EISSMANN16
•� FEE $35.00
CITY OF LA QUINTA
A. o'C /- /6 , ?�
7-
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
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.
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�/�L7� � , c�/SSMfJN� Z�✓C BUSINESS NAME Wba, - P ID ARK E T`/nJG PHONE
PROPERTY OWNER 777 - , Ci sPHONE 6�y-Srg�,S-
PROPERTY ADDRESS 7 9- 98 o 6c ---DA 2 7 -
MAILING
MAILING ADDRESS s+1.-,
TYPE OF RESIDENCE ( -ngle multiple, mo it home, etc.)
TYPE OF BUSINESS
BRIEF,DE4C ION OF HQW THE SINESSWILD• OPERA4E /(!j
NUMBER OF PERSONS INVOLVVD IN BUSINESS SELi= d- L✓i �=`c
LIST NAME OF PERSONS EMPLOYED /^t 4-7—
SQUARE
.TSQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) &10�
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINE �QUIPMENT, AND SUPPLIES BEING USE IN THE
BUSINESS OPERATION �,�-
R ER D, AND AGREE WITH THE CONDITIONS BY WHICH A
OCC O OWED (CONDITIONS ATTACHED).
14 APPLICANT SIGNATURE,.. DATE
IF APPLICANT .IS OTHER THAN PROPERTY OWNER, A TTHORIZK9ION OF OWNER
OR AGENT IS REQUIRED.
OWNER/AGENT. S.I,riNATURE Ft kmE
IMPORTANT: FALSE OR' ..MISLEADING' INFORMATION SI�'.L GROUNDS FOR
DENYING YOUR HOME -OCCUP e!0N; FAI),-CRE TO CONP-4Y `3bk-d CONDITIONS
LISTED ON THE ATTAW,0.0 PAGE SHALL BE GROUW&§ =�F0 ' `REVOCATION OF
PERMIT.
• Build'- and Saetv.:Depci€tent -
�.
'APPROVED DENIED CONDITIONS ATTACHEEl
•
T-4bt 4 4aQumrw
78-495 CALLE TAMPICO — LA QUINTA, 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 -THE AMOUNT OF COVERAGE AND
EXPIRATION DATE FOR WORKMEN'S COMPENSATION IS REQUIRED TO PROCESS
THIS APPLICATION.
I certify that in the performance of any business activities
7fdr• 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 provision o ect'o 3 00.
Date: ���/ 9 Applicant:
`
/
WARNING: Failure to secure workman's compens ion 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 ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 ��
•
PGA WEST II RESIDENTIAL ASSOCIATION,.INC.
P.O. Box 1282 • La Quinta, CA 92253
January 10, 1996
Walter J. Eissman
79 980 Cedar Crest
La Quinta, CA 92253
RE: - PGA WEST II Residential. Homeowners Association
79 980 Cedar Crest
Dear Mr. Eissman:
is In response to your letter of January 9, 1996 requesting the approval of PGA WEST II
Residential Homeowners Association to allow you to conduct a business from your home
as stated in said letter, the Board of Directors, per President Jim Saul, has consented to
this venture.
is
If you have any further questions or comments, please feel free to call (619) 360-4161,
and good luck in this endeavor!
Sincerely,
John H. Handel
Association Manager
tv no n a rc ti', a se rs`su zy`•ha VII) p 2 t.e i ssman, %v. due