SOCORRO07
TdY 4 4 Qgha - -1
COMMUNITY SAFETY DIVISION
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
HOME OCCUPATION PERMIT
Permit Number: 13-00000793
(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) GUTIERREZ SOCORRO C
Property address: 78725 WAKEFIELD CIR Phone: (760) 200-9569
Mailing address: 78725 WAKEFIELD CIRCLE JULn2013
Property owner: GUTIERREZ SOCORRO C CITY OF LA QUINTA
FINANCE DEPT.
Type of business: typing/editing
Brief description of how the business will operate: _ e/n(.akQ
PF t
Square footage of usable floor area in house (exclude garage) 1500 sq. ft.
Location and square footage of area of business activity in home (Example: Bedroom — 125 sq ft.) bedroom,
100 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
OCCUPATION I ALLOWED. (Conditions Attached)
r7
APPL T A URE DATE
CODE COMPLIANCE DIVISION
If applicant is other than the property owner, authorization of orVor ig Vital/le'asnage1�i`seui,ed.
Your inspection has been scheduled for Home Occupation Inspection between 10:00 a.m to 10:30 a.m.. Your
inspector will be Aathan�vre pyR, � INITIAL
--------------------------------------------INSPE 0 rE ONLY------------------------------ ----/3 ---------
• ❑ APPROVED `
❑ DENIED Inspector Signatur Date
CE HP
0
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
(7 60) '177-7000
FAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS
FEE $70.00 �3 —. l % 3 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 officers
LP
Soc
ALAA,(_ ma_6ho C&7 lei
D _.
PROPERTY ADDRESS: / r� F72 5 ! —A -Ke Le/Gr PHONE:
'MAILING ADDRESS: %9 /•25 W" IFFERENT FROM ABOVE)
- PROPERTY OWNER:
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): tel' h
n /� z
'TYPE OF BUSINESS: / y,0%Nrr. a4- hO/n-e
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE:
NUMBER OF PERSONS INVOLVED IN BUSINESS: 5& F �t1
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): Z0_0
LOCATION AND SQUARE FOOTAGE
125 SQ FT.): 100 �—;,aN
DESCRIPTION OF
'OPERATION:
AREA OF JSINESS ACTIVITY IN HOME (EX. BEDROOM -
-J
AND,SUPPLIES BEING USED IN THE BUSINESS
I HAVE READ, UNDERSTAND, AND AGR"E WITH THE CONDITIONS BY WHICH A
HO
OCCUP NIS LOWED. (CONDITIONS ATTACHED)..' .
APPLICANTS SIGNATURE DA
IF APPLICANT IS OTHER THAN THE -PROPERTY O': 'NER, AUTHORIZATION OF OWNER OR
• REN"TAL/LEASING AGENT IS REQUIRED.
•
0
OWNER/AGENT SI NA D
.7b0 --Z co GSr,ct
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.
'BUILDING AND SAFETY.DEPARTMENT/CODE COMPLIANCE DIVISION:
APPROVED V DENIED SPECIAL COND ONS
OFFICER I.D. # DATE Z O /-3
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.
Signa e
r�
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:
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 (I0) days of the change in requirements.
T S GNAT 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.