Loading...
KOZLOFFFEE $70.00 P.O. Box 1504 wryo`F U ( V 6 v 78-495 CALLE TAMPICO �IkAN Fa�pTTA /� r(760)' 777-7000 LA QUINTA, CALIFORNIA 92253 ` FAX 7 - 1 APPLICATION FOR HOME OCCUPATION OF A BUSINES 9!30 —to;Cv INSPECTION DATE: 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 NAMES: (List all owners, partners, and/or corporation e7 - V—(j WK'ic? PROPERTY ADDRESS: f0-1415; 62/-Z�D&- PHONE MAILING ADDRESS: 5W SFS A-61 t6 (IF DIFFERENT FROM ABOVE) PROPERTY OWNER: }� TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): [i TYPE OF BUSINESS: • BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: ® 1 tG LS `D2wl✓n Uf— i5y'd MA,ihU USe V 1SI "0y\- NUMBER OF PERSONS INVOLVED IN BUSINESS: SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): LOCATION AND SQUARE, F,,QQO��TAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - 125 SQ FT.): i /N/j� DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS OPERATION: / I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A OME OCCUPATION IS ALLOWED. (CONDITIONS ATTACHED). APPLIC 'S SIG D TE IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR RENTAL/LEASING AGENT IS REQUIRED. 0 N r • O R/AGENT SIGNATURE DATE Leo -5i nogMir? a 2-11 gh 3 A9en� AGENT ONW 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. ******************************************************************************************** BUILDING AND SAFETY DEPARTMENT/CODE COMPLIANCE DIVISION: APPROVED DENIED SPECIAL CONDITIONS OFFICER I.D. # DATE • P 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. '�WWill Signature 1 - • • 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 a 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: 2, Policy Number —O 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. 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. L UNIT 0024787 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this. certificate of insurance may be issuedor may pertain', the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. !d' AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER ,OCCURRENCE. EMPLOYER • rRIAGENT SIGNATURE DATE�yL.eaSi n� A-9 2-11 6 j 'AGENT OMPANY NAME CONTACT PH. # DATE -7�l1 fkq. It I Gulrrr* CIA IMPORTANT: FALSE OR MISLiADING 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. ******************************************************************************************** BUILDING AND SAFETY DEPARTMENT/CODE COMPLIANCE DIVISION: APPROVED DENIED SPECIAL CONDITIONS OFFICER_ I.D. # DATE Z2l/C' • 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 • • • HOME OCCUPATION CONDITIONS AND CRITERIA ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS AND REQUIREMENTS: 1. -No one, other than the resident of the dwelling shall be employed on the premises in the conduct of the Home Occupation. (Spouses are okay) 2. The Home Occupation shall be conducted entirely within the enclosed area of the main building and shall not occupy more than 25. percent of the total area of the structure. 3. A Home Occupation shall not be conducted within an accessory structure. There may be storage of equipment or supplies in an accessory structure. Garage space may be used for the conduct of a Home Occupation only when it does not interfere with the use of such space for the off-street parking or -vehicles required by Chapter 9.160 of the Zoning Ordinance. 4. There shall be no outdoor storage of equipment, machinery, supplies, materials, or merchandise. 5. There shall be no sales activity, either wholesale or retail, except mail order sales, nor shall there be the maintenance of an office open to the general public. 6. There shall be no supply of hazardous materials stored on the premises at any given time (i.e. pool, chlorine, paint thinner, etc.), unless the hazardous materials are stored in a manner approved the State Fire Marshall or any other regulating agency. 7. There shall be no dispatching of persons or equipment to or from the subject property, including the use of vehicles which operate to and from the premises. 8. No vehicles or trailers, except those normally incidental to residential use, shall be parked at the residence at any time. 9. There shall be no use of any mechanical equipment, appliance, or motor outside of the enclosed building or which generated noise detectable from outside the building in which it is located that is related to the business. 10. There shall be no signs or other devices identifying or advertising the home occupation. CITY 01 In no way shall the appearance of the building or lot be so altered, or the home occupation be so conducted, that the lot or building may be reasonably recognized as serving a non-residential use (either by color, materials, construction, lighting, sounds, vibrations, etc.) No Home Occupation shall create a nuisance by reason of noise, odor, dust, vibration, fumes, smoke, electrical interference, traffic, or other causes. The use shall meet reasonable special conditions as established and made of record in the Home Occupation Permit, as may be deemed necessary to carry out the intent of this section. Listed below are special conditions which shall be considered a part of the conditions and criteria directly related to 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 Quints, 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 a declaration that states the followine• 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 Compqnsation insurance carrier and policy number: Carrier: Policy Number -CO 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. lD 0 APPL ANT SIGN 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. 