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FISHERD Box 1504, 7 5 CALLE TAMPICO (760) 777-7000 Ep 15Im-SLA INTA, CALIFORNIA 92253 FAX (7 60) 7 7 7-7101 S � �n��tAAPP CATION FOR HOME OCCUPATION OF A BUSINES 70.00 INSPECTION:DATE: Please read each condition listed on the attachment m -this packet to see -if -the- proposed activity complies with the City's Home Occupation -Regulations. APPLLIICANT NAMES: (List all owners, partners, and/or corporation officers Dq V I ct P` s A r_ r PROPERTY ADDRESS: 7F-70-5— 13o #le- beUZ A PHONE: MAILING ADDRESS: ! 0 0iC 1"77X LAQ�t � w�lci (IF DIFFERENT FROM ABOVE) PROPERTY OWNER: LJeIVIVIS Yd S� TYPE OF RESIDENCE, SINGLE MULTIPLE, MOBILE HOME, ETC.): TYPE OF BUSINESS:�e-x je- -e.- Ur'.V 1 C oA✓7RGc7�4-/ • BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: NUMBER OF PERSONS INVOLVED IN BUSINESS: oZ SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): /Gao LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - 125 SQ FT.): /3C�itooaJ DESCRIPTION OF MACHINERY, EQ MENT, AND SUPPLIES BEING USED IN THE BUSINESS OPERATION: c I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOM UPATION IS A LOWE (CONDITIONS ATTACHED). —10-0.3 APPLICANT'S SIGNATURE DATE IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR RENTAL/LEASING AGENT IS REQUIRED. G Mrs ONER/AGE S ATURE ATE W AGENT COMPANY NAME CONTACT PH. # DATE IWORTANT: 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 V DENIED n / SPECIAL CONDITIONS OFFICE I.D. # •y DATE • 0 OWNER/AGE S ATURE ATE :7 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 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. Signature 0 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 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. 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: �19��"�� moe�vs.v�o.✓ Policy Number: 93 //—.1roo3 Expires: I — C2 el 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. APPLICANT SIGNATURE 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. 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 such space for the oft -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: MY SIGNATURE BELOW INDICATES THAT I HAVE READ, UNDERSTAND AND AGREE TO COMPLY WITHIP OF THESE C NDITIONS: PRINT S ATURE DATE �� b ��"�-br's K Office Copy -White Customer Copy - Yellow CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 lcz— COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-11-2003 GROUP: 000229 POLICY NUMBER: 9311-2003 CERTIFICATE ID: 18 CERTIFICATE EXPIRES: 01-01-2004 01-01-2003/01-01-2004 CITY OF LA QUINTA PO BOX 1504 LA QUINTA CA 92253 This is to ceriify that we have issued _a valid Worker's Compensation insurance policy inn -a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions, of such policies. �iQin.n..t_ y VICKI,, AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - DAVID FISHER PRES,SEC,TRES - EXCLUDED. EMPLOYER DAVID FISHER CONSTRUCTION, INC. PO BOX 1772 LA QUINTA CA 92253 KEF,SK EF M: 08.11-2003 SCIF 10262E Accept this certificate only if you see a faint watermark that reads "OFFICIAL STATE FUND DOCUMENT" PAGE 1 OF 1 • rJ P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 August 15, 2003 Fisher Construction 78705 Bottlebrush Dr. La Quinta, CA 92253 Subject: City of La Quints Home Occupation Permit and Business License. Dear Mr. & Mrs. Fisher: COMMUNITY SAFETY DIVISION (760) 777-7050 FAX (760) 777-7011 We have received your business license renewal paperwork. If you reside in La Quinta, any business that you own that is not being run from a commercial location is required to obtain a Home Occupation Permit prior to the processing of your business license. Please find the enclosed paperwork for a Home Occupation Permit. After we receive the completed Home Occupation paperwork and one-time fee of $70.00, we can schedule a time for a home inspection (usually the next business day between 9:30 a.m. and 4:00 p.m.). We will try to schedule it at a time that is convenient for you. It takes about 10 to 15 ► minutes and we will schedule a half-hour window for the inspection time. If you are leasing the iE residence, please obtain either the owner's or property manager's signature on the Home Occupation Permit giving you approval to run the business. After your Home Occupation Permit approval, I will complete the processing of your license. If I can be of assistance, please do not hesitate to call me at (760) 777-7050. Sincerely, Gina McElroy y Counter Technician/Code Compliance Department r CERTIFIED MAILT,., REC (Domestic Mail Only; No Insurance C, co F I C it A L rZI Postage $ C3 Certified Fee O C3 Return Reciept Fee (Endorsement Required) O Restricted Delivery Fee ul (Endorsement Required) r-1 M Total Postage & Fees $ ru O Sen tA C3 Vt et, Apt No.�� (n or PO Box No. Postal EIPTCERTIFIED MAILT,,RECEIPT m •(Domestic D"' For delivery information visit our website at www.usps,comb n UCr C _ \�(P CA 9c, rq Postage $ \N 7 A 1-N (c1 Certified Fee o FadC w i � PJ'A Retum Rede pt Fee f�� (Endorsement Required) j O Restricted DeliveryFee Ln (Endorsement Required) rq U mDotal Postage d Fees $ •S ru Se o r3 2- -� -•------ - - - -- -- --- --- ---- - f� S`freet t. No.; Y ------------------ -- PO Box No. !� .. CiN.Stai9.Zl ,�vl - ■ Complete items '1, 2; and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Fisher Construction P.O. BOX 1772 La Quinta, CA 92253 A. Signat ent X ddressee eceived by ( Printed Na C. Date of Delivery G D. Is delivery address different from item 1? ❑ Yes IfYYES,Enfer,delivery address below: 0 No s" 10 cry —o ". 7K"sY / ertified Mail ❑ -press Mail Registered Return Receipt for Merchandise 13 Insured Mail 13C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yes 7002" '3 150: `00'0;4,,,--1 4,8 9 ,9537 PS Form 3811, August 2001 Domestic Return Receipt 2595 -02 -nn -1540 ' .i