Ramirez (2)P.O. Box 1504
78-495 CALL£ TAMPICO
LA QUINTA, CALIFORNIA 92253
(760) 777-7000
FAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS
FEE $70.00 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 ���� �rL
PROPERTY ADDRESS: �A PHONE:
MAILING Ai3DRESS: (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER:
TYPE OF RESIDENCE, (SINGLE, MULTIPLE.., MOBILE HOME, ETC.):
INVOLVED IN BUSINESS:„
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE):
LOCATION AND
125 SQ FT.):.2
DESCRIPTION OF
OPERATION: Ce
AGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM -
USED IN THE BUSINESS
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
I�QIVIE OCCUPC
ON IS ALLOWED. (CONDITIONS ATTACHED).. k
t
AP .ICA9tj NAAT[7RE DATE
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTADLEASING AGENT IS REQUIRED.'
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151.
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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 complete and sign_a
declwation that states the follQyina:
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, I will provide the City with a
policy or certificate copy within ten (10) days of the change in requirements.
A C SI ATURE
-�--- 1 -0 11
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.
r
R
AGENT COMPANY NAME
-IV -ro-n
DATE
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-SM1-GL-BE-GROUNDS-FOR-MVGCATION-OF PERMIT.
BUILDING AND SAFETY. DEPARTMENT/CODE COMPLIANCE DIVISION:
APPROVED DENIED SPECIAL CONDITIONS
OFFICER ,O A��r, I.D. # % -/ DATE
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
HOME 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 on 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 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.
T There shall be no dispatching of per or equipment to or from the subject property, including the use of vehicles
which operate to and from the premises.
ti_ 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
generatednoise 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 of noise, odor, dust, vibrations, fur es, 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.
III
0
hanergency Medical Inforiiiatiori
OP.tw-JO
Our online database
Neill include:
1. Photo I.D.
2. Personal Information
and Insurance(s)
3. Each of your doctors name
4. List of allergies and medications
5. Medications suppliers list
G. Preferred hospital in case of
an emergency
r ,4 letter of approval for services
8. DNR Form
Reduce or eliminate medical errors by consulting a
Know My Care representative today at (760) 564-8916
For more information visit us online at: www.Know-My-Care.com
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. VA !101,11MT . ► 1 W ■
SPECIAL OFFER
Our membership cost consist of an initial payment of $99 dollars to
set up your account and introduce your information in to our online
database. this price also includes an I.D. with a custom OR Code
directed to your emergency information account with your image and
basic information.
$9.99 a month
payment to provide you with a represenlative Thal will keep your iecords up to date.
- All records will be revised every 3 months unless you contact us
with any new updates on your medications or health condition.
If you loose or misplaced your I.D Please contact us as soon as
possible..I Replacement LD cards will have a cost of $20
HOME OCCUPATION CONDITIONS
ADDRESS: 53270 Eisenhower Dr. H.0.2017-0019
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 orders sales, nor there the maintenance of an office
opened 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.
SIGNATURE OFAPPROVAL
,5-I'l;��
DATE
** OFFICERS SIGNATURE INDICATES HOME OCCUPATION APPROVAL