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WILLIAMSON• IN _ _ P.O. BOX 150,4 COMMUNITY SAFETY DIVISION 78-495 CALLS TAMPICO (760) 777-7050 LA QUINTA, CALIFORNIA 92247 FAX (760) 777-7011 HOME OCCUPATION PERMIT Permit Number: 10-00005050 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 name(s): (List all owners, partners, and/or corporation officers) JEFFREY A WILLIAMSON Property address: 54640 AVENIDA RUBIO Phone: (760) 342-2717 Mailing address: 54640 AVENIDA RUBIO Property owner: JEFFREY A WILLIAMSON Type of business: Home Inspections Brief description of how the business will operate: CITY OF LA QUIt1TA Square footage of usable floor area in house (exclude garage) 1450 square feet Location and square footage of area of business activity in home (Example: Bedroom — 125 sq ft.) Home office, 125 square feet Description of machinery, equipment, and supplies being used in the business operation: I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME OCCUPATION IS ALLOWED. (Conditions Attached) -Z1- 10 P I ANT SIGNATURE DATE If applicant is other than the property owner, authorization of owner or rental/leasing agent is required. Your inspection has been scheduled for Home Occupation Inspection between 10:00-10:30 a.m. on 09-30-10. Your inspector will be Elizabeth Escatel. •-- - - - ----------------INSPECTOR USE ONLY ------------ ---------------- APPROVED ❑ DENIED Inspec or Signature T J CE HP FEE P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 (7 60) 777-7000 FAX (760) 777.-7101 APPLICATION FOR HOME OCCUPATION OF A BUSINESS FEE $70.00 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 J e�e,.�o A G�� �ew►,� r� PROPERTY ADDRESS: SSI '1� q0 A lwid a 066L0 ' PHONE: 40 -3 q 2. _ Z I MAILING ADDRESS:IF DIFFERENT FROM ABOVE) PROPERTY OWNERr t I TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.)-? I W [�Q -�yk I (y dW • TYPE OF BUSINESS: BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: I V Q,L� ►G �or NUMBER OF PERSONS INVOLVED IN BUSINESS: SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): LOCATION AND SQUARE F OT GE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM. - 125 SQ FT.): DESCRIPTION OF MACHINERY, QUIPMEN'T, ANDSUPPLIES BEING USED IN THE BUSINESS OPERATION: (� .J GAN N eA,— I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME OCCUPATION IS ALLOWED. (CONDITIONS ATTACHED). CIANCE DIVISION 4L11C4ANT'S SIGNATURE PPROVED IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR, . RENTAL/LEASING AGENT IS REQUIRED. INITIAL m R/AGENT SIGNATURE `l=L(-ty 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 DEPARTMENT/CODE COMPLIANCE DIVISION: APPROVED . DENIED SPECIAL CONDITIONS OFFICER • I.D.'# DATE 1. ,t • 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. �Ay Si n tore • 0 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. 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 sign a declaration that states the followine: 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: Expires: 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 PLICATION. 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. CANT SIGNATURE q-z�-tip DATE 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.