RobertsP.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
JUL 21 2016
COMMUNITY DEVELOPMENT
(760) 777-7000
FAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS
FEL 0.00 INSPECTION DATE:
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
MAILING ADDRESS: (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER: A&+TIP�a 61--
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.):
TYPE OF BUSINESS:
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL O[IERATE.
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE �XCLUDE GARAGE): 7
LOCATION AND SQUARIE, FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM -
125 SQ FT.): 1.�_-
DESCRIPTION OF,�4ACH14MIY, EQUIPMENT,
OPERATION: )Pe&A)
BEING USED IN THE BUSINESS
I HAVE READ, UNDERSTAND, AND AG*EE WITH THE CONDITIONS BY WHICH A
HOME OCC�i, T- ON �. LLQ ED- (CONDITIONS ATTACHED).
APPLICANT'S SIGN TURF DAT
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
,,-<'t1e)1,1 —
..a-
��l�o �Y.S »– �✓
OWNER/AGENT SIGNATURE
DATE
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 .
APPROVED
OFFICER _
i
.PARTMENT/CODE COMPLIANCE DIVISION.-
DENIED
IVISION:
DENIED SPECIAL CONDITIONS
I.D. # I DATE . s ! b
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 HAVE 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 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 cMplctc and_sign a
declaration that states the following:
WORKER'S MPENSATIO 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: 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 compensation laws of California, and agree that if I should become subject to
the worker's compensation provisions of Section 3700, 1 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.
HOME OCCUPATION CONDITIONS AND CRITERIA
ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS AND REQUIREMENTS:
1. No one, other that 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% 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 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 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
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.
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 reasonably 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 ofnoise, 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.
CITY OF LA QUINTA MUNICIPAL CODES: 9.60.110, 9.160, and 9.210.060
PETER ALDANA
COUNTY OF RIVERSIDE P.O. Box 751, Riverside, CA 92502-0751 -- (951) 486-7000
ASSESSOR -COUNTY CLERK -RECORDER 38-686 El Cerrito Road, Palm Desert, CA 92211 -- (760) 863-8732
OFFICE OF THE COUNTY CLERK
FICTITIOUS BUSINESS NAME STATEMENT
COUNTY CLERK'S FILING STAMP
SEE REVERSE SIDE FOR FEES AND INSTRUCTIONS
F I L E D
County of Riverside
CLERK'S USE ONLY
Peter Aldana
- USE BLACK INK ONLY -
$ # 16-230017
Assessor -County Clerk -Recorder
MUST BE TYPED OR PRINTED
INITIAL CROSS OUTS Fee Re dpt
R-201609013
NO WHITE OUT ALLOWED co�ras.
07/15/2016 01:15 PM Fee: $58.00
_
Page 1 of 1
THE FOLLOWING PERSON(S) IS (ARE) DOING BUSINESS AS:
In. Fictitious Business Name (If more than one business name at same address - Attach Supplemental Sheet)
NETTLE'S JEWELRY
lb. List COMPLETE Physical Business Address (No P.O. Boxes or Postal Facilities) lc Name of County (where business is located)
54700 AVENIDA RAMIRE� LA UINTA, CA M53 _RIVERSIDE
Mailing Address (If different than business address — optional)
2a. Registrant Information (Individual, Corp., LLC, Gen. Partner, etc.)
2b. Registrant Information (Individual, Corp., LLC, Gen. Partner, etc.)
CHERYL BREWER ROBERTS
If individual -spell out first, middle and last names (use dash if no middle name)
_NETTIE
If individual -spell out first, middle and last names (use dash if no middle mune)
54700 AVENIDA RAMIREZ_
_
Residence Address (if Corp. or LLC enter the physical address of the Corp./LLC)
__ _
Residence Address (if Corp. or LLC enter the physical address of the CorpJLLC)
LA CA -92253
City State Zip
List State of Corp./LLC. Must be registered in California
City State Zip
List State of CorpJLLC. Must be registered jnCaWanial
2c. Registrant Information (Individual, Corp., L.LC, Gen. Partner, etc.)
