WHITENERFEE $35.00
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� FEB 14 1996 II11 1
CITY OF LA QUINTA
BY
78-495 Calle Tampico, P. O.Box 1504, La Quin a, C 922-5.,
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 C VNt,�c_re e_S PHONE 3
PROPERTY OWNER PHONE
PROPERTY ADDRESS %A?--t,Q) Q ,a S o ��-
MAILING ADDRESS
TYPE OF RESIDENCE single, multiple, mobil home, etc.) Sc
TYPE OF BUSINESS ib.r5c�nrx cze_c, c�h�on S
BRIEF DESCRIPTION 0 HOW THE BUSINES� WILL OPERATE 1tave
e .c. e S -k
NUMBVR OF PERSONS INVOLVED IN BUSINESS
LIST NAME OF PERSONS EMPLOYED
• SQUARE FOOTAGE OF USABLE FLOOR AREA
IN HOUSE (EXCLUDE GARAGE)
LOCATION AND SQUARE FOOTAGE OF .AREA \h --Ie --4-
OF BUSINESS ACTIVITY IN HOME 6a'Js e 61F
(EXAMPLE, "BEDROOM -125 S.F. ") any -,j r q_-
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE
BUSINESS OPERATION - c, Sy n\C*Vre 4 _A-r-.oP - S�rONe.T
I HAVE -READ, UNDERSTAND, AND -AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPATION IS ALLOWED (CONDITIONS ATTACHED).
APPLICANT SIGNATURE DATE
IF APPLICANT IS OTHER THAN PROOPF09T CV5��IR, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
OWNER/AGE'KwZ SIGNATURE 'u' z� DATE
IMPORTANT: FALSE OR MISLEADING- INFORMATIQa G)LALL BE GROUNDS FOR
DENYING YOUR HOME OCCUPATION; FkTLURE "k) CAA'AV'!,Yr. WITH CONDITIONS
LISTED ON THE ATTACHED PAGE SHA1a1, BE r,, � t ` .••.FOR REVOCATION OF
PERMIT.
ld nq and Safety Department
PROVED D�'NIE� e=;���iri�l��'IONS ATTACHED _-a .
•
040 W A mAr& - FJ we - a � iWO � N
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 REQUIRED TO PROCESS
THIS APPLICATION.
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 shot#d become subject to
the worker's compenAation provisions of Sec on 3700.
Date: LZ _ Applicant:
WARNING: Failure to secure workman's compensation coverage is
unlawful, and shall subject an employer to criminal penalties and
civic fines up to $100,000. In addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
Code, interest, and attorney's fees.
bus.fac
A-,
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 �.
F'e rV 3-96 10:49A
P. 02
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February .15,,199$ '• �,
+ t 4 r
City of i.,a Quitlt� �
P. 0. Box 1504
La �inta, CA 32253
S
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Re: Streec Fair. 'Applicahi ,
Susan Whitener, Owner of Chuckies ,
To Whom_�E May Cohcerri:
The Mast"fir,Associatiibn` fox Rancho LA Qtlipr a acknow.'I edcJes t Y:ax +:
of our homeowners 'and resident, tusan W�itenex, owns and opp.r= - - ;
a business known As Chuckies . we are 'alsp aware that sbe s�+�,'
paper products.in her garage, 'Her business it, not in vi6!P_tter. t►•
anv Association rules,.
It further documentatioft is necessary from the Assoc, atiorl in crr:`
to grarm Mrs. whitener a Lpermit -to participate in the Street FAr, L ,
please contact the. unders-i,gned, M
Carol KWh i tlock, , P( 'X%l -CCAM,
CommunidtV, Ar$ovtaLior,
'I4ci271a j" jt, -C
Rancho ija Qv i nth Tib 3 rC dL L4:
c Susan wh�I ter�c�z` i
f ,