AMON0,c/10/2003 12:32
7607777011
P.O. Box Box 1504
78-495 CALL$ TAMPICO
LA QUINTA, CALIFORNIA 92253
LA QUINTA
PAGE 01
I I'llll I"II "II I��I
70
(7 60) 777-7000
FAX (760) 777-7101
OCCUPATION OF A BUSXNESS c- 0 0 - " su FAI
FEE $70.00 U JUL 11 2003 U INSPECTION DATE: 7- y 0t3��
c1ITY �?F ua Q" J' e
Please read each ondihon�lrsee-A n . ge att chment in this packet to see if the proposed
activity complies with the City's Bourne Occupation Regulations.
APPLICANT NAMES: (List all owners, partners, and/or corporation officers Ad y4 A N a Q u 4v j
._ ,
UAvk 1-4 GWAt4l CA 1.2.253
PROPER'T'Y ADDRESS -50.3,25 Cr- JnZ4 d Ti�aI�P,I��-
MAILING ADDRESS: m e 6oVe (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER: AA Qh
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): S-! n aI f. 6 %i/'/V
• TYPE OF BUSINESS: Pe a L b � -o_ k le- _arili ces
d e�,e rfs
BRIEF DESCRIPTION OF HOW T/HE BUSINESS WILL OPERATE: /If :Lh
. 54 [ /� 6 F Q t L Cc-*,rr / �_— L,1's4,,, n P,_ 0'_e4 Gin..) Ar-. kor.
NUMBER OF PERSONS INVOLVED IN BUSINESS:W
SQUARE FOOTAGE OF USABLE FLOOR AREA INHOUSE (,EXCLUDE GARAGE): S
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM -
125 SQ FT): a �'
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN
OPERATION: (7nrnD1A41tr4- raYP1 _.4 -,1—
Ic:e.. E
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPATION IS ALLOWED. (CONDITIONS ATTACHED).
APPLICANT'S SIGNATURE
��Mt
IF APPLICANT IS OTHER THAN THE PROPERTX OWNER, AUTHORIZATION OF OWNER OR
• RLNTAULEASING AGENT IS REQUIRED.
N
6le-G� �� II 103
OWNER/AGENT SiGNATURPD
V�Q�� ReOffy
rigi- t IIg oq1ll 03
AGENT CONIPANY" N - CONTACT pH. # DA
IMPORTANT.- FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING
YOUR HOME OCCUPATION; FAILURE TO COMPLX WITH THE CONDITIONS LISTED ON THE
ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMIT.
BUIL DING AND SAFETY DEPARTMENT/CODE COMPLIANCE DIVISION:
APPROVED DENIED SPECIAL CONDITIONS
OFFICER - '
I.D. # DATE
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07/10/2003 12:32
7607777011
LA QUINTA
PAGE 02
ai /11103
OWNER/AGENT SIGNA DATE
A.d v"f,tye Rea ffY
Eg4- 7rr0.c LWI)i6 . TAC-, _ �G�l - i 1 I q 0 O�
AGENT COMPANY N_A_j& CONTACT PH. # DAFE
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING
YOUR ROME OCCUPATION; FAILURE TO COWLY WITH THE CONDITIONS LISTED ON THE
A'T'TACHED PAGE SHALL BE GROUNDS FOR REVOCA,'I SON OF PERMIT.
BUILDING AND SAFETY DEPAR'T'MENT/CODE COMPLIANCE DIVISION:
APPROVED DENIED SPECIAL CONDITIONS
OMCER I.D. # DATE
C
C7
C.
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07/10/2003 12:32
7607777011
LA QUINTA
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PAGE 03
Please contact your Homeowner's Association prior to paying for your Home
Occupation Permit. Your Homeowner's Association may restrict or prohibit
home based businesses.
I HAVE READ AND UNDERSTAND THIS
STATEMENT.
4-;�—
Signature
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07/10/2003 12:32 7607777011 LA QUINTA PAGE 04
HOME OCCUPATION CONDMONS AND_QJUM IA►
ALL HOW OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDMONS 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. (Spouses are okay)
2. The Horne Occupation shall be conducted entirely within the enclosed area of the main building and shall not occupy
more than 25 percent of the total area, of the structure.
3. A, Home Occupation shall mot 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-strcct panting or vehicles requiued by Chapter 9.160 of the
Zoning Ordinancc.
4. These 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. Them shall be no supply of hazardous materials stored on the preauises at any given time (i.e. pool, chlorine, paint
thinner, etc.), unless the hazardous materials are stored in a manner approved the State Fire Marshall or any other
regulating agency.
• 7. There shall be no dispatching of persons or equipmcnt to or from the subject property, including the use of vehicles
which operate to and from the premises.
8. 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.
lo. There shall be no signs or other devices identifying or advertising the home occupation.