2d. Registrant Information (Individual, Corp., LLC, Gen. Partner, etc.)
If individual -spell out first, middle and last names (use dash if no middle name )f
if individual -spell out first, middle and last names (use dash if no middle name)
Residence Address (if Corp. or LLC enter the physical address of the CorpJLLC)
Residence Address (if Corp. or LLC enter the physical address of the Corp./LLC)
City State Zip
City State Zip
List State of Corp./LLC. Must be registered in California
List State of CorpJLLC. Must be registered in California
3. This business Is conducted by: (It More Than lour Registrants - Attach Additional Shoal Showing Owner Information)
® Individual ❑ Married Couple ❑ Trust ❑ Corporation ❑ General Partnership
❑ A Limited Partnership ❑ Co-partners ❑ Joint Venture ❑ Limited Liability Company ❑ Limited Liability Partnership
❑ An Unlncornorated Association - other than a Dartnershio ❑ State or Local Re Is Bred Domesfic Partnurshli)
_
4. ❑ Registrant has not yet begun to transact business under the fictitious names) listed above.
® Registrant commenced to transact business under the fictitious business riarne(s) listed above on 1/10/2014
1 declare that all the information In this statement Is true and correct. (A registrant who declares as true any material matter pursuant to Section 17913 of the
Business and Professions Code that the registrant knows to be false Is guilty of a misdemeanor punishable by a line not to exceed one thousand dollars ($1,000).)
S. Signature(s)4---j i�
(Only one Is rerlulre )
Typed or Printed Name(s) NETTIE CHERYL BREWER ROBERTS
If Limited Liability Company/Corporatlon, Title OC'D BY:
THIS STATEMENT WAS FILED WITH THE COUNTY CLERK OF RIVERSIDE COUNTY ON DATE INDICATED BY FILE STAMP ABOVE
NOTICE -IN ACCORDANCE WITH SUBDIVISION (a) OF SECTION 17920, A FICTITIOUS BUSINESS
I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY
NAME STATEMENT GENERALLY EXPIRES AT THE END OF FIVE YEARS FROM THE DATE ON
OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE.
WHICH IT WAS FILED IN THE OFFICE OF THE COUNTY CLERK, EXCEPT, AS PROVIDED IN
PETER ALDANA
SUBDIVISION (b) OF SECTION 17920, WHERE IT EXPIRES 40 DAYS AFTER ANY CHANGE IN THE
FACTS SET FORTH IN THIS STATEMENT PURSUANT TO SECTION 17913 OTHER THAN A
CHANGE IN THE RESIDENCE ADDRESS OF A REGISTERED OWNER. A NEW FICTITIOUS
RIVERSIDE COUNTY CLERK
BUSINESS NAME STATEMENT MUST BE FILED BEFORE THE EXPIRATION. THE FILING OF THIS
STATEMENT DOES NOT OF ITSELF AUTHORIZE THE USE IN THIS STATE OF A FICTITIOUS
By. Deputy
BUSINESS NAME IN VIOLATION OF THE RIGHTS OF ANOTHER FEDERAL, STATE OR COMMON
LAW (SEE SECTION 14411 ET SEG., BUSINESS AND PROFESSIONAL CODE).
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HOME OCCUPATION CONDITIONS
ADDRESS: 54700 Avenida Ramirez
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 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 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.
PRINT NAME
OFFICE SIGNATURE OF APPROVAL
SIGNATURE DATE
** OFFICERS SIGNATURE INDICATES HOME OCCUPATION APPROVAL
HOME OCCUPATION CONDITIONS
ADDRESS: 54700 Avenida Ramirez
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 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 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.
rmum i njmiviC
OFFICE SIGNATURE OF APPROVAL
SIGNATURE DATE
** OFFICERS SIGNATURE INDICATES HOME OCCUPATION APPROVAL