BAUDER•
�Oj RECEIVED
FEE S35.00 MAY 0 7 SM
16 = INANCE DEPT
CITY OF LA QUINTA
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.
#1
BUSINESS NAME PHONE 011' �714600K_
PROPERTY OWNER pvnur 77/ -,fin Y7
PROPERTY ADDRESS S '
MAILING ADDRESS to /-c. 9 -
TYPE OF RESIDENCE (single, multiple,
TYPE OF BUSINESS W&Pc '
BRIEF DES RIPTIgy OF HOW TH _BUSIN)ESS
M, _' .a-t(,Unu�c�
NUMBER OF PERSONS INVOLVED IN BUS S
LIST NAME OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AMEX�J
IN HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME /
(EXAMPLE, "BEDROOM -125 S.F.") 0,64-e '
DESCRIPTION OF MACHINERY, EQTJIPMENT,
BUSINESS OPERATION +,oA_.wr,-, . C,exX
mobil home, etc.)
i A Y 1 1990
v
SUP -PLIES BEING USED IN -THE
I HAVE
READ, UNDERSTAND, AND
AGREE WITH THE CONDITIONS
BY
WHICH A
HOME OCC�UPATIOI�,
IS_ALLOED XOND�S
ATTACHED) .
ICANT 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 YOUR HOME OCCUPATION; FAILURE TO COMPLY WITH CONDITIONS
LISTED ON THE ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF
PERMIT.
B nd Safety Department '
PROVED DENIED CONDITIONS ATTACHED
9
CJJ
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 policy number:
Carrier:
Policy Number:
A "COPY" OF THE POLICY SHOWING THE AMOUNT OF COVERAGE AND
EXPIRATION DATE FOR WORKMEN'S COMPENSATION IS REOUIRED TO PROCESS
THIS APPLICATION.
li 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 suLbject to
the worker's compensation provisions of Section 3700.
Pate: 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 QUINTA, CALIFORNIA 92253 ���.
r:
POA WEST RESIDENTIAL. ASSOCIATION, INC.
April 26, 1996
Ms. Nan de Brandt (Bauder) "7;2 CJ �17
54-833 Shoal Creek
La Quinta, CA 92253
Re: 54-833 Shoal Creek
PGA West
Dear Ms.de Brandt:
RZQ�ly '
MAY ��
FPr
Thank you for your letter requesting permission to operate a
• business from your home at PGA West. The Board of Directors
approved your request at the board meeting on April 25, 1996.`
•
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.
The Board of Directors reserves the right to revoke this
decision.
Sincerely,
*Milc-/hael
6r, M.S., C.A.C.M.
General Manager
PGA West Residential Association Inc.
P.O. Box 1060, La Quinta, California 92253, Telephone 619-771-1234 Fax 619-771-5125
BUS. LIC. NO,
1996 BUSINESS LICENSE APPLICATION FORM
* APPROVED•BY, S DATE
PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED PRIOR TO ISSUANCE
1. IS THIS
2. Business
MY
- M�L - I I
5. Business Phone: W"
6. Owned By
CORD
7. If Corporation or Partner
LL C__._
Mailing Address
3�
8. If Individual Owner: Social Securi x/
9. Name of Owner Hap, d e, L L a Title:
or Officers e
• 10. Type of Business: �'� Qui G� i rk .� 137 ��-5 01- h2445(-
_11.. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO
EResale Number:
13. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To Building Contractors):
A. Estimated Gross Business Receipts for New Business Only:
$ i , $�'o . N ; / ✓F�iv'l dst j JZoiLa,-�L-C.�7-°°`
B. Previous Year Gross Receipts for Established Businesses:
******************GOOD ONLY FOR JANUARY 1, 19% THRU DECEMBER 31,1996***************
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 in full force and effect.
Signatw*e Title Date
Send Completed Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495.Calle Tampico
• P.O. Bos 1504
La Quinta, CA 92253
RECEIPT CitY of La?Quinta, 78-495 Calle am co, P. O. Box 150
�1, La Quinta CA 92253
DATEC 16 7 ? o
19 4� L
RECEIVED FROM � �; G
ADDRESS.
•
FORi DOLLARS $ ,
e
AMT.
DUE I I IOFiDER I 113Y /
v _L
3. Business Address Mailing Address _Ap
5. Business Ph1441one: /' I4(AA � 4r�j'u- 1 14,;,06/l U. �e�V-�c. /ViF
3 `E
6. Owned Bv: CORPORATION PARTNERSHIP INDIVIDUAL
7. ' If Corporation or Partnership: TAX I.D. # Gi✓ d eS k e� .
RECEIPT City of La Qui ta, 78495 Calle Tampico, P. O. Box 1504, La Quinta CA 92253
19 16773
RECEIVED FROM
ADDRESS
DOLLARS
FOR
ACCOUNT HOW PAID
AMT. OF CASH
i.
IANC MONE BY
WE' R
B. Previous Year Gross Receipts for Established Businesses:
.******************GOOD ONLY FOR JANUARY 1, 1996 THRU DECEMBER 31 1996
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 in full force and effect.
Signature
•
Title
Send Completed Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
. P.O. Box 1504
La Quinta, CA 92253
Date