CubbisonFEE $70.00
P.O. Box 1504
78-495 CALLE TAMPICo
LA QUINTA, CALIFORNIA 9
APPLYCATTON FOR
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(760) 7 7-70 0
FAX (760) 777-7101
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: P133 Ci [c PHONE: ? T O
MAILING ADDRESS:. (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER:
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.):
TYPE OF BUSINESS: W 'J a(i� . e Aic
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE:
NUMBER OF PERSONS INVOLVED IN BUSINESS:. I
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): -2-7�_O
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN ROME (EX. BEDROOM -
.. 125 SQ FT.): 12-0
DESCRIPTION OF MACHINERY, EQUIPMENT�PLIES BEING USED IN THE BUSINESS
OPERATION: n�
-HAVF.READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
noOC- ATION L5 D. (CONDITIONS ATTACHED).
to 6
APPL 'S SIGNATURE bAT,8
IF APPLICANT IS OTHER THAN TEE -PROPERTY OWNER, AUTHORIZATION OF OWNER OR
REh'TAL/LEASING AGENT IS REQUIRED.
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AGENT SIGNATURE DA h
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 SAFETY.DEPARTMENT/CODE COMPLIANCE DIVISION:
APPROVED- &AC, DENIED _ SPECIAL CONDITIONS
OFFICER _� 0 I.D. # I A l� _ DATE I
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PLEASE READ!
Please contact your Homeowner's Association prior to paying for your Home
Occupation Permit. Your Homeowner's Association may restricfor prohibit
home based businesses.
I HAVE RE •AND UNDERSTAND THIS
'STATEM
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.
T
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 azid sip_ zea
declamliozi that states the .fol lowi a r
WORKER'S COMPEWSATION DECLARATION
I hereby affirm under penalty of perjury, one of the following declarations:
I have and will maintain a cY z Iii.icxte of consent to self -insure for Worker's
Compensation, as provided by Section 3700 for the duration of any business acfvifcs
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
ssued
My Worker's ("oxnpensation insurance carrier and policy number:
Carrier:
Policy Number: Expires:
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 compensatioin 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.
APPLICANT 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.
DOME OCCUPATION CONDITIONS AND CRITERIA
ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS AND REQUIREMENTS:
No one, other that the resident of the dwelling shall be employed ori the premises in the conduct of the Horne
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 stmeture.
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 rna 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 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
reg Sating 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 atiered, or the honie occupation be so conducted, that the lot
or building may be.reasonably recognised as serving a non-residential use (either by color, inaterials, construction,
lighting, sounds, vibrations, etc)_
12. No Home Occupation shall create a nuisance by reason of noise, odor, dust, vibrations, fumes, smoke, electrical
iutcrlerence, 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 fteei ed necessary to carry out the intent of this section.
CITY OF LA QA M ICIPAL CODES: 9.60.110, 9.160, and 9.210.060