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','� • 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 9 53 - (760) 777-7000of �� FAX (760) 777-7101
APPLICATION FOR r--s-Q a Iso) 777-1227
HOME OCCUPATION OF A BUSINESS
Fee $70.00 I� JA#11 2 9 2004
Read each condition listed on the attachment to this form to see if the
with. the City's Home Occupation Regulations.
APPLICANT NAMES (List all owners, partners and/or corporation officers)
/ tl,6 ,�EL/ C �4 -9, l-11j5/AlES
PROPERTY ADDRESS 7760- Avyry/DA /�,1iyz2�7?--yAm PHONE SX 06,5
BUSINESS NAME k k / #4-W=y227-tii A7 D0 $l
PROPERTY OWNER A62J61 41 GC 14-1) ki A-L/Aj�.5
MAILING ADDRESS (if different from business address) 14'2e �d)C 4Z Wo
Lam- v/•v7. QA—
TYPE
ATYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE1��
NUMBER OF PERSONS INVOLVED IN BUSINESS /
LIST NAMES OF PERSONS EMPLOYED %yDNk57- .
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.) 3619 s_#
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION l/Ma T 44 .41.4011R11.I
I HAVE READ, UNDERSTAND, AND AGREE WITH .THE CONDITIONS BY WHICH A HON -11
OCCUPATION IS A� LIO N&4jggdil-410 8064 - LA QUINTA, CALIFORNIA 92253
MALN
Date 7— /> 7
App 'cant's Signature
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION. OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
Date
Owner/Agent Signature
Agent Company Name
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
APPROVED DENIED SPECIAL CONDITIONS ATTACHED
BY: !l ' ��2�'`'�— I.D.#2 DATE Z ��
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Date 7—
App 'cant'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
APPROVED DENIED SPECIAL CONDITIONS ATTACHED
BY: I.D.#
•
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DATE
r f 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
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.
r 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 policynumber:
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.
V 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: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
-1
DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED
CALIFORNIA STATE BOARD OF EQUALIZATION
SELLER'S PERMIT
ACCOUNT NUMBER
8/1/2001 SR EHC 97-895164
KIK! HAYNES PHOTOGRAPHY
ANGELICA "KIK-'" MEAD HAYNES
LA QUINTA, CA 92253
THIS PERMIT DOES NOT
AUTHORIZE THE HOLDER
TO E N G A GE IN ANY
L BUSINESS CONTRARY TO
J LAWS REGULATING THAT
BUSINESS OR TO
IS HEREBY AUTHORIZED PURSUANT TO SALES AND USE TAX LAW TO ENGAGE IN THE C POSSESS OR OPERATE
BUSINESS OF SELLING TANGIBLE PERSONAL PROPERTY AT THE ABOVE LOCATION' ANY ILLEGAL DEVICE.
THIS PERMIT IS VAUD UNTIL REVOKED OR CANCELED BUT IS NOT TRANSFERABLE IF YOU SELL YOUR BUSINESS,
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.
Not valid at any other address
FOR GENERAL TAX QUESTIONS, PLEASE TELEPHONE OUR INFORMATION CENTER AT 1-800-400-7115.
BOE -442-R REV. 13 (6-00)
•
HOME OCCUPATION CONDITIONS
ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS:
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 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 su:,h 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 hazardcus 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: 7 _ _ _ / '&9 1 11.4 - 71
MY SIGNATURE BELOW INDICATES THAT I HAVE READ, UNDERSTAND AND AGREE TO COMPLY
WITH ALL OF THESE CONDITIONS:
V��VNI_0/-\
Office Copy -White
DATE
Customer Copy - Yellow