MILLLERl IIIIII VIII I'll IIII
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78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA .92253 -
.(619)..777--7050
FAX (619) ?77-7011
APPLICATION FOR PAID
Fee 35.0 HOME OCCUPATION OF A BUSINESS JUL 2 9 1997
Read each condition listed on the attachment to this form to see if tkrrproposed activity
complies with the City's Home Occupation Regulations.
APPLICANT NAMES (List all owners, partners and/or corporation officers)
Cheri L. Miller
PROPERTY ADDRESS 79-975 Westward Ho Drive, La Ouinta CA PHONE 760-347-4532
BUSINESS NAME C.L. Miller & Associates
PROPERTY OWNER Cheri L. Miller
• MAILING ADDRESS if different from business address) Same as above
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) Single
TYPE OF BUSINESS Paralegal Services
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE All business will be conducted
by phone fax, or modem and will consist of preparing and filing 1 Pgnl dnr,tmPntG _
NUMBER OF PERSONS INVOLVED IN BUSINESS 2
LIST NAMES OF PERSONS EMPLOYED Outside legal. assistant by contract _
.SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (exclude garage) 11 x 12 (132 sq. ft. )
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN' HOME (example,
"bedroom - 125 sq. Ft.) Converted bedroom - 132 sq. Ft.
• DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION Computer, modem fax telephone- ropy marhi na , typewriter, calculator
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
�� I HAVE REA UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
UPATI I ALLOWED (conditions attached).
�. (-� Date 7/29/97
Applicant's Signature
IF APPLICANT IS OTHER THAN PROPERTY. OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
Date
Owner/Agent Signature
Date
Agent Company Name Agent/Owner Contact Phone #
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.
-40 ✓ AP
BY: /
DENIED SPECIAL CONDITIONS ATTACHED
I.D.# DATE %
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 be received before
the business license can be processed.
your company has employees, a copy of the workman's
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 nuinta, a Home Occupation Permit is required before a
business license is used.
If you have any questions, please contact the Code Compliance Division at 777.7050.
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 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:
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 ill provide t City with a policy
or certificate copy within ten (10) days of the chan a in re uirem
Date:., �' Z� Applicant:
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.