AMEN- � IIIII IIIII IIII IIII
56
C7 4
• FEE $35.00
CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
U
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 %__
PROPERTY OWNER
PROPERTY ADDRES
MAILING ADDRESS
TYPE OF RESIDENCE
TYPE OF BUSINESS
BRIEF DESCRIPTION
�19� ��l-look
NUMBER'OF PERSONS INVOLVED IN BUSINESS '
LIST NAME OF PERSONS EMPLOYED -0-
SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE) IkO
LOCATION AND SQUARE FOOTAGE OF REA 4b I
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED I
BUSINESS OPERATION �i90 O kZ4,ta
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPA ON IS A LOWED DITIONS ATTACHED).
_-) ( A Y)C,
APPLICANT SIGNATURE 1JATE
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 YOUR HOME OCCUPATION; FAILURE TO COMPLY WITH CONDITIONS
LISTED ON THE ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF
PERMIT.
•Buildilng and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
•
•
T-itT 4 4a Qumz.
78-495 CALLE TAMPICO — LA QUINTA, 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 Policv
Carrier:
Policy Num
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
"Por which this license is issued I shall not employ person in
P Y an Y
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 co pensation provisions of Section 370
i
Date: I5 Applicant:
WARNING: Failure to secure workman's compe isation 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 QUINTA, CALIFORNIA 92253
4
MEMORANDUM
TO: Mr. & Mrs. Jerry Amen
FROM: Building & Safety Department 6"Y
DATE: November, 15, 1994
SUBJECT: Home Occupation Approval
A letter of final approval by the Board of Directors is required from the PGA West
Residential Association, Inc.for a home occupation at 54-407 Shoal Creek.. We require a,.
copy of this letter by December 5, 1994.
Thank you.
/ES
12
PGA WEST RESIDENTIAL ASSOCIATION, INC.
November 11, 1994
Mr. Jerry Amen
54-407 Shoal Creek
La-Quinta, CA 92253
Re: 54-407 Shoal Creek
PGA West
Dear Mr. Amen:
Thank you for your letter requesting permission to operate a
business from your home at PGA West.
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.
solicitation or on site storage as well.
At this time,,I can foresee no reason why you would not be
granted permission. Therefore, you may apply for your business
license. The Board of Directors will meet on December 1, 1994 at
8:00 AM. Your request for permission to operate a business out
of your home will officially appear on the agenda and will be
considered.
The Board of Directors reserves the right to revoke this
decision.
Sincerely,
Michael Walker
Property Manager
PGA West Residential Association Inc.
P.O.. Box 1060, La Quints,California 92253,,Te1ephone'619=771=1234 Fax 6197771-512'SY
i r
1994 BUSINESS LICENSE APPLICATION FORM
BUS. LIC. NO.
Send Completed Form To:
CITY OF LA QUINTA ************** *******
BUSINESS LICENSE DIVISION *APROVED BY
78-495 Calle Tampico * DATE (l
La Quinta, CA 92253 ************* *****
. PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED
1. Business Name: ``� r r q Amt -n 0 C
2. Business Address: P O RnT ZI;--
2zs3
3. Mailing Address:
4. Business Phone: () -7-71
5. Owned By: CORPORATION PARTNERSHIPNDIVID AL
6. If Corporation or Partnership: Tax I.D.#
7. If Individual Owner: Social Security SJ�� '7 46 93Q�'
'8. Name of Owner or Officers and Title:
OAT
9. SBEResale Number:
10. Number of Decals Needed:
11. CONTRACTORS ONLY: COPY OF STATE CONTRACTORS LICENSE IS REQUIRED
A. Type of Contractor:
B. Classification:
C. State License Number:
CONTRACTORS - GENERAL $100.00 Per Year
CONTRACTORS - SUB $ 50.00 Per Year
or $50.00 Semi-annual
or $25.00 Semi-annual
CONTRACTORS ARE ON A CALENDAR YEAR BASIS ONLY; ANNUAL FROM JANUARY 1ST
THROUGH DECEMBER 31ST. SEMI-ANNUAL FROM JANUARY 1ST THROUGH JUNE
30TH; OR JULY 1ST THROUGH DECEMBER 31ST.
I HEREBY CERTIFY that all the information supplied by me is correct and •
any licenses required by the County, State or Federal Government have been
issued to me and are i full force and effect.
1A 1A
ignature Title D t