HENNESSY�
t
78-495 CALLS -rAMPICO ---- LA QUINTA,
111111 IIIII IIII IIII
`--- - -40
CALIFORNIA 92253 - (619) 777-7050
FAX (619) 777-7011
APPLICATION FOR
r
Fee HOME OCCUPATION OF A BUSINESS
INA �
G. � !V! �VIT�C ��/��99
Mb'
SA �,14c97176016
Read each condition listed on the attachment to this form to see if the proposed activity
complies with the City's Horne Occupation Regulations.
APPLICANT NAMES (List all owners, partners and/or corporation officers)
PROPERTY ADDRESS ,� �'� i...1�(� �- A. L•l -i_ -.fit-'tom PHONE (2!2_1 _7 j T
BUSINESS NAME` Z-(:'>'
' PROPERTY OWNER
MAILING ADDRESS (if different from business address)
r
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
r
TYPE OF BUSINESS
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE . L.14i"-tt-t��'
-----�----
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE.FLOOR AREA IN HOUSE (exclude garage.) ` �y
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (example,
"bedroom - 125 sq. Ft.)��-��"�M
MAILING ADDRESS . P_O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 �(�
•
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 followino:
WORKER'S COMPENSATION DECLARATION
.M- -
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:
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.
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 ity with a policy
or certificate copy within ten (10) days of the chane in equireme t .
Date: ? Applicant:
r
WARNING: Failure to secure worker's compensation covera a is unlawful, and shall su ject 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.
C
November 20, 1997
To The Montero Estates Board Of Directors,
I am your neighbor, Laura Hennessy, at 78477 Calle Remo. I am wishing to begin a part-
time, homebased specialty gift basket business. My target audience will be local
businesses as well as friends.
I will operate my business in a discreet manner. There will be no other employees nor any
foot -traffic to the home. My business mailing address will be located at an off-site post
office box.
I have received permission from the homeowner, Ken Bilsten. I am also required by the
-Ee�ty.to obtain signed approval from the Association's Board Of Directors.
I would appreciate your approval signatures so that I may begin my business venture. If LL QQ
you have any questions of concerns, please do not hesitate to contact me: 771-9455.
Thank you.
Sincerely,
Laura Henne sy
�
Approval Signatures
c
1..)^ �S�
/ 21317
Title
V1LC ' 1ZCStr>GDA- , CASIT*S
40me, Oc,CrAev-6 40e---
6C01A'01SI na 3C1 -S400
�� re c P, ✓� e2. v�� cL�� f yds- � • � r�� : �''l�r�
vC c ,,a4n �� Mo r- r7ee x7GlDe4 rO
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION�-r?,_�".-��.�u
• 1 HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (conditions attached).
Signa ure/J�
Date
Applicant's
OCCUPATION IS ALLOWED (conditions attached).
It is required that all applicants who reside in a gated community and are regulated by a
VIM' a Cwn per's Association must provide ars cnginal letter on letterhead -stationery, stating the
approval of the business operation at the residence by the current management company
and/or directly from the Board of Directors of said association.
Initial home inspection, prior to application approval, will not be required unless requested
by the management company or the board of directors.
i Date /l�
licant's ignature
k�/
IF APPLICANT IS OTHER THAN PROPERTY
RENT / SING AGENT S REQUIRED.
r
Own r/Agent Signature
OWNER, AUTHORIZATION OF OWNER OR
Date / q -7
Agent Company Name AgentiOwner Contact Phone # 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 & SAFETY EPARTMENT[QQDE COMPLIANCE DIVISION
' A ROVED _ DENIED SPECIAL CONDITIONS ATTACHED
BY: I.D.#DATE: 2 �3