MOOTY (2)•
•
•
FEE $35.00
CITY OF LA QUINTA
1 111111 11111 1111 1111
64
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 NATE Sandy's Creations PHONE 619-360-6530
PROPERTY OWNER Richard & Sandy Mooty PHONE 619-360-6530
PROPERTY ADDRESS 78-740 Sanita Drive La Ouinta, CA 92253
MAILING ADDRESS SAME
TYPE OF RESIDENCE (single, multiple, mobil home, etc.) Single
TYPE OF BUSINESS Retail -handmade crafts -ranging from wreaths,etc
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE working part-
time at night -for the holidays -to start out, to see how it
NUMBER OF PERSONS INVOLVED IN BUSINESS(1) takes off.
LIST NAME OF PERSONS EMPLOYED Sandy Mooty
SQUARE FOOTAGE OF USABLE FLOOR AREA E J,
IN HOUSE (EXCLUDE GARAGE) 140 square feet.
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME spare room. 140 square feet.
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION ornamental objcg is . graraPvi nP wrPath,,. Gi i k
flowers and leaves -wood frames -possibly teeshirts(Daintina) etc
I HA E READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME1OCCUP�TIOI� S M OWED (CONDITIONS ATTACHED).
APPLIZANT S
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
OWNER/AGENT SIGNATURE DATE
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR
DENYING YO HOME OCCUPATION; FAILURE TO COMPLY WITH CONDITIONS
LISTED ON HE ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF
PERMIT.
and Saf et,
APPROVED
(7 y/
Department
DENIED CONDITIONS ATTACHED
J
af . a ka4t&
BUS. LIC. NO.
1994 BUSINESS LICENSE APPLICATION FORM
************* * ***
*APPROVED BAL
* DAT
......PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED........
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES X NO
2. Business Name: San6y's Orations
3. Business Address:78-740 Sanita Drive4. Mailing Address: SAME
La nu i nt.. CA Q r 1 '
5. Business Phone:( Qlg )_360-6530 (for now, unless I need to -et
another nur173.er) .
6. Owned By: CORPORATION PARTNERSHIP INDIVID�IAL _
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security # 562-57-46350
9. Name of Owner Sandy Mooy Title: Ounsr
• Or Officers
10. Type of Business:
M all vinric 11111 f r.r�f t- ;.
nogt i v�ea t i ons
11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO
12. SBE Resale Number:
13. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gros's Business'Receipts for New Businesses Only:
$ 500.00
B. Previous Year Gross Receipts For Established Businesses:
$ 0.00
********GOOD ONLY FOR JANUARY 1,1994 THRU DECEMBER 31,1994*******
I HEREBY CERTIFY that all the information supplied by me is correct and
any licenses required by the County, State or Federal Government haVe
issued to me and are ill ful;.force an effect.
e
• Signatu
Title Date
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
La Quinta, CA 92253
�v
' OF
78-495 Calle Tampico, La Quinta, CA 92253 (619)'7`17-7050'
FAX (619) 777-7011
Dear Business License Applicant:
every employer who applies for any license or for 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 of the states the following:
it GRXER * S COMPENSWZION DEC:..�RATION
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 prcvided 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 workers' compensation insurance carrier and policy number
are:
Carrier
Policy Number
X_ I cartify ttact in the performance of any buSinesE
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 workers'
compensation provisions of Section
o� ci
Date: r )1,:;2
/ 94� Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPEN TION COV GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIC FINES UP TO $100 000, IN ADDI-:ION TO THE COST OF
COMPENSATION, DAMAGES AS PRCVIDED FOR IN SECTION 3706 OF THE LABOR
CODE, INTEREST, AND ATTORNEY'S FEES.
MAIUNG ADDRESS - P.O. BOX 1504 - LA OUINTA. CALIFORNIA 9=3