APPLICANT'S SIGNATURE DATE IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR RENTAL/LEASING AGENT IS REQUIRED. r1 L_J Nes,wg CJ • OWNER/AGENT SIGNATURE DATE AGENT COMPANY NAME CONTACT PH. # DATE 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 AND SAFETY PARTMENT/CODE COMPLIANCE DIVISION: APPROVED DENIED SPECI=CONDIONSOFFICER I.D. # DATE • HOME OCCUPATION CONDITIONS AND CRITERIA ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING COND11IONS 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. (Spouses are okay) 2. The Home Occupation shall be conducted entirely within the enclosed area of the main building and 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 or 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 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 this permit: • CITY OF LA QUINTA MUNICIPAL CODES: 9.60.110, 9.160, and 9.210.060 /j 0 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 STATEMENT. Signatu e • 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. • 0 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 si n 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 m nsatio insurance carrier and policy number: Carrier: Policy Number: ' Z Expires: I Z' Z I -fl� 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, I will provide the City with a policy or certificate copy within ten (10) days of the change in requirements. I ffij�_ff A "M 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. 07/09/2013 10:14 FAX 0 002 ' cQ o -CERTIFICATE OF LIABILITY INSURANC ,SAL R ° 09; 9 0 PR?Q99-"-.1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Desert Southwest Ins Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 74-785 Highway 111 Suite 216�iC� j F' r ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. jpIan Wells CA 92210 `� f, y CS., .6 F1� ne:760-773-5955 Fax:760-779,,5.� INSURERS AFFORDING COVERAGE INSURED L - IV _ � INSURER A: Preferred Employers Ins. Co. _ INSURER B: LaSalle Painting Z Alc. INSURER C: 50855 Washington Street, #118 INSURER D: La Quinta CA 92253 _ - INSURER E: COVERAGES Inc rULII It, Ur IKJUKANLIZ LIN I tU BtLUW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY AEOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - LTR TYPE OF INSURANCE POLICY NUMBER DATE MWD Pb FOUCY LTE MMfDD/YI LIMITS GENERAL LIABILITY EACH OCCURRENCE S r� CO.MMERC;AL GONSR:.L UABIL171 CLAM MADE OCCUR ((( I FIRE DAMAGE (Arty one fire) s _ L7 MED EXP (Any ane pYrwn) S PERSONAL & ADV INJURY S Ir ) GENERAL AGGR7:T3ATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIQP AGG S POLICY 17 JECT 17 LOC , AUTOMOBILE LIABILITY L»- 1 ANY AUTO COMBINED SINGLE LIMIT (Eo evident) S ALL OWNED AUTOS BODILY INJURY` SCHEDULED AUTOS I (par Pe,z„) S HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per aedden,) S PROPERTY DAMAGE S _.�. _._.. (Per =idenl) GARAGE LiAmLrTy AUTO ONLY . EA ACCIDENT S I ANY AUTO I I EA ACC s OTHER THAN AUTO ONLY; AGG S EXCESS UABIUIY OCCUR u CLAIMS MADE I EACH OCCURRENCE S AGGREGATE -_ S S DEDUCTIBLE _ _ S RETENTION 11 _ $ WORKERS COMPENSATION oND EMPLOYERS LIABIL TY A I WYQd104502-2 I ' 12/21/02 12/21/03 TORY LIMITS °R' _ E.L,EACHACCIDENT S 1000000 E.L. DISEASE :EAEMPLOYEE. $ 1000000 E.L. DISEASE. POLICY LIMIT S j, 000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEMCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS *10 DAYS NOTICE OF CANCELLATION APPLIES FOR NON-PAYMENT OF PREMIUM LICENSE #: 780683 ,r. r-IVVVGR 1 14 wuUl,ruw,� IKDVKtY; IMIUMK LCI I CK: liAlrliCl.L.A I lu" 7 CONTSLB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _10-* DAYS WRITTEN • NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUY FAILURE TO DO SO SHALL Board Contractors Stats License IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR B P.O. BOX 269074 1 REPRESENTATIVES Sacramento CA 95826-9074 AUTNDROWREPR Hous® Accou ACORD 25-S (7197) ®ACORD CORPORATION 1988 HOME OCCUPATION CONDITIONS ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS: 1. No one, other than the resident of tre 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 and 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 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 directly related to this application and this permit: 1-7 _ / i.6 o MY SIGNATURE BELOW INDICATES THAT I HAVE READ, UNDERSTAND AND AGREE TO COMPLY WITH ALL OF THESE O ITIONS: P A- 03 �A SIGNATURE DATE �3� ice o - White Customer Copy -Yellow