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P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92247
'i I IIIIII VIII IIII IIII
03 _
COMMUNITY SAFETY DIVISION
HOME OCCUPATION PERMIT
Permit Number: 08-00000234
(760) 777-7050
FAX (760) 777-7011
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) SILVA SEGRIST
Property address: 80515 VIA TALAVERA Phone: (760) 777-4345
Mailing address: 80515 VIA TALAVERA
Property owner: SILVA SEGRIST
Type of business: FINE ART
Brief description of how the business will operate:
Square footage of usable, floor area in house (exclude garage) 4400 SQUARE FEET
Location and square footage of area of business activity in home (Example: Bedroom - 125 sq ft.) OFFICE
AND STUDIO, 450 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
OC UPATION IS ALLOWED. (Conditions Attached)
O
APPLICAN SIG URE DATE
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 16:00-10:30 A.M. ON 01/18/08)
Your inspector will be Michael Morris.
-------------------------------------------- INSPECTOR USE ONLY ----------------------------------------------------
APPROVED oa- IS! -e29
❑ DENIED Inspector Signature Date
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P.O. Boz 1504
78-495 CALLE TAMPICO '
LA QUINTA, CALIFORNIA .92253 6V
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APPLICATION FOR HOME OCCUPATION OF.A BUSINEv
FEE $7.0.00 INSPECTION DATE:. DI
Please read each condition listed on the attachment in thisacket to see if -
p theproposed .
activity complies with 'the City's Home Occupation Regulations.
APPLICANT NAMES:. (List all owners, partners, and/or corporation officers
Si�vf4. Sf� G121 S7
PROPERTY ADDRESS: O 51 S . VIA - TA LA v E 2-A PHONE:
LA a u -r-A cq el
MAILING ADDRESS: S A r i E (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER: 5/.I—VA � P4 U k_ SE 6, 21 S7 -
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): -SING, Lr
TYPE OF BUSINESS: F 1 NE Af2T
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE:.0 / LP -4 1A11_1 AJ 6; S W I/L L QC PA I N 7r-- D
PI,Ei,K(A;r,., onI Bgou4HT 7-o SiuOlo 7,0 FINISH , TO t3E Z.A-TCS
Gc•NSiGNP�r� T�..SG�i. 1n� GA-LL�(tiC� ,
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): 't, 40 S Q • % T
.; Vd pl.
.LOCATION'AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - .
125 SQ FT.): '`S p 5 Gl f=T /Sru pIo % o f=Fi S®aG),. .
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION: IN �rrlcE : c,anPu�E2 �21�j�e Of;SC� ff�E �1��N�T-F pA-PE,2 Suo.ipLy 5HC1_✓jCS . '
jN Sii+D�o: ifkfZ4,E EHSE�.,Ssfu- LIFr SET u0, wo+� -roe,-C, 4A7 Qn�r= SHEi✓CS, ye0-"TiN4.
pt PA,nrTs a MF -0I urel '
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HO CCUPATION ALLOWED. (CONDITIONS ATTACHED).
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APPLICANT' SIGN DATE
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTTAL/LEASING AGENT IS REQUIRED.
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AGENT COMPANY NAME CONTACT PH. # DATE
IMPORTANT: FALSE. OR MISLEADING INFO ION SHALL BE GROUNDS FOR DENYING
YOUR HOME OCCUPATION; FAILURE TO C LY WITH THE CONDITIONS LISTED ON THE
ATTACHED PAGE SHALL BE GROUNDS F REVOCATION OF PERMIT.
BLTII,DING AND SAFETY DEP IN/CODE COMPLIANCE DIVISION:
APPROVED DENIED SPECIAL CONDITIONS
'OFFICER I.D. # DATE
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
STATE ENT.
4G�
Signature
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WORKER'S COMPENSATION
If your company has employees, a copy of the Workman'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.
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 La Quinta, 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
37101 of the government Code or Section.7284 of the Revenue and Taxation code shall complete and sign as
declaration that states the following:
WORKER'S COMPENSATION DECLARATION
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 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: Expires:
A'COPY OF SAID POLICY OR CERTIFICATE OF CONSENT SHOWING THE AMOUNT OF
COVERAGE. AND EXPIRATION DATE FOR WORKER'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 should become subject to
the worker'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.
APPLICANf SIG URE DATE
WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer
to criminal penalties'and civil fines up to $100,000. In addition to the cost of compensation, damages,
interest, and attorney's fees may be assessed to. you as provided in Section 3706 of the Labor Code.