PhotiasP.O. Box 1504
78-495 CALLE TAMPICo
LA QWNTA, CALIFORNIA 9225$
(7 60) 777-7000
FAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS flo-L&j,
FEE $70.00 INSPECTION DATLO. .11 N...= r01)
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Please read each condition listed on the attachment in this packet to see if the proposed �v in �
activity complies with the City's Home Occupation Regulations.
APPLICANT NAMES: (List all owners, partners, and/or corporation officers.
`Iv o - Q-�� CAs
PROPERTY ADDRESS: 1?J2�Oz� Wrk-C�G�. ,, )E _ _ PHONE: 7
MAILING ADDRESS: (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER: 14 nZ d _ i � . _ �.
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.):
TYPE OF BUSINESS:
I 0i,I((VI Ic-
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE:
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NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE):
1
LOCATION AND SQUARE FOOTA OF AREA F BUSINESS ACTIVITY IN HOME (EX. BEDIA
125 SQ FT.): �e- too
DESCRIPTION OF CIQNF.RY, EQUIPMENT, AND SUPP S BEING IN THE BUSINESS
OPERATION: b (2
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Ylo ,y
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
OCCUPATIONXSL LOWED. (CONDITIONS ATTACHEVDA
CANT'S SIGN Tf]RE '1't:.
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
fdz_NTALILEASING AGENT IS REQUIRED
OWNER/AGENT SIGNATURE DATE
AGENT COMPANY NAME CONTA
IMPORTANT: FALSE OR MISLEADING INFO]
YOUR HOME OCCUPATION; FAILURE TO C[
ATTACHED PAGE SHALL BE GROUNDS FOR
CT PH. # / DATE
HALL BE GROUNDS FOR DENYING
WTM THE CONDITIONS LISTED ON THE
'ATION OF PERMIT.
BUILDING AND SAFETY DEP ' ENT/CODL; COMPLIANCE DIVISION:
APPFtOVI?I] DENIED SPECIAL CONDITIONS
OFFICER ] I.D. # DATE 5 r-
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 Clete and sigMa
gyration that states the following:
I hereby af£rm 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 MIRATION 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 maturer 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
policy or certificate copy within ten (10) days of the change in requirements.
DATE
WARNING- Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer
o 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.
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.
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 shal l be no signs or other devices identifying or advertising the home occupation.
H. 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 of noise, odor, dust, vibration, filmes, 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
WIT ALL OF THESE CONDITIONS:
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Office Copy — White Customer Copy — Yellow