WALTER4aubtrw
iiiii
•
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: 08-00002271
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) TRICIA WALTER
Property address: 54840 SECRETARIAT DR Phone: (760) 771-9420
Mailing address: 54840 SECRETARIAT DRIVE a
Property owner: TRICIA WALTER
Type of business: Interior Design
Brief description of how the business will operate: Clio of LAQUINTA
FINANCE DEPT•
Square footage of usable floor area in house (exclude garage) 4000 square feet
Location and square footage of area of business activity in home (Example: Bedroom — 125 sq ft.) , 200 square
feet
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
OCCUPATION IS ALLOWED. (Conditions Attached)
. T
APPLICANT SIGNATURE DAT
If applicant is other than the property owner, authorization of owner or rental/leasing agent is required.
Your inspection has been scheduled for Home Occupation Inspection between 10:00-10:30 a.m. on 04/29/08.
Your inspecto ill be Jackie Misuraca.
•----------------
--- ----------------IN.
------ APPROVED
❑ DENIED I�
CE HP
USE ONLY----
O�
D to
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
t
(760) 7.77-7000
FAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS
FEE $70.00 INSPECTION DATE: Zhim0`(D .
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
76c�w 1 Lal�-eY
PROPERTY ADDRESSPHONE: 7&40) ZZ
MAILING ADDRESS:1- � (IF.DIFFERENT FROM AB_QyE)
k
PROPERTY OWNER: /d � icun L. '�- rQ ^/�� L • Wa 4:w /rush'
TYPE OF RESIDENCE, (SINGLE, MULTIPLES, MOBILE HOME, ETC.):
• TYPE OF BUSINESS: rl.v l0 ✓ VCS q h
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: Z d G S 14n nu + c — home,
C t' hc.e- J9 u.-1" do 6 t SGB, GI I cA+.s QlhI's. f o c'-r-kon
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): _46o0
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM -
125 SQ ITT):. 4ZO0
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION: (!/5/n,0v-� L 1 vi,1Heti -D h6n-c
I HAVE READ; UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPATION IS ALLOWED. (CONDITIONS ATTACHED).
3 �
AP LICANT'S SIGNATURE D TE
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
l
OWNER/AGENT SIGNATURE DATE
AGENT COMPANY NAME CONTACT PH. _# DATE
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING
YOUR HOME OCCUPATION; FAILURE TO COMPLY WITH THE CONDITIONS' LISTED ON THE
'ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMIT.
BUILDING AND SAFETY.DEPARTMENT/CODE COMPLIANCE DIVISION: .
APPROVED DENIED SPECIAL CONDITIONS
OFFICER I.D. # DATE
•
W]
0
PLEASE READ!
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
Apr 27 08 11:17a Tricia Walter
09/Zb/ZUU3 PKI 1U:U1 rAA
r�
L
760-771-0134
I S
WORKER'S CONTENSATION
If your company Lias employees, a copy of the Worlanan'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 C. '
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 is Quints, 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
31101 of the government Code or Section 7284 of the Revenue and Taxation code shall -i mpme and sign a
declaration that states the follm1k
'� � �. t� • 1_' _ � . '- -�- � ! _� tai_ . ; t: �. !
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 licease is issued.
I have and will maintain Worker's Compensation Insurance, as requirgd 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.
PoIicy V tuber: —Expires:
—
A COPY OF SAID POLICY OR CERTIFICATE OF CONSENT SHOWING THE AMOUNT OF
COVERAGE AND MMIRATIGN DATE FOR WORKER'S COMPENSATION IS REOUQtED TO
�PAOCESS.TSIS,APPLICATtQN.
' V V •I certify that in the performance of any business activities for which this lioaase 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 became subject to
the vwrker'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.
' APPLICANT SIGNATURE - DA'L'E
WARNING: Failure to secure Worker's Coinpensation coverage is unlawful, and shall subject an employer
"to criminal penaltiefand civil fines up to $100,000. In addition to foe cost of compensation, damages,
interest, and attorney's fees maybe messed to you as provided in Section 3706 of the Labor Codc.
p.2