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JOHNSONeF `----78-495 C A L L E TAM PI CO 70 UVII QCcv IIIIIIIIIIIIIIIIIIII LA QUINTA, CALIFORNIA 92253 (7 60) 777-7000 FAX (760) 777-7101 APPLICATION FOR HOME OCCUPATION OF A BUSINESS S00 FEE $70:00 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 + 4*1 O�lnSO PROPERTY ADDRESS: 778W 4a&% '& C/ e PHONE: 74-4) MAILING ADDRESS: -.57/ X20,? (IF DIFFERENT FROM ABOVE) PROPERTY OWNER: �Se Ar TYPE OF RESIDENCE, (SINGLE, MULTIPLE,/MOBILE HOME; ETC.): S/h • TYPE OF BUSINESS: _A00 BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: C` lt'4/7 7A ,Ll4/s»�/mss 4kevo 7: 8/11 i NUMBER OF PERSONS INVOLVED IN BUSINESS: SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): 3cOW O LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - 125 SQ FT.): lSl> DESCRIPTION OF MACHINERY, EQUIPMENT ND� SUPPLIE BEING USED IN THE BUSINESS OPERATION: 72 -Ate Id Ar �ele"S P. I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME TION ISA LOWED. (CONDITIONS ATTACHED). P DATE • IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR RENTAL/LEASING AGENT IS REQUIRED. CODE COMPLIANCE DIVISION HOME OCCUPATION APPROVEDL I • � Eti ` • 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. BUILDING AND S DEPARTMENT/CODE-COMPLIANCE DIVISION: / APPROVED DENIED SPECIAL CONDITION OFFICE I.D. # v 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 STATEMENT. .0. 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 bereceived 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 followin 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. r Y.—. 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:6:rXnjr �r��P Grocc,n Policy Number: ADfUIGS.0/4 3 Expires. G 11/,$-/4 el A COPY OF SAID POLICY OR CERTIFICATE OF CONSENT SHOWING THE AMOUNT OF' COVERAGE AND EXPI ATION DATE FOR WORKER'S COMPENSATION IS REQUIRED TO PROCESS THIS APPLICATION. I certify that in the performance of anybusiness 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. SIGN TU 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. ' HOME OCCUPATION CONDITIONS AND CRITERIA • ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS AND REQUIREMENTS: 1. No one, other that the resident of the dwelling shall be employed ori 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% 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 of supplies in an accessory structure. Garage space maybe used for the conduct of a Home Occupation. only when it does riot interfere with theuse 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 by the State Fire Marshal 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 frorn'the premises. 8. No vehicles or trailers, except those normally incidental to residential use, shall be parked at the residence at anytime: .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 ofnoise, odor; dust, vibrations, fumes, smoke, electrical interference, traffrc,.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. CITY OF LA QUINTA MUNICIPAL CODES: 9.60.110, 9.160, and 9.210.060 f G U A RD 'p -S INSURANCE •�r GROUP Workers' Compensation and Employer's Liability Policy NorGUARD Insurance Company - A Stock Company Policy Number ADWC658143 Renewal of NEW NCCI No. [25844] [1] Named Insured and Mailing Address JOHNSON, ADAM L. (AN IND.) (DBA) AQUAPOOL CO 50855 Washington St, #202 La Quinta, CA 92253 Federal Employer's ID 020744809 Agency PAYCHEX AGENCY, INC. 1175 John Street West Henrietta, NY 14586 Agency Code: NYPAYC10 Insured is Individual [2] Policy Period From June 15, 2005 to June 15, 2006, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: California B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $1,000,000 Bodily Injury by Disease - each employee $1,000,000 Bodily Injury by Disease - policy limit $1,000,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of. North Dakota, Ohio, Washington, West Virginia, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms -. WC 040004 [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 4,544 Total Surcharges/Assessments $ 119 Total Estimated Cost $ 4,663 INTERNAL USE T7 Page - 1 - Information Page MGA : ADWC658143 WC.000001A A Date :06/24/2005 16 South River Street 9 P.O. Box A -H 9 Wilkes-Barre, PA 18703-0020 9 www.guard.com P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 2,7q V (760) 777-7000 FAX (760) 777-7101 APPLICATION FOR HOME OCCUPATION OF A BUSINESSf-1,tNpd0�K (7� y FEE $70.00 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 PROPERTY ADDRESS:10 �. 1 D• • �• i �i MAILING ADDRESS: PROPERTY OWNER: --ZZ)Z TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): _ Jnr i✓ v • TYPE OF BUSINESS: Q • FROM ABOVE) BRIEF I' • OF •W THE BUSINESS WILL •• • •. • •. • ... •� i a els. • NUMBER OF PERSONS INVOLVED IN BUSINESS: O� SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): I LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - 125 SQ FT.): Q�(`3 c G ��- DESCRIPTION OF MACHINERY, EQUIPMEN'(j'''� AND SUPPLIES BEING USED IN THE BUSINESS OPERATION: �r t.r lr c l', c �c Vim, c . _. , ►,. _ , I HAVE READ, UNDERSTAND, AND AGREE WITH THE COI HOME OCCUPAT 6 IS ALLOWED. (CONDITIONS ATTACHED). VP&INVGNA t I IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZE RENTAL/LEASING AGENT IS REQUIRED. I L v V-751-0 l 10 �"r�u 0 04 iV6 5 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 -W05 -C;z��o (7 60) 77.7-7.000 FAX (760.) 7.7.7-7101 APPLICATION FOR HOME OCCUPATION OF A BUSINESS FEE $-70;00 INSPECTION DATE: r_ 0 • =0 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 0 6��. .7 _ �? S '2 7j 2PROPERTY ADDRESS:/ MAILING ADDRESS: �'—OSI S GU�is�ii, lye .SX ' 20.2 (IF DIFFERENT FROM ABOVE) PROPERTY OWNER: .TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME; ETC.): 45/.01 • TYPE OF BUSINESS: /000 BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: D/►i�r��� 7�0 Ooo�s. NUMBER OF PERSONS INVOLVED IN BUSINESS: SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - 125 SQ FT.)`.. DESCRIPTION OF MACHINERY, EQUIPMENT/ ! SUPPLIE,§ BG USED IN THE BUSINESS OPERATION: %',sr c;e -Zlr I HAVE READ, UNDERSTAND, AND AGREE WITH- THE CONDITIONS BY WHICH A HOME TION IS A ,LOWED. (CONDITIONS ATTACHED). DATE IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR • RENTAL/LEASING AGENT IS REQUIRED. 'n HOME OCCUPATION CONDITIONS ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS: I. 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 application and this permit: MY SIGNATURE BELOW INDICATES THAT I HAVE READ, UNDERSTAND AND AGREE TO COMPLY WITH ALL OF THESE CONDITIONS: �`fo(o •� o `i�so� . PRINT NAME NA DATE Office Copy — White Customer Copy — Yellow