0 January 8, 2003 �Tbl- i t vr/ P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 KC Development, Inc. 80145 Vista Grande La Quinta, Ca 92253 Dear Mr. Kozloff: (760) 777-7000 FAX (760) 777-7101 Please find the enclosed Home Occupation Permit form to obtain City approval for your business. In the City of La Quinta, if you do not work from a commercial location, i.e. a residential area, you are required to obtain a Home Occupation Permit and a city business license. After we receive the completed paperwork and fee, we can then schedule a time for a home inspection • (usually the next business day between 9:30 a.m. and 4:00 p.m.). We will try to schedule it at a time that is convenient for you. It takes about 10 to 15 minutes and we will schedule a half-hour window for the inspection time. After the approval, your City Business License will be processed. Thank you for your cooperation. If I can be of assistance, please do not hesitate to call me at 777-7050. Sincerely, Gina McElroy Counter Technician • g�r9 STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION N SU RAN C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE JULY 11 Z002 POLICY NUMBER: CERTIFICATE EXPIRES: F- CITY OF LA QUINTA BUILDING AND SAFETY .P.O. BOX 1504 LA QUINTA CA 92253 L 229-02 UNIT 0024787 b-1-03 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of. insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions_ and conditions of such policies. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000000 PER OCCURRENCE. EMPLOYER F K.C. DEVELOPMENT INC • 80-145 VISTA GRANDE LA QUINTA CA 92253 ov. arm THIS DOCUMENT.HAS A'BLUE 'PAT•TERNED BACKGROUND sclF.�ozsz�REv:s=9si HOME OCCUPATION CONDITIONS • ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS: 1. No one, other than the resident of the dwelling shall be employed on the premises in the conduct of the Home Occupation. 2. The Home Occupation shall be conducted entirely within the enclosed area of the main building and shall not occupy more than 25 percent of the total area of the structure. 3. A Home Occupation shall not be conducted within an accessory structure. There may be storage of equipment or supplies in an accessory structure. Garage space may be used for the conduct of a Home Occupation only when it does not interfere with the use of such space for the off-street parking of vehicles required by Chapter 9.160 of the Zoning Ordinance. 4. There shall be no outdoor storage of equipment, machinery, supplies, materials, or merchandise. 5. There shall be no sales activity, either wholesale or retail, except mail order sales, nor shall there be the maintenance of an office open to the general public. 6. There shall be no supply of hazardous materials stored on the premises at any given time (i.e. pool, chlorine, paint thinner, etc.), unless the hazardous materials are stored in a manner approved the State Fire Marshall or any other regulating agency. 7. There shall be no dispatching of persons or equipment to or from the subject property, including the use of vehicles which operate to and from the premises. 8. No vehicles or trailers, except those normally incidental to residential use, shall be parked at the residence at any time. 9. There shall be no use of any mechanical equipment, appliance, or motor outside of the enclosed building or which • generated noise detectable from outside the building in which it is located that is related to the business. 10. There shall be no signs or other devices identifying or advertising the home occupation. 11. In no way shall the appearance of the building or lot be so altered, or the home occupation be so conducted, that the lot or building may be reasonably recognized as serving a non-residential use (either by color, materials, construction, lighting, sounds, vibrations, etc.) 12. No Home Occupation shall create a nuisance by reason of noise, odor, dust, vibration, fumes, smoke, electrical interference, traffic, or other causes. 13. The use shall meet reasonable special conditions as established and made of record in the Home Occupation Permit, as may be deemed necessary to carry out the intent of this section. 14. Listed below are special conditions which shall be considered a part of the conditions directly related to this MY SIGNATURE BELOW INDICATES THAT I HAVE READ, UNDERSTAND AND AGREE TO COMPLY WITH ALL F THESE CONDITIONS: - 2) ; ?'F 16 if= - PR NA � ' a SIGNATUR DAT �� Office Copy -White Customer Copy - Yellow January 8, 2003 P.O. Box 1504 78-495 CALLE TAMrrco (760) 777-7000 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101-1 KC Development, Inc. 80145 Vista Grande La Quinta, Ca 92253 Dear Mr. Kozloff: Please find the.enclosed Home Occupation Permii form to obtain City approval for your business. In the City of La Quinta, if you do not work,'from a commercial location, i.e. a residential area, you are required to obtain a Home Occupation Permit and a city business license. After we'.receive the completed paperwork and fee, we can then schedule, a time for a home inspection {; (usuallythe next business day between 9 30. a.m. and 4:00 p.m.). We will try to schedule it at a time that is convenient for you. It takes about 10 to 15 minutes and we will schedule a half-hour window for the inspection time. After the approval, your. City Business License will be processed. Thank you for your cooperation. If I can be of assistance, please do not hesitate to call me at 777-7050. Sincerely, Gina -McElroy . . /Counter Technician Business License No. " = `BUSINESS LICENSE APPLICATION FORM APPROVED BY� DATE 00 •iiiii#i#ii#iiiiii#####i#•iiiiii Business Name: Business Address:-" - - �•--l4� Mailing Address: Business Phone: (74,a, 57f -o7 ;-2(:r Owned By: (CORPORATION PARTNERSHIP INDIVIDUAL If Corporation or Partnership, Tax 1. D. #:—(Z�d�¢�Q If Individual Owner, Social Security #: a-n-no of Owner or Officers and Title: l s� iLo� pw 6 ED Resale Number: Number of Decals Needed: Vehicle License Number Permit Number (Finance Dept. Only) 0A &� D27 1-3 CONTRACTORS ONLY: Copy of State Contractors license Pe Me• r„a 1. o d ype of Contractor: . B. Classification: :ate License Number: 3 3 License Classification $100.00 Per Year or $ 50.00 Semi -Annual snse Classification $ 50.00 Per Year or $25.00 Semi -Annual :BY CERTIFY that all the information supplied by me is correct and any licenses required by the Y. State or Federal Government have been issued to me and are in full fort ran effect. SignaVire V v Title Date ..��, . y j• ; :oat'ed Form To:=1. .. CITY OF LA QUINTA BUSINESS LICENSE DIVISION P.O. BOX 1504 La Quinta, CA 92253