Saul�� 70.00
P.O. Box 15:04
78-495 C.A1LF TAMPICO (760) 777-7000
LA Q,UINTA, CALIFORNIA 92253 FAX (760) 777-7101
APPLICATION FOR ROME OCCUPATION OF A BUSINESS
INSPECTION DATE:.
PIease 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 0 r v r vel / 41_ PHONE:
MAILING ADDRESS:
PROPERTY OWNER -
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC-):
TYPE OF BUSINESS.-
BRIEF
USINESS:
DIFFERENT FROM ABOVE)
I
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OP TE: �� 7o'
NUMBER OF PERSONS INVOLVED IN BUSINESS: `{r �• v+-�
�� rl/1Lpff
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): c� /
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM -
125 SQ FT-)-. 117>4 itcl?
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION: ' -
f
I IIAVE, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
IIOME OCCUPATIQN IS ALLOWED- (CONDITIONS ATTACHED).
P SIGNATURE DATE
IF APPLICANT -IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED-
mac,
OWNERIAGTT SIGNATURE
a //y S.m rl�
AGENT COMPANY NAME
1 13 ON
ATE
93Z -3W
CONTACT PH. # DATE
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR -DENYING
YOUR ROME OCCUPATION; FAILURE TO COMPLY WITH THE CONDITIONS LISTED ON THE
ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMIT.
********************************************************************************************
BUILDING AND SAFELY DEPARTMENT/CODE COMPLIANCE DIVISION:
APPROVED _ L DENIED. SPECIAL CONDITIONS
OFFICERC44,rA I.D. # `t DAA 1
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 RAVE READ AND UNDERSTAND THIS
STATEMENT..
Signature
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 Iicense 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, Seiion
37101 of the government Code or Section 72-84 of the Revenue and Taxation code shall. coMP'rtte and sign a
declaration that statim the
[owing:
WORKER'S COMPENSATION DE ARATION
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 Ston
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. E�,pires:
A COPY OF SAID POLICY OR CERTIFICATE OF CONSENT SHONVING THE AMOUNT OF
COVERAGE. A]D EXPIRATION DATE FOR WORHEWS COMPENSATION IS REQUDMD TO
PROCESS TME APPLICATION
e orntanrn of business activities for which this license is
that th perl' �'
I oertdy m
issued, I shall not employ any person in any manner so as to became subject to the
worker's compensation laws of Cal. rfornia, 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 cf the change in requirements_
A. P GNATURE
DAT
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
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 9.60 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.
] 1. 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 Hone 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'THES>MD !IONS:
PRINT [HAM I/
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Office Copy — White Customer Copy — Yellow