CARPENTER (3)•
FEE $35.00
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.
BUSINESS NAME COAAEC.T T-AjsAEn_ i PHONE (6l4)S6N-ooRs
PROPERTY OWNER 14. CflRPCnITER PHONE
PROPERTY ADDRESS 7gs5 o Srnl6Zn16 PA�.nns DAxv6r
MAILING ADDRESS <i9n.►C
TYPE OF RESIDENCE (41�, multiple, mobil home, etc.)
TYPE OF BUSINESS NOME Sr4SPCe'rro,4S
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE 4QAX-TZ-J5
&i POATS i o^lic PHo.-46r 0619&c flr i*0^.4t
NUMBER OF PERSONS INVOLVED IN BUSINESS t
LIST NAME OF PERSONS EMPLOYED -4 f
SQUARE FOOTAGE OF USABLE FLOOR AREA I
IN HOUSE (EXCLUDE GARAGE) 1,7
FE 0 6 1996
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME gy
(EXAMPLE, "BEDROOM -125 S.F.")
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION Fig)C, Ptroyigf, C6^Aj0u rER ltlgp P 5 vPPcs� S
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCU-TION IS ALLOWED (CONDITIONS ATTACHED). / /_ ,
CANT SIGNA
DATE
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.
• Building and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
•
•
T4ty,,, - 4 4a Qamm
78-495 CALLE TAMPICO - LA OUINTA, CALIFORNIA 92253 - (619) 777-7000
t 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 REQUIRED TO PROCESS
THIS MPLICATION.
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.
Date: �, ��. ��� 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 OUIN.TA, CALIFORNIA 92253 ���,
r.: 4
BUS. LIC. NO
1996 BUSINESS LICENSE APPLICATION FORM
************************************************
* APPROVED BY DATE
************************************************
PROOF OF WORKERS COMPENSATION INSURANCE IS REQUIRED PRIOR TO ISSUANCE
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES ✓ NO
2. Business Name: e'—ORA i; CT j SPE C TJ
78sso 5�..r6s,,,7v
3. Business Address: PA/-^^ s QA, 4. Mailing Address -7-6556 !�-/=NV.ri I6
%�i`�Lnnf /)a4. L A-Cl/y�.•/rA lj� q��s 3
5. Business Phone: 00 ;-!�-
6. Owned By: CORPORATION PARTNERSHIP �,U
7. If Corporation or Partnership: TAX I.D. #
8. If Individual Owner: Social Securri y# /�S �
9. NameofOw\\/4M
ner �)rS N. e)9A0e;V76R Title: �70LE
or Officers
• 10: Type of Business: H6^1\E Z14SP!�G 7- --t-0
-11. IF YOU ARE A FOOD VENDOR, DO YOU HAVE A COUNTY HEALTH PERMIT:
YES NO
12. SBEResale 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:
$ 9-0
"yo0
B. Previous Year Grass Receipts c:r Established Businesses:
******************GOOD ONLY FOR JANUARY°1; 1996 THRU DECEMBER 31,1996***************
I HEREBY CERTIFY that all the intoimation 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 Date
Send Completed Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
78-495 Calle Tampico
P.O. Bos 1504
La Quinta, CA 92253
P
BUSINESS LOCATED IN THE CITY OF LA QUINTA ONLY
GROSS RECEIPTS
RANGE
CLASS 1 CLASS 2 CLASS 3
0
- 25,000
$ 15.00 $ 18.00 $ 21.00
25,001
- 50,000
25.00 30.00 36.00
50,001
- 100,000
30.00 36.00 43.00
100.,001
- 250,000
46.00 55.00 66.00
250,001
- 500,000
76.00 90.00 108.00
500,001
- 750,000
114.00 135.00 162.00
750,001
- 1,000,000
150.00 180.00 216.00
1,000,001
- 2,000,000
400.00 500.00 600.00
2,000,001
- 3,000,000
500.00 625.00 750.00
3,000,001
- 4,000,000
600.00 750.00 900.00
4,000,001
- 5,000,000
700.00 875..00 1,050.00
5,000,001
- 10,000,000
1,000.00 1,250.00 1,500.00
10,000,001
- and up
1,500.00 1,875.00 2,250.00
r =.
CLASS 1
Automobile Repair
and Services; Laundry, Dry Cleaning &
Garment Services;
Manufacturing; Retail & wholesale
Trade.
CLASS 2
Amusement & Recreation
Services, including Motion
Pictures; Architectural
Services; Automotive Sales;
Barbers & Hairstylists;
Beauty Shops; Engineering
Services; Landscape & Horticultural Services; Operators
Renters & Lessors
of Comercial Property; Services to
7BUI Id.16ag ;,; and all
other persons engaged in business
not specifically
listed elsewhere.
CLASS
Accounting, Auditing & Bookkeeping Services; Financial
Services; Insurance Brokers & Services; Legal Services;
Management & Public Relations Services; Medical &
Health Services;
Real Estate Agents, Brokers, Managers
& Services.
0