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P.O. BOX 1504 COMMUNITY SAFETY. DIVISION
78-495 CALLS TAMPICO (760) 777-7050
LA QUINTA, CALIFORNIA 92247 FAX (760) 777-7011
HOME OCCUPATION PERMIT
Permit Number: 11-00000501
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Please read each condition listed on the attachment in this packet to see if the proposed activity complies
with the City's Home Occupation Regulations.
Applicant name(s): (List all owners; partners, and/or corporation officers) LUIS ERNESTO ALVA
Property address: 80167 PALM CIRCLE DR Phone: (760) 625-1031
Mailing address: 80167 PALM CIRCLE DRIVE
Property owner: ADVANCED REO FUNDS
Type of business: Pool Service
Brief description of how the business will operate:
Square footage of usable floor area in house (exclude garage) 1200 square feet
Location and square footage of area of business activity in home (Example: Bedroom — 125 sq ft.) bedroom, 10
X 5 office/ 10 X 14 garage
Description of machinery, equipment, and supplies being used in the business operation:
I HAV AD, DERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCU A IO S ALLOWS onditions Attached)
APPLICANT SI
DATE
If applicant is other than the property owner, authorization of owner or rental/leasing:filwnt is
Your inspection has been scheduled for Home Occupation Inspection between 10:0 .30 02-01-
2011
AN
Your inspe for will be Jackie Misuraca. .
--------------------------------------------
IN PECTOR USE ONLY -------------------------- Opt �-
f3EP_T
• APPROVED
❑ DENIED InAltv S\ Date
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P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
(7 60) 777-7000
FAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS
FEE $70.00 INSPECTION DATE:
Please read each condition listed on the attachment in this packet to see if the proposed
activity complies with the City's Home Occupation Regulations.
APPLICANT NAMES: (List all owners, partners, and/or corporation officers
Li
.PROPERTY ADDRESS: CAJ 6 &-M Qe(Lz --Dz PHONE: `/ 0 3 i
MAILING ADDRESS:&4 CAL---X�Z, LAWL Aj q?153(IFDIFFERENTFROMABOVE)
PROPERTY OWNERAT314IZ ,fcJ I'5f A Li T DjA? IA G1RiT5614fi �MQ
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): SI
TYPE OF BUSINESS:
•
/BRIEF DESCRIP'T'ION OF HOW THE BUSINESS WILL OPERATE: V l t��5
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN H
TbZSHAU.-�AOTS (00 GtIEtA1CALS
LOCATION AND SQUARE FOOTAGE OF AREA OF I
125 SQ FT.):: �PWR 10 X 15 7::�_.=Z
DESCRIPTION OF MACHINERY, EQUIPMENT, AND
OPERATION: t�UiPl
(EXCLUDE GARAGE): l o X N 1 f I iE C?A6iF
['Y IN HOME (EX. BEDROOM -
rA-Y-C A Mo►� 1! 1 W iCt )
BEING USED IN THE BUSINESS
HAVE AD, UNDERST D, AND AGREE WITH THE CONDITIONS BY WHICH A
H ME CCU TION IS ALL D. (CONDITIONS ATTACHED).
APPL ANT'S SIGN DATE
IF LICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
• RENTAL/LEASING AGENT IS REQUIRED.
• w
SIGNATURE DATE
c �CZ 1`uyr�s a� • / 1R1q � is—S oa ".
AGPNT CO ARTY AN>Ir ONTACT PH. # VAJE
UVWORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING
YOUR ROME OCCUPATION; FAILURE TO COMPLY WITH THE CONDITIONS LIS'T'ED ON THE
ATTACHED PAGE SMALL BE GROUNDS $OR REVOCATION OF PERIVIU.
*at**►a+u��gn#s*#tr*tit*ss****ttt�tsser***swa�*ssssss:�t*tM��mssttt*,e,�s*k�rRs*��*tt*t*s�raM9
BUILDING AND SAFE'T'Y DEPARTMENT /CODE COMPLIANCE DIVISION:
APPROVED DENIED SPECIAL CONDrtIONS
OFFICER I.D. # DATE
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PLEASE READ!
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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.
Signature
•
•
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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 following:
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 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, I will provide the City with a
policy ertificate copy within ten (10) days of the change in requirements.
T SIGNATURE DATE
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.