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Community Development
Department
78-495 CALLE TAMPiCO (760) 777-7125
LA QuiNTA, CALIFORNIA 92253 FAX (760) 777-701 1
HOME OCCUPATION PERMIT
Permit Number: 14-00000558
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 name(s): (List all owners, partners, and/or corporation officers) JACOB BANDA
Property address: 52190 AVENIDA JUAREZ Phone: (760) 625-24
Mailing address: 52190 AVENIDA JUAREZ
Property owner: JACOB BANDA E
Type of business: DELIVERY SERVICE rK
Brief description of how the business will operate:
Square footage of usable floor area in house (exclude garage) 1200 SQ FT
Location and square footage of area of business activity in home (Example: Bedroom —125 sq ft.) LIVING
ROOM, 50 SQ FT MOISES RODARTE
Description of machinery, equipment, and supplies being used in the business operation:
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCC�J I'ATl0 LLOWED. (Conditions Attached)
de
P CANT SI TilR : DATE
If applicant is other than the property owner, authorization of owner or rental/leasing agent is required.
Your inspection has been scheduled for Home Occupation Inspection between 10:00-11:00 AM 05/20/2014.
Your inspector will be Moises Rodarte.
---------
------- ---------------INSP C" it ❑ L------__-____
APPROVED 0 I�f
❑ DENIED ector Signature Da
CE HP
P.O. Box 1504
78-495 CALLE TAMPIco
LA QUINTA, CALIFORNIA' 92253
- ssz
(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 COL ..L
PROPERTY ADDRESS: SU _ At So, "e u PHONE: Q r
MAILING ADDRESS: f22 &Q /irX �u4/T'1- __ (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER: 0 /'/ �C ��' c ,(— -- -
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): S:
kor
TYPE OF BUSINESS:
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: mil,
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE):
LOCATION
125 SQ FT.).
AREA OF BUSrSS ACTIVITY IN HOME (EX.
Il. l f% _ I+' 14, X" A" A. k
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION:
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
OCC WED. (CONDITIONS ATTACHED).
'CANT'S SIGNATURE DATE
IP APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
r
rr -
OWNER/AGVNT SIGNATURE
AGENT COMPANY NAME CONTACT PH. #
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 SAFE DEPARTMENT/CODE COMPLIANCE DIVISION:
APPROVED DENIED SPECIAL CO ITIONS
OFFICER I' aol* I.D. # ._ _l DATE 19
PLEASE READ!
Please contact your Homeowner's Association prior to paying for y6ur Home
Occupation Permit. Your Homeowner's Association may resl ict or prohibit
home based businesses.
I HAVE READ) AND UNDERSTAND THIS
STATEM16NT.
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 complete and sign a
declaration that states the following:
WORKER'S COMPENSATION 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:
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 " "PLICATION,
I at in the erfornlance of an business activities for wluch this license is
ceat�fy ilt p y
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
nalicv or certificate couv within ten (10) days of the change in requirements.
DATE
WA."JLNq.j: r"atture to secure workers �,ompensation 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.