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P.O. Box 1504 "00�).30
78-495 CALLS TAMPIco (760) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101
APPLICATION FOR IIOME OCCUPATION OF A BUSINESS
R Zn 1(0 - DD I q INSPECTION DATE: L/6 g, 50 P
Please read each condition Iisted 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
PROPERTYADDRESS: 1- _r r PHONE- ?Ge q - 33 �'
MAILING ADDRESS: (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER-
TYPE
WNER
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC_):
TYPE OF BUSINESS: ,�; {'4i �- • �- o ^' tx A
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE:
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE):
LOCATION ANDS UARIy FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM -
125 SQ FT.): 1, l of i . C " ---
DESCRIPTION OF MACHINERY, LQUIPME
OPERATION: Co — �
AND SUPPLIES BEING USED IN THE BUSINESS
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPlk ' N IS ALLOWED_ (CONDITIONS ATTACHED). f
LI 'S SIGNATURE DATE
IF APPLICANT -IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
WNLR/AGENT SIGNATURE
AGENT COMPANY NAME
DATE
CONTACT PH. # DATE
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING
YOUR HOME OCCUPATION; FAILURE TO COMPLY'WnM THE CONDITIONS LISTED ON THE
ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMIT.
BUILDING AND SAFETY DEPARTMENT/CODE COMPLIANCE DIVISION:
APPROWZDDENIED--- SPECIAL CONDITIONS
OFFICER I -D. W i fS DATE
PLEASE DEAD?
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.
Signature
WORKER'S COMPENSATION
If your company has employees, a copy of the Workman's Compensation Policy roust 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
ssued,
If you have any questions,'please contact the Code Compliance Division at 777-7050.
lies for any license o - renewal of any license for a business issued pursuant to -Section
Every employer who app
37101 of the government Code or Section 7284 of the Revenue and Taxation code shall.tete and si a
declaration that states the
[owing:
WORKER'S COMPENSATI N ]3ECTARA TION
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 businessactivities
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: aC?o Expires- �' f -
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 shalt 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
r,oIicy or certificate copy within tcn (10.) days of the change in requirements.
.r G- od- ILI- l�
r.
YPLI T SIGNATURE 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
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 maybe storage of equipment of
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 or vehicles required by Chapter 9.160 of the.Zoni g
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, rlalorxne, 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 from the premises.
$_ No vehicles or trailers, except those normally incidental to residential use, shall. be parked at the residence at any time.
9_ There shalt be no use of any -mechanic al equnpmcnt, 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 h,,) re occupation be so conducted, #hat die lot
or building may be reasonably recognized as serving a non-residential use (either by calor, materials, construction,
-lighting, sounds, vibrations, etc).
12. No Home Occupation shall create a nuisance by reason of noise, odor, dust, vibrations, 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.
:ITY OF LA QUINTA MUNICIPAL CODES: 9.60-110,9-160, and 9.210.060
'heck A License - License Detail - Contractors State License Board Page 1 of
Contractor's License Detail for License # 964123
DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this
information, you should be aware of the following limitations.
CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below. Click on the
link or button to obtain complaint and/or legal action information.
Per B&P 7071.17 , only construction related civil judgments reported to the CSLB are disclosed.
Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration.
Due to workload, there may be relevant information that has not yet been entered onto the Board's license database.
his license is current and active.
All information below should be reviewed.
Business Information
BAJA CONCRETE
52435 EISENHOWER DR
LA QUINTA, CA 92253
Business Phone Number:(760) 296-3368
Entity Sole Ownership
Issue Date 08/04/2011
Expire Date 08/31/2017
License Status
Classifications
-8 - CONCRETE
Bonding Information
formation
Contractor's Bond
Pis license filed a Contractor's Bond with WESCO INSURANCE COMPANY.
,Bond Number: 04WBO30648
$onci Amount: $15,000
effective Date: 01/01/2016
Contractor's Bond History
Workers` Compensation
This license has workers compensation insurance with the EVEREST NATIONAL INSURANCE COMPANY
Policy Number:7600012943
Effective Date: 03/16/2014
Expire Date: 03/16/2016
'A'orkers' Compensation History
ttps://www2.cslb.ca.gov/OnlineServices/CheckLicenseIIlLicenseDetail.aspx?LicNum=964123 2/19/20
HOME OCCOPATION CONDITIONS
ADDRESS: 52435 EISENHOWER DR.
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 no 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 on
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 orders 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 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 devised 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 reasonable 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, UNDERTAND AND AGREE TO COMPLY WITH ALL OF THESE
CONDITIONS.
0
PRINT NAME OFFICE SIGNATURE OF APPROVAL
E -�
7Sr N DATE
** OFFICERS SIGNATURE INDICATES HOME OCCUPATION APPROVAL