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EstradaNo zo[q - P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIrORNIA 92253 (760) 7 7 7 - 7 0 0 0 FAX (760) 777-7101 APPLICATION FOR HOME OCCUPATION OF A BUSINESS F4m.00 INSPECTION DATE: &/15/ 1'r 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 G tauljW J, PROPERTY ADDRESS p., -r a U PH 'Zr opj PHONE: MAILING ADDRESS: 1'D - (5,y 3' �0 1i (IF DIFFERENT FROM ABOVE) PROPERTY OWNER: G-Mipd, EArm di _ -- TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): Sri r�* TYPE OF BUSINESS: ---.�_ 3'� C D(IC(a e-L- BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: _ �C� N 5A o L -C�l (fie ib �! 0 �!1 p � o,�/ NUMBER OF PERSONS INVOLVED IN BUSINESS: SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE) -_ MOD LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM - 125 SQ FT.): OPERATION: ON OF MACHINERY, Y, C�[1��I�P N,T�,�D IN Sey- , , G 71ez I HA REA ,_.II T P OC A IS 1 IG ATURE AND, AND AGREE WITH THE CONDITIONS BY WHICH A 'ED. (CONDITIONS ATTACHED). DATE IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR RENTAL/LEASING AGENT IS REQUIRED, 7 P,D(sovA` o�ro wG��d (� AA COI A)o �y � ll� . Ap COUiJ "- lM/ Q9 ✓�� i 0 COMf) , AGENT COMPANY NAME CONTACT PH. # _71Z P/ toy DATE 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 ^PARTMENT/CODE COMPLIANCE DIVISION; APPROVED DENIED SPECIAL CONDITIONS OFFICER I.D. # _ DATE ' ` 1 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. Si a e 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 comp gad ma A declaration that states the follayiDg= 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: a Expires: = l 8 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 copy within ten (10) days of the change in requirements. 7 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 CIUTERAA 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 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 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. CITY OF LA QUINTA MUNICIPAL CODES: 9.60.110, 9.160, and 9.210.060 _-IM, BAJACON-01 4CCPRd CERTIFICATE OF LIABILITY INSURANCE D 03 171/1201 YY) 0311712017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu_ of such endorselnent(s). PRODUCER License # OE63493 CONTACT Orr & Associates Insurance Services PHONE 506-5859 (A/C, NoA800) 474-3003 28780 Single Oak Dr IPA,,' rCApILo, Ert). {951 ) Ste255 L%Lss:Service -orrandassociates.com Temecula, CA 92590 iucnwcarm eccnwmwa rruFanrc I Nmc a INSURED Baja Concrete I INS PO Box 5204 WSLLRERn; La Qulnta, CA 92248 INSURER E American Insurance C THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN7R TYPE OF INSURANCE ,4DDL SUBA POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X I COMMERCIAL GENERAL LIABILITY R £iV E S 1,000,000 CLAIMS -MADE ❑X occuR IJ17AC81103-03 02/2312017 02/23/2018 QPiP`°£T°R£NTl=sa 100,000 S PLR UNAL & ADV INJURY S 1,000,000 L AGGR TF LIMIT APPLIES PER X POLICY jE�7 � LOC l3THER- GFNFRAI. AGGRFGATF S 2,000,000 PRODUCTS - OMPIOPAGG S 2,000,000 S B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS Dp X AURTOS ONLY X AUTOS ONEY IBAW67062945 12/13/2016 12/13/2017 crsM91N 11.1 EL! rr � m S 1,000,000 BODILY INJURY P son S B llR P accidenn S PF . MADE S S A X UMBRELLA LIAB X OCCUR EXCESS LAB J, CLAIMS -MADE DIED RETENTIONS IU17AC81103-03 02/23/2017 02/23/2018 EACH OCCURRENCE S 1,000,000 A F ATE 1,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN AApNFFTI PERMRIETOER EXCLUDED? ECUTIVE ❑ [fAanGatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA _ 17600012943171 03/16/2017 03116/2013 X PER OTH- rAr R C E L EACH ACCIDENT S 1,000,000 E.1DISEASE -FA EMaLOY - 1'000'000 E L DISEASE - POLCY LIMIT S 1,000,0001 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be etmched if more space is required) License #964123 Contractors State License Board Workers Compensation- Unit PO Box 26000 Sacramento, CA 95826 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD HOME OCCUPATION CONDITIONS ADDRESS: 53275 Avnida Herrera H.0.2017-0043 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 COMPyY 1ITH ALL OF THESE CONDITIONS. J_ �I 1 PRINS ,AME USIGI A OFFICER SIGNATURE OF 9 - is- i l DATE ** OFFICERS SIGNATURE INDICATES HOME OCCUPATION APPROVAL