Loading...
PADDENt FEE $35.00 - C17Y OF LA, QUINTA o 0.. � r ..78-495. Ca lie Tampico, P. O.Box 1504, -'La uinta, CA 9.2253: a4^ N HOME OCCUPATION PERMIT - Read each condition listed on the attachment to this form to see if the proposed activity can comply with the City's Home Occupation ` Regulations. aaa=sYas===a�aaye===aa===xa;����=oa»�3=-::�elaaoaaaaaaa a==saax=�aa BUSINESS NAME � `' � �UA PHONE PROPERTY OWNER ►,r,,� .,p PHONE PROPERTY ADDRESS 152-196 C K�J�r.►?�A LA MAILING ADDRESS %, �, ,. �--► TYPE OF RESIDENCE nqI multiple, mobil home, etc.) TYPE OF BUSINESS e_5AL9— BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATEfvi- NUMBER OF PERSONS INVOLVED IN BUSINESS, t LIST NAME OF PERSONS EMPLOYED SQUAME FOOTAGE OF USABLE FLOOR AREA IN HOUSE ( EXCLUDE GARAGE) aC0 ,,g_ LOCATION AND SQUARE FOOTAGE - OF AREA Or BUSINESS ACTIVITYINHOLE ( EXAMPLE, "BEDROOM -125 5 S.F.,I) 12�' � ��U L+ g. 6r- . DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES B7E�I'NG'USED IN THE ^� BUSINESS OPERATION �1 I HAVE R" UNDERS:ALLOWED AND, ANO AGREE WITH 'I`n CONDITIONS BY WHICH AA HOME OCC A ION IS (CONDITIONS -ATTACHED). LA-tv -q(a OPLXCANT SIGNATURE ... _.. IF APPLICANT. IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT I8 REQUIRED. OWNER/AGENT SIGNATURE DATE IMPORTANT: FALSE OR MISLEADING; INFORMATION SHALL BE GROUNDS FOR DENYING YOUR.HOME OCCUPATION; FAILURE TO COMPLY WITH CONDITIONS LISTED ON THE ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMIT. ism s=_====saama=aasxi====seism==_= amp= ===aAVa==s==xv* P 'Unc_end Safety DQ'Dartment APPROVED �DtHIED CONDITIONS ATTACHED /' ' To ' 8 T T 0LLLL61 9 H1M I 1-10 kI1 30 Al13 9 T : = 31-11 9G-9 T -add+ • • 0, 111111111 IN 34 T4'tt 4 4 Qu,41Z 78-495 CALLE TAMPICO — LA. OUINTA, CALIFORNIA 92253 - (619) 777-7000 FAX (619) 777-7101 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 following: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury, one of the following declaration: 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 THE POLICY SHOWING IRATION DATE.TOR WORKMEN'S COMPEN: S APPLICATION. I P F.T7117 �1vI 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 wo er's compensation laws of California, and agree that if I "ioµl become subject to the worker's compensation provisions of S c io 3700. Date:- N ;j�- Applicant: WARNING: Failure to secure workman'.s compensation coverage is unlawful, and shall subject an employer to criminal penalties and civic fines up to $100,000. In addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. bus.fac MAILING A00SESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 � .