THOMAS40"
P.O. Box,1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92247
42
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\ COMMUNITY SAFETY DIVISION .
HOME'OCCUPATION PERMIT
Permit Number: 07-00003164
(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) TOM M & ANDREA C THOMAS
Property address: 55706 BRAE BURN Phone: (760) 844-2416
Mailing address: 55706 BRAE BURN
Property owner: TOM M & ANDREA C THOMAS �j _ VVV JUN 2 6 2007
Type of business: Accounting Services CI
OF
Ft ANCE QUINTq I
Brief description of how the business will operate: �EPr
Square footage of usable floor area in house (exclude garage) 3100 square feet
Location and square footage of area of business activity in home (Example: Bedroom —.125 sq ft.) Bedroom, 60
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)
APPLICANT 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 July 3,07 between 10:00-10:30.]
Your inspector will be Jackie Misuraca.
-- ------=---- ---------------------------IN EC R USE ONLY--------------------------------- --------=---------
APPROVED
❑ DENIED I ct r,i t e Dat
CE HP
FEE $70.00
P.O. Box 1504 TA
I Luj
78-495 CALLE TAmpico L C1—�,�_��A- (760) '177-7000
LA QUINTA, CALIFORNIA 92253 FINANcEDEPTAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS
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
�ncL-e C, Thomas , CPA , Inc. _2 AYIOLKea. 60hozna,s PKe5
PROPERTY ADDRESS: 55-x106, Rraw. PSI _r -✓1 PHONE: '1&o- X44-Z141(o
l.cL (::. uCIA+rL_ e -A 97253
MAILING ADDRESS: (IF -DIFFERENT FROM ABOVE)
PROPERTY OWNER Ayid -(ems C - J hornaS H . -Tho rq 42 5
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): S i il�ile
• TYPE OF BUSINESS: he -c OLLn-ti ng '5e4ry(ce5
BRI EF'DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: pYo-J, d G acro Lirrhr7c,
Y� a D h o n e 1-�wx_l e -mai 1 and a. -t c b eiy+5 7o Ifo ei'i errt-n (.J j rem► cI e nc_e"
. I �od' bu5irte55.
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): 3 1 o O
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVI'T'Y IN HOME (EX. BEDROOM
125 SQ FT.): &6ty-,00 j?0 res on r?) 5 -f -I ng a ?Pgy_ 1,
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION: (,o rn 0 Qe) d ��
' , ce_ 5!:�:j2y Is e5
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDMONS BY WHICH A
HOME OCCUPATION IS ALLOWED. (CONDITIONS ATTACHED)..
APPLICANT'S SIGNATURE DATE
IF APPLICANT IS OTHER THAN THE -PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED_'
1�
FJr
•
OWNER/AGENT SIGNATURE 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 GROUNDSF RPREVOCATION OF PERMIT.
BUILDING AND SAFETY.DEP ° /CODE COMPLIANCE DIVISION:
APPROVED DENIED SPECIAL CONDITIONS
OFFICER y 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.
•
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 Quina, 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 com lleete and sign a
declaotim that states the following:
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 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.