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CITY OF LA QUINTA
78-495 Calle Tampico, P. O.Box 1504, La Quinta, CA 92253
HOME OCCUPATION PERMIT
Read each condition listed on the attachment to this form to see if
the proposed activity can comply with the City's Home Occupation
Regulations.
BUSINESS
NAME
PY1VTIPUG-PHONE
7�'�/
PROPERTY.
OWNER
PH7E
PROPERTY
ADDRESS
`f9- /Si ly,9SiIIAJJ�TD
MAILING
ADDRESS
/,?f -r
G.� 0VIA-- 7q
TYPE OF
RESIDENCE
(single, i
mobil home,
etc.)
TYPE OF
BUSINESS
/0%ip - T
BRIEF DESCRIPTION
OF HOW THE BUSINESS WILL OPERATE Off'/4E o uTv-
NUMBER OF PERSONS INVOLVED IN BUSINESS /
LIST NAME OF PERSONS EMPLOYED
SQUARE FOOTAGE OF USABLE FLOOR AREA
• IN HOUSE (EXCLUDE GARAGE) /6�d
LOCATION AND SQUARE FOOTAGE OF AREA
OF BUSINESS ACTIVITY IN HOME
(EXAMPLE, "BEDROOM -125 S.F.")
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_ IS ALLOWED, S,COJNDITIONS ATTACHED) .
APPLICANT STATURE DATE
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER
OR AGENT IS REQUIRED.
OWNER/AGENT SIGNATURE DATE
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR
DENYING YOUR HOME OCCUPATION; FAILURE TO COMPLY WITH CONDITIONS
LISTED ON THE ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF
PERMIT.
•
Buildinq and Safety Department
APPROVED DENIED CONDITIONS ATTACHED
5 i
Lo�v
On,
78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101-
Dear
77-7101
Dear Business Owner:
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
mount.This proof of coverage must be received before the business
license can be processed.
If you do not have employees, please check the last line on the
first 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. Approval of the Home Owners Association is also required
if you live in a gated community.
If you have any questions, please contact me.
Sincerely,
Ellie Shepherd
Building & Safety
t
buslic.hoc
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253
T-,dy 4 4aQuiKrw
78-495 CALLE TAMPICO — LA DUINTA, ,CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
Every employer who applies for any license or a 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
declaration:
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: .STATE
Policy Number:
A "COPY" OF THE POLICY SHOWING THE. AMOUNT OF COVERAGE AND
EXPIRATION DATE FOR WORKMEN'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 Sion 3700.
Date: %�� �1f Applicant:
WARNING: Failure to secure workman's compensation coverage is
unlawful, and shall subject an employer to criminal penalties and
civic fines up to $100,000. In addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
Code, interest, and attorney's fees.
bus.fac
L,
MAILING ADDRESS - P.O. BOX 1504 - LA DUINTA, CALIFORNIA 92253 Q4&/`
4NSEP-28-95 THIS 1 2 :46. OTr- i aLciEnt ---r Fr i :se
THE VILLAS OF LA QUINTA
Homeowners Association
•� P.O. Box 88
La Quinta, CA 92253
619/564-2177
September 28, 1995
P _ 0 1
CITY OF LA QUINTA
Code Enforcement Dept.
ATTN: Ellie Shephard
P.O. Box 1506 ,
La Quinta, CA 92253
RE: City Business License
Dear Ms. Shephard:
Mr. Ted Llewellyn has requested we;direct correspondence to you relating to
his business, Ted Llewellyn Painting.
For your records, the Board of Directors is aware that Mr. Llewellyn manages a
business, i.e. telephone service, billings, etc., from his home within The
Villas of La Quinta Homeowners Association.
If additional information is required please contact our office at the above
phone nunber. .
FOR THE BOARD OF DIRECAViRS
ANNE TUTTLLE
Manager
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