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MARTINEZ• 40" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92247 64 COMMUNITY SAFETY DIVISION HOME OCCUPATION PERMIT Permit Number: 07-00001260 (760) 777-7050 FAX (760) 777-7011 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) JUAN RAMON MARTINEZ Property address: 51510 AVENIDA VILLA Phone: (760) 834-5570 Mailing address: 51510 AVENIDA VILLA Property owner: MARTINEZ FRANCISCO Type of business: ELECTRICIAN Brief description of how the business will operate: •Square footage of usable floor area in house (excludegarage) 1380 SQUARE FEET Location and square footage of area of business activity in home (Example: Bedroom — 125 sq ft.) BEDROOM / HOME OFFICE, 183 SQUARE FEET Description of machinery, equipment, and supplies being used in the business operation: I HAYE D, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME P T NML9 itions Attached) APPLICANT . IGI DA E If applicant is other than the properly_ finer, authorization of owner or rental/leasing agent is required. Your inspection has been scheduled for Home Occupation Inspection between 10:30 TO 11:00 A.M.. Your inspector will be a=Axie. --------------------------------------------INSPECTOR SE ONLY ------------------------------------------ I& Z APPROVED O DENIED Inspector Signature Date CE HP FEE $70.00 M P.O. Box 1504 78-495 CALLS TAMPICO..' (760) 777-7000 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101 APPLICATION FOR HOME OCCUPATION OF A BUSINESS INSPECTION DATE: 0 3 19 0 7 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 PROPERTY ADDRESS:.' )1 ;�, Q�`I[ lri V i PHONE: Uoc( ) B14 55-1f—llj, MAILING ADDRESS: V.D. �l�X �I i ) (IF DIFFERENT FROM ABOVE) PROPERTY OWNER: an- o s cb " 1 1P 2 TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): • TYPE OF BUSINESS: BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: .s NUMBER OF PERSONS INVOLVED IN BUSINESS: --- SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE):``� LOCATION Aff OTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM-� 125 SQ FT.): �'P °�OC)Yl( DESCRIPTION OF MACHINERY EQUIPMENT, AND SUPPLIES BEING USED �N THE BUSINESS OPERATION: OWa rr . �. �Yi v* -n Pt -)D P_r, �m 1\ ,i � �� CY✓ J - I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH' A E OCCUPATION S ALLOW ,D. (CONDITIONS ATTACHED). E, i ICANT'S SIGNATURE 4� ATE ' IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR . RENTNTAL/LEASING AGENT IS REQUIRED. 10UMN j)cic--:�co. I KIS-- n ONER/AGENT SIGNATURE ATE W i Lz 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 • • PLEASE READ! .Please contact your Homeowner's Association prior o paying for your Home Occupation Permit. Your Homeowner's Associ on may restrict or prohibit home based businesses. I AVE READ AND UNDERSTAND THIS grTATEMENT. Signature 0 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 sin 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 Com ensation insurance carrier and policy number: Carrier: �� Q Policy Number: Expires:i 17' 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 LICATION. 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. PLICANT SIGNATU 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. 44" T4hf 4.4 adArw P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92247 COMMUNITY SAFETY DIVISION HOME OCCUPATION PERMIT Permit Number: 07-00001260 (760)777-7050 FAX (760) 777-701.1 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) JUAN RAMON MARTINEZ Property address: 51510 AVENIDA VILLA Phone: (760) 834-5570 Mailing address: 51510 AVENIDA VJLLA ua�-� +Zt!>1cr,N1Lt MAR 16 2007 Property owner: T Z C17Y of Type of business: ELECTRICIAN FINANCE D. EpT. Brief description of how the business will operate: • Square footage of usable floor area in house (exclude garage) 1380 SQUARE FEET Location and square footage of area of business activity in home (Example: Bedroom -125 sq ft.) BEDROOM / HOME OFFICE, 183 SQUARE FEET Description of machinery, equipment, and supplies being used in the business operation:. I HAVE AD, UNAERSTAND9 AND AGREE WITH THE CONDITIONS BY WHICH A HOME OC NL D. (Conditions Attached) O A PT.TCA T, T N JRE 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 10:30540 �1: 0 A.M.. Your p P p inspector will be Khatami, Stephanie. -----------------------------------------INSPECTOR USE ONLY ❑ APPROVED ❑ DENIED Inspector Signature CE HP Date