WILCOX�Gv
FEE $35.00
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT
Read each condition listed on the attachment to this form. to see if
the proposed activity can comply with the City's Home Occupation
Regulations.
BUSINESS NAME PHONE
PROPERTY OWNER / e Nk wh PHONE
PROPERTY ADDR SS 7-- Ow 9�a.
MAILING ADDRESS
TYPE OF RESIDENCE �(ingl multiple, bil home etc.)TYPE OF BUSINESS
BRIEF DESCRIPTION ®F HOW -THE HUS ESS WILL QPERATE
NUMBtR OF PERSONS INVOLVED IIS BUSINESS �.
LIST NAME OF PERSONS ENFLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA U �
• IN HOUSE ( EXCLUDE GARAGE)
AR 01 1996
LOCATION AND SQUARE FOOTAG$ OF AREA
OF BUSINESS ACTIVITY IN HOME Y
( EXAMPLE, "BEDR0014-125 S.F.") 1460
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING US D IN THE
BUSINESS OPERATIOM
'I HAVE READ, UNDERSTAND, AND AGREE WITH THEfCONDITIONS BY WHICH A
HOME OCC AT N IS =AD (C NDITIONS ATTACH D)
APPLICANT SIGNA7�IRE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
OWNER/AGENT SIGNATURE DATE
IMPORTANT: FALSE OR MISLEADING. INFORMATION GHALL- BE GROUNDS FOR
DENYING YOUR HOME OCCUPATION; FAILURE TO COkPILY WITH CONDITIONS
LISTED ON THE ATTACHED PAGE SHALL BE GROUNDS -FOR REVOCATION OF
PERMIT.
• BuiliinQ and Safety Depagtment--�•=�________________________e=-==
APPROVED. DENIED - CONDITIONS ATTACHED
. r{
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T4t�t 4 4a Q"Kt
78-495 CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 . - (619) 777-7000
FAX (619) 777-71.01
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 hould become subject to
the workee's compensation.provisi s ection 37
/'
Dat 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 .-f ac
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 ���.
LA QUINTA PALMS HOMEOWNERS ASSOCIATION
c/o J. & W. Management Co.
P.O. Bog 1398
Palm Desert, CA 92261
(619) 568-0349
December 12, 1995
Eileen Wilcox
79-847 Horizon Palms Circle
La Quinta, CA 92253
Dear Ms: Wilcox:
The hoard of Directors of the La Quinta Palms Houieowfizi-s Associat:3u, have re V ev:ed
your request for permission to operate a business in your home at La Quinta Palms.
Your request was approved unanimously by the board, with certain conditions as follows:
No employees are permitted
No customers will be permitted to visit your office
No loud noises
We certainly wish you success in your new business venture.
• Sincerely,
LA QUINTA MS HOMEOWNERS ASSOCIATION
For the Bo d of hectors
Jim McPhe son
Property anager , z
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