Loading...
Ochoa (2)09 All 4 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7050 FAX (619);777-7011 APPLICATION FOR Fee 35.0 HOME OCCUPATION OF A BUSINESS, � JVN Read each condition listed on the attachment to this form to see if the—p.r sed active ty complies with the City's Home Occupation Regulations. P� J�ANT NAMES (Lisj pll owners partners and/or corporation officers) Ufy� . PROPERTY ADDRESS 5 �^ � � cllG i��j�o�.� PHONE BUSINESS NAME /s PROPERTY OWNER 0 MAILING ADDRESS (if different, from business address) TYPE OF RESIDENCE (single, multiple, mobile home, etc.) TYPE OF BUSINESS ���✓/Z'o/Z/CI'� BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE C Gr%i l 4_�-a IAI u, C NUMBER OF PERSONS INVOLVED IN BUSINESS LIST NAMES OF PERSONS EMPLOYED US� SQUARE FOOTAGE OF: USABLE FLOOR AREA IN HOUSE (exclu LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS' ACTIVITY IN HOME (example, "bedroom - 125 sq. Ft.), ' 7 a4w r j SCJ WDESCRIPTION OF MAC�HINE Y, EQUIPMENT, AND SUPPLIES BEING USED IN -TH BUSINESS OPERATION baxol O�✓ MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 ��(, • I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME OCCUPATION IS ALLOWED (conditions attached). Date Applicant's Signature IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR &r/Agent LEA NG AGENT IS REQUIRED. Date Sig atur 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. BY: countera I.D.# 6—((jjJ0/ SPECIAL CONDITIONS ATTACHED r 4 :. 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 complete and sign a declaration that states the .following: WORKER'S COMPENSATION DECLARATION 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. 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: 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. • • .. Page 1 APN 773-181-015 Use: SINGLE RESIDENCE Phone Owners: MITCHELL,PATRICIA M Pg-Grd: 224 -D1/879 -F1 S' e 51815 AVENIDA MENDOZA*LA QUINTA CA 92253 Census: 0451.046 i 370 17TH ST 3650*DENVER CO 80202 Zoning: R1 F1oodP: 060245 2270 Legal : LOT 3 BLK 118 MB 018/079 SANTA CARMELITA AT VALE Map: MB -018-079 Tr/Lot/Bl: 00000-00/L-0003/118 Assd :.$74,807 TRA 020016 SaleDt: 07/01/81 SaleAm: $52,000 Land :$11,663 Tax $1,046.08 Doc # : 143063 1st Td: PerImp: 8.406 Sta/Ex: CUR Lender: Addl: Ownshp: MRRD WOM S TaxYr : 95-96 Title : CHICAGO PrevDt: Last Trans W/O $: $/SgF.t: $41.67 PrevAm: Yr Blt: 1978 SgFeet: 1,248 OutImp: GarSgF: 400 BedBth: 2/2.0 Addtnl: StSurf: Y GarTyp: ATTACHED #Story: 1 - Roof : ROLL COMP MscBdg: CarSgF: #Units: 1 Electr: DEVELOPED Ht/C1 : B GarSF2: LotSz : 4,791 Gas NO FirePl: GarTy2: Water DEVELOPED Pool CarSF2: Sewer NO View ----------- ------------------------------------------------------------------ Copyright (C)1996 Dataquick Information Systems • • ..