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FEE $35.00
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CITY OF LA QUINTA
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58
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT
Read each condition listed on the attachment to this form to see if
the proposed activity can comply with the City's Home Occupation
Regulations.
BUSINESS NAMEy�k 601F PHONE CG 19) s'G S/ - d .2t l
PROPERTY OWNER A i c?, oorl PHONE (6M S'6'/-- 0,1-a3
PROPERTY ADDRESS SSS •11 G �� o � T.�► J_ 4 �..�.� , G a. _ S i Zs3
TYPE OF RESIDENCE (single, multiple, mobil o e, etc.)
TYPE OF BUSINESS pt .✓7�r�w�-t'-
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE bt t,&�,C �.�..:.�
NUMBER OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED A'1 C,Z►
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE ( EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA f SC., f0�
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION /
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME Qe=ATION I.$ 4LLO1]EjV (COND.ITIONS ATTACHED) .. ,
APPLICANT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY -OWNER, AUTHORI;ATION OF OWNER
OR AGENT IS REQUIRED.
OWNER / AGENT S IGNt` `1"UAE DATE
IMPORTANT:, FALSE OR ..MI�;LEADING INFORMATION SFL%LL BE GROUNDS FOR....
DENYING YOUR HOME OCCUPA 7 20a; FAT-WRE WITH CONDITIONS'
LISTED ON THE ATTACHED PAGE. SHALL BE GROUNDS�.;,TMR REVOCATION OF
PERMIT..,:
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dinq a Safety Departmtent
AP ���EDbE�1IED C®IIDI IONS ATTACHED:
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PGA WEST
RESIDENTIAL ASSOCIATION, INC.
June 7, 1996
Mr. Richard M. Kopplin
55-116 Oak Tree
La Quinta, CA 92253 ;
Re: 55-116 Oak Tree
PGA West
Dear Mr. Kopplin:
Thank you for your letter requesting permission to operate a
business from your home at. PGA West.
Please be advised that at the Board of Directors meeting on
May 30; 1996 you were granted permission to conduct your business
from your home located at 55-116 Oak Tree.
,It is understood that there will be no visual or audio signs of
this business being operated from your home as well as no
additional foot or vehicular traffic. There will be no on site
solici,tat:ion, or on site storage as well.
The Board of:Directors reserves the right to .revoke this decision.
Sincerely,
Michael L. Walker AMS CCAM'PCAM -
General Manager,
PGA West Residential Association, Inc.
ox4-060.1.a QU*jnta.Za1ifor6ia 92253, Telephone,619-77,:1``1.234 • FAX 619-77.175125-t,
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78-495 CALLE TAMPICO — LA OUINTA, 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 should become subject to
the worker's compensation provisions of Section 3700.
Date': 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