11. In no way shall the appearance of the building or lot be so altered, or the home occupation be so conducted, that the
lot or building may be reasonably recognized as serving a non-residential use (either by color, materials, construction,
lighting, sounds, vibrations, etc.)
12. No Home Occupation shall create a nuisance by reason of noise, odor, dust, vibration, fumes, smoke, electrical
intcrference, 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 this permit:
CITY OF LA QUINTA 11ZMCIPAL CODES: 9.60.110, 9.160, and 9.210.060
A
• 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.
If you do not have employees, please check the last section on this 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 issued.
If you have any questions, please contact the Code Compliance Division at 777-7050.
Every employer who applies for any license or 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 followine:
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 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: Expires:
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 T"PLICATION.
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.
li
1"3
'07/
PLICANT SIGNATURE DA
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.
HOME OCCUPATION CONDITIONS
0 ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS:
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 and 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 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. 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.
11. In no way shall the appearance of the building or lot be so altered, or the home occupation be so conducted, that the
lot or building may be reasonably recognized as serving a non-residential use (either by color, 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 directly related to this
MY SIGNATURE BELOW INDICATES THAT I HAVE READ, UNDERSTAND AND AGREE TO COMPLY
WITH ALL OF THESE CONDITIONS:
Debra A8 A rn o
PRINT NAME
SIGNATURE DATE
4ftN
5) l G-0cla*L
Copy -White Customer Copy -Yellow
���-��NJJ "',,,---iii
*------------------==-=------• MetroScan /:Riverside (CA)•----------------*
- -Own re Bowers-Robert-P`Trust Parcel :770 050 028
Sit-e--1-.-503-25 Grand Traverse Ave La Quint 92253 Xfered :08/19/2002
Mail._ :-50325 Grand- Traverse Ave La Quinta °Ca 92253 Price
Use _ : ROl- Res,_Sing-l-e--Fa_mi-ly-Residences Phone :760-771-2516
�edrmc3 __-. 7Bath-:2:-50 TotRm: ---YB: 1991 Poo1:No B1dgSF:2, 305 Ac:. 18
•
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Information compiled from various sources. Real Estate Solutions makes no representations
or warranties as to the accuracy or completeness ofinformation contained in this report.
07/10/2003 12:32
7607777011
LA QUINTA
P.O. Box 1504
78-495 CALLS TAMPICO
LA QVINTA, CALIFORNIA 92258
CITY OF LA QUINTA
WORKER'S COMPENSATION DECLARATION
PAGE 05
(76 0) 777-7000
FAX (760) 777-7101
If your company has compensated employees, a copy of your WORNMAN'S COMPENSATION POLICY
must accompany your BUSINESS LICENSE APPLICATION, showing the dates of coverage, including the
expiration date, and the dollar abuounL TSIS PROOF OF COVERAGE MUST BE RECEIVED BEFORE
YOUR BUSINESS LICENSE CAN BE PROCESSED.
IF YOUR B USINESS IS BEING OPERATED FROMA PRIVATE RESIDENCE WITHIN LA QUINTA, A HOME
OCCUPATIONPE -9T ISREQUIRED BEFOREA BUSINESS LICENSE CANBE ISSUED.
Every employer who applies for a Business License or License renewal which is to be issued pursuant to
Section 37101 of the Government code or Section 7284 of the Revenue and Taxation Code 5JL4LL,
COMMETE AND SIGN A RECLARATIONIHAT STATE5 OU OF THE G:
I HEREBY AFFIRM, UNDER PENALTY OF PERJURY, ONE OF THE FOLLOWING
DECLARATIONS: (Check One)
I Have and will maintain u Certificate of Consent to self -insure for Worker's
Compensation, as provided by Section 3700 for the duration of any business
conducted for which a Business License is issued. .
Have and will maintain Worker's Compensation Insurance, as required by
Section 3700 for the duration of any business conducted for which a Business
License is issued.
WORKER'S COMPENSATION INSURANCE CARRIER: .<4q1 Fkna►
POLICY NUMBER80-2.W XPIRATION DATE: 0— o l :1-01 _
(IF YOU DO NOT HAVE ANY EMPLOYEES, PLEASE INDICATE BELOW)
I Certify that in the.performance of any Business activity for which a Business License is
issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation
Laws of the state of California, and I agree that if I should become subject to the Worker's Compensation
provisions of Section 3700, I will provide the City with a Policy or Certificate copy within ten (10) days of the
change in requirements.
R#***+C tRRR Rik****xftRARRWRRk***fe ft=RRRRt****RRAR WRW9F*!lel7�RAARAWRfkA**!*feRRARRARk***=RRRRRRRRefk***
"WARNING: FAILURE TO SECURE WORNIR'S COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO $100,000.
IN ADDITION TO FINES AND PENALTIES, ADDITIONAL COMPENSATION DAMAGES; INTEREST .
A" ATTORNEY'S FEES MAY BE ASSESSED TO YOU AS PROVIDED IN SECTION 3706 OF THE
LABOR CODE.
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