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Jackman1� ',r I IIIIII II'll IIII IIII 20 • ��IY�YI fly P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92247 COMMUNITY SAFETY DIVISION HOME OCCUPATION PERMIT Permit Number: 11-00004878 (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) JACKMAN ERIC Property address: 78955 VIA TRIESTE Phone: Mailing address: *NOT ON FILE Property owner: JACKMAN ERIC Type of business: Financial Planning Brief description of how the business will operate: Square footage of usable floor area in house (exclude garage) 2500 Square feet Location and square footage of area of business activity in home (Example: Bedroom — 125 sq ft.) Home office / Den, 120 Sq Ft 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 ,ATION IS ALLOWED. (Conditions Attached) 0/1, tow- - APPLI NT.SIGNATUREI-I-� DATE -j 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 10:00 AM. Your inspector will be Kevin Meredith. -------------------- --------------------INSPECTOR USE ONLY- - ------ --------------------- APPROVED ❑ DENIED Inspector Signatur Date CE HP • 0 P.O. Box 1504 78-495 CALLE TAMPIco LA QUINTA, CALIFORNIA 92253 SEP 12 2019 APPLICATION FOR HOME OCCUPATION OF FEE $70.00 INSPECTION DATE: (760) 777-7000 FAX'(760) 777-7101 i Please read each condition listed on the attachment in this packet to see it the proposed activity complies with the City's Home Occupation Regulations. APPLICANT NAMES: (List all owners, partners, and/or corporation officers PROPERTY ADDRESS: ri%5S V, I'lS_isib. PHONE: _ILgO- LogL—Icca MAILING ADDRESS: (IF DIFFERENT FROM ABOVE) PROPERTY OWNER: TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOLE, ETC.): r �` TYPE OF BUSINESS: li�_ I p NIT BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: 0\ NUMBER OF PERSONS INVOLVED IN BUSINESS: SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): LJco LOCATION AND SQUARE FOOTAG OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - 125 SQ FT.): Q EYt, DESCRIPTION OPERATION: AND SULLIES BEING USED IN THE BUSINESS I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A 5,HOEOCCUPATIO ALLOWED. (CONDITIONS ATTACHED). q -CANT'S IGN TURF DATE IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF RENTAL/LEASING AGENT IS REQUIRED. OWNER/AGENT SIGNATURE DATE AGENT COMPANY NAME CONTACT PH. # DATE IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING YOUR HOME OCCUPATION; FAILURE TO COMPLY WITH THE CONDITIONS LISTED ON THE ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMIT. BUII:DING AND SAFETY DEPARTMENT/CODE COMPLIANCE DIVISION: APPROVED DENIED SPECIAL CONDITIONS OFFICER I.D. # DATE 0 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 STATEMENT. Signature • • 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 sigh a declaration that states the following: �'iiLl :. ti a l' ► Y 1 MY • 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, 1 will provide the City with a policy or certificate copy within ten (10) days of the change in requirements. L ` (D (� (� l _Cl ICANT. IGN TURE DATE WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to 5100,000. In addition to the cost of compensation, damages, interest, and attorney's fees may be assessed toyou as provided in Section 3706 of the Labor Code.