McGeeaxiia MAR 21 1995
• FEE $35.00 civ ._
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT 722 IIIIIIII"II'II'II
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.
BUSINESS NAME Fh .a' j I d L 04C P �t fc �u /�S PHONE & /9 3 �s yz z
PROPERTY OWNER Alen / t 4A ,„ &7 16 c PHONE (n L4 3uS' N 2- Zq
PROPERTY ADDRESS qS-2. '140 13e4cr+ ru'X /J✓ L4
MAILING ADDRESS St—_`i
TYPE OF RESIDENCE ( in , multiple, mobil home, etc.) ,
TYPE OF BUSINESS t 5c,I/c 3
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE ,S% esq 777.
NUMBER OF PERSONS INVOLVED IN BUSINESS -2--
LIST
LIST NAME OF PERSONS EMPLOYED In e(o if
• SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.") l� S
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLI S BEING USED IN THE
BUSINESS OPERATION &., Z4F,
I HAVE READ, DERSTAND,'AND AGREE WITH --THE CONDITIONS BY WHICH A
HOME OCCUPAT S OWED (C O DITIONS ATTACHED)..
APPLICANT SIGNATURE PATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS 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.
• Buil nq andSafet Department
APPROVED DENIED CONDITIONS ATTACHED
T4ttt 4 4a-QuiK&
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
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 sh uld become subject to
the worker'sec,
mpensation provisions of S ion 3700Date: l G� S 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 ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 �(�i
•
�LaLlµ�
1
P.O. Box 1504
La Quinta, CA
CITY OF LA QUINTA (619) 564-2246
HOME OCCUPATION APPLICATION
92253
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.
------------------
APPLI CANT' S NAME PHONE
PROPERTY OWNER C/ �v / �] PHONE
If
PROPERTY ADDRESS `7J ���0 I��l P ll�.(T � 10 �� � G✓ 215 -
TYPE OF RESIDENCE (single, multiple, mobile home, etc.)
TYPE OF BUSINESS cy�7 -7
BRI F DESCRIPTION OF HOW THE BUSINESS WILL OPERATE
NUMBER OF PERSONS INVOLVED IN BUSINESS °2 -
LIST NAMES OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA IN PAin _V14 00
HOUSE ( EXCLUDE GARAGE) 2 OO 9 M4rASTAMP
• LOCATION AND SQUARE FOOTAGE OF AREA OF J U L 2 2 1993 ad
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 S.F.") /oZ �' S
BY
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IITTHE
BUSINESS OPERATION
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
V 7 -aZ 3- Ps
APPLICANT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
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.
Buildingand SafetyDe ar t
rP-
2LAPPROVED4 BY -TE CONDITIONS ATTACHED '
��/
DENIED BY DATE�0, M