SaygePermit Details
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Enter Permlt Number H02014-1009
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Find I Next ® M
ry Permit Details PERMIT NUMBER
s �^u City of La Quinta H02014-1009
Description: MEDICAL CONSULTING
Type: HOME OCCUPATION
Subtype: STND
Status: SUBMITTED
Applied: 7/31/2014 PJU
Parcel No:
Site Address: ,
Approved:
Subdivlslon:
Block:
Lot:
Issued:
Lot Sci Ft:0
Building Sq Ft: 0
Zoning:
Flnaled:
Valuatlon: $0.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories:0
No. Unites:0
Details:
ADDITIONAL SITES y
CHRONOLOGY I
CONDITIONS
CONTACTS
NAMETYPE
NAME
ADDRESSS
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
THOMAS JACOB SYAGE
55504 FIRESTONE
LA QUINTA
CA
92253
(619)602-0717
OWNER
KENNETH NORTHRUP
55504 FIRESTONE
LA QUINTA
CA
92253
(619)602-0717
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
LTD
CBY
BY
HOMEOCCUPATION
1 101-0000-42447 1
0
$70.00
$0.00
19
Total Paid for HOME OCCUPATION: $70.00
$0.00
TOTALS: $70.00
$0.00
I INSPECTIONS
PARENT PROJECTS
REVIEWS
REVIEWTYPE REVIEWERJ SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
BOND INFORMATION
ATTACHMENTS
Printed: Thursday, July 31, 2014 8:46:39 AM 1 of 1 s-sixv�
(-OC,E COMPLIANCE DIVISION
HOME OCCUP4TION APPROVED
:)
INITIAL .
vV t��
-
http://laquinta.erw.cornitrakit9lDocumentViewer.aspx?&report=lDocumentsIPERMITS/Pe... 7/31 /2014
P.O. Box 1504
78-495 CALLE TAMPIco (760) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101
"7CATION FOR ROME OCCUPATION OF A BUSINESS
$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 _
�'JAAG
C
PROPERTY ADDRESS:Ig�mNE PHONE: Wbq r�"2-o� 1-7
MAILING ADDRESS: (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER: N L- t I'I 1V Old -m our
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.): _7�g C t ff. M U �-� I�� f—C 0 1,j 00)
TYPE OF BUSINESS: MC1 CAL CO OSUl 1 I SIG
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: (KfrUz ) A X
NUMBER OF PERSONS INVOLVED IN BUSINESS: i
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE):
1293
LOCATION AND SQUARE FOO AGE OF AREA OF BUSINESS ACTIVITY IN HOE (EX. BEDROOM -
125 SQ FT.): _ �T Mt� MG - -
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION:
- I I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME QCCUPATION IS WED. (CONDITIONS ATTACHED).
011V 6 1q
APPLICANT'S SIG A DATE
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR -
RENTAL/LEASING AGENT IS REQUIRED. 7Y
g
X
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 AND SAFETY DEPARTMENT/CODE COMPLIANCE DIVISION:
APPROVED DENIED SPECIAL CONDITIONS
OFFICER ___......._._ _... I.D. # . DATE.--
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.
71 ).)"100
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
T 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:
C;�rzicr:
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 ICATION.
I certify that in the performance of any business activities for which thus 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_
APPLICANT SIGNAT + 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.