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78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 - (619) 777-7050
FAX (619) 777-7011
APPLICATION FOR
HOME OCCUPATION OF A BUSINESS g t 1991
E
Read each condition listed on the attachment to this form to see
complies with the City's Home Occupation Regulations.
F V,,0014) r% QF �
if t00 oposed activity
APPLICAiv r DAMES (List ail owners, partners anchor corpOratiun officers)
PROPERTY ADDRESS 4141770 f 2UAIrikAA- Pit PHONE C Ig QLD -91 3
I -A a LL I N 77A 1 CA- R 7-2-6-3
BUSINESS NAME t�' e-iW DA F. W AL-7'CU . eoMpa7- ie 5P>~C 1 11 i-rs r'
PROPERTY OWNER 121 C1- It 6 j d ki- dh- f. LAI 7 -614 -
MAILING
614 -MAILING ADDRESS (if different from business address) P 1) 30Y 65P
t0AL, M T>f s-cle- r .164 92261
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) 61A)61 -f --
TYPE OF BUSINESS 1°) mParee 0D1USaL-rA yr
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE USE- OF dfr-ie-4 O
1FN50fte CAL -L-5 APPTs 1�:6t P 8USrA✓"s er e aOOP-os
C0N5uLr11v& 41 eomoar£2 z-,0eh-Tt,9
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAMES OF PERSONS EMPLOYED All) A)
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (exclude garage) D 06 <4f
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (example,
"bedroom - 125 sq. Ft.) 6j2e-v- &OZOOM — /`-1 d 6 -f&
• DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION D`F-�-t� 444jZf 7 _ d
&17)a• -cam /T Ak
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 �c
.•
•
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS. BY WHICH A HOME,
OCCUPATION IS ALLOWED (conditions attached).
Date
Applicant's Signature
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
Date
Owner Agent Signature
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.
C3'A
counters -
CONDITIONS ATTACHED
HOME OCCUPATION
CONDITIONS AND CRITERIA
ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS AND REQUIREMENTS:
1. / No one other than the resident of the dwelling shall be employed on the premises in the conduct of the
Home Occupation.
2. ✓ The Home Occupation shall be conducted entirely within the enclosed area of the main building & shall not
occupy more than 25 percent of the total area of the structure.
3. ✓ A Home Occupation shall not be conducted within an accessory structure. There may be storage of
equipment or supplies in an accessory structure. Garage space may be used for the conduct of a Home
Occupation only when it does not interfere with the use of such space for the off-street parking of vehicles
required by Chapter 9.160 of the Zoning Ordinance.
4. // There shall be no outdoor storage of equipment, machinery, supplies, materials, or merchandise.
5. ✓ There shall be no sales activity, either wholesale or retail, except mail order sales, nor shall there be the
maintenance of an office open to the general public.
6. ✓ There shall be no supply of hazardous materials stored on the premises at any given time (i.e. pool, chlorine,
paint thinner, etc.) Unless the hazardous materials are stored in a manner approved by the State Fire Marshall
or any other regulating agency.
7. ✓ There shall be no dispatching of persons or equipment to or from the subject property, including the use. of
vehicles which operate to and from the premises.
• 8..l No vehicles or trailers except those normally incidental to residential use shall be parked at the residence at
any time.
9. ✓ There shall be no use of any mechanical equipment, appliance, or motor outside of the enclosed building or
which generated noise detectable from outside the building in which it is located that is related to the
business.
10. ✓ There shall be no signs or other devices identifying or advertising the home occupation.
In no way shall the appearance of the building or lot be so altered, or the home occupation be so conducted,
that -the iot or bu ldiiyi miry u6 iaasonaably r6cognized a:: saiiiing a rwin-residential, u a (either by vv+aii,
materials, construction, lighting, sounds, vibrations, etc.)
12. ✓ No Home Occupation shall create a nuisance by reason of noise, odor, dust, vibration, fumes, smoke,
electrical interference, traffic, or other causes.
13. ✓ The use shall meet reasonable special conditions as established and made of record in the Home Occupation
Permit, as may -be deemed necessary to carry out the intent of this Section.
14. Listed below are special conditions which shall be considered a part of the conditions and criteria directly
related to this application and permit.
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 Ouinta, 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 comolete and sign a
declaration that states the followina:
WORKER'S COMPENSATION DECLARATION
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 37.00. for the duration of any business activities conducted .for
which this license is issued.
• _ 1 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:
H0%0%rnV1 Ac lbAlr% V%^@ fi %J As ^01MT101^AT0 AC ^^K101'1k1T 0LA^%A/1
AAS •mow A!. A ftdw M ATr 9.0%r% P%d%RMr11F-A1n AT1AR■ IdM rf1L—f1112r%Cr% TA
SS THIS _A PP! ATIO .
X 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, 1 will provide the City with a policy
or certificate copy within ten (10) days of the change in requirements.
Date: 9 — g q7 Applicant:&Lx
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.
•
•
Lw U. -� • r�
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Dear Business License Applicant: .
Every contractor that applies for a city business license or renewal of a business license 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
hereby affirm. under penes n- of perjury, one cf he feftwing declw-ationz:
I have and will provide 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 provide a worker's compensation insurance policy, with
The City of La Quints listed a certificate holder, as required by Section
3700, for the duration of any business activities conducted for which this
license is issued. (See attached contractor record status)
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.
Date: - ' �7 Applicant:
Business Name
.41y770 FWV I ,fA# PP,-- 1�} �i uirvT/� . 64, qg g,53
Address
yn�rt i= 4,Oo/2fss P11P0
GSH 9.2,761
Al &
Contractors License Number Classification
WARN 14G: FAILURE TO SECURE WORKERS' 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 AS PROVIDED FOR LV SECTION 3706 OF THE LABOR
CODE, INTEREST, AND ATTORNEY'S FEES.