DelSartoP.O. Box 1504
78-495 CALLS TAMPICO
LA QUINTA, C:ALIFORNIA 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
I TUYTI W C,-�Q-ri70
PROPERTY ADDRESS: U 1(P S f' I S h OyPHONE:
MAILING ADDRESS:
DDTERENI'FROM ABOVE)
PROPERTY OWNER: ( &A,rW I ' t " ' - 7>1U
-TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC_): 6
TYPE OF BUSINESS: �� - �-�--t �C� �- '1 L -t r\,44 -- -
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE:
b �-AWLK . b-e d rvorn .:
NUMBER OF PERSONS INVOLVED IN BUSINESS:.
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE):
LOCATION AND
125 SQ FT.):
ARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM
DESCRIPTION OF MACRINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION:
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
UI'ATION 75 ALLOWED_ (CONDITIONS ATTACHED)..
-
ICANT'S SIGNATURE - DATE
IF APPLICANT IS OTHER THAN THE -PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED--
R��
r
OW N A16AGENT ti GNATURB
AGENT COMPANY NAME
CONTACT PH..#
V ' V.
DATE
DATE
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING
YOUR HOME OCCUPATION; FAILURE TO COMPLY VMM THE CONDITIONS LISTED ON THE
ATTACHED PAGE SHALL BE GROUNDS FOR REVOCATION OF PERMPT.
'BUILDING AND SAFETY.DEPARTN=/CODE COMPLIANCE DIVISION:
APPROVED
SPECIAL CONDMONS
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.
.0 HAVE READ AND UNDERSTAND THIS
STATEMENT.
Signature
WORKER'S COMPENSATION
If your company has employees, a copy of the Workman's Compensation Policy mast accompany thebusiness
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 codeshall complete and sign
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 rnimber:
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 ccrti icate. copy within ten (10) days of the change in requirements.
� ' r
APP ANT SIGNATURE DATE ,
WARNING. Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer
to criminal penalties'and civil fines up to S100,000. 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.
Permit Details
Page 1 of 1
Enter Permit Number H02014-1014
I i l 1 of 1 H I• I } 100°h
Find I Next
f Vlew.Re. a,. j
Permit Details PERMIT NUMBER
- City of La Quinta H02014-1014
Description:
Type: HOME OCCUPATION
Subtype: STND
Status: SUBMITTED
Applied: 8/6/2014 KME
Approved:
Parcel No: 775310007 Site Address: 80916 SPANISH BAY LA QUINTA,CA 92253
Subdivision: TR 28960
Block:
Lot: 7
Issued:
Lot SgFt: 0
Building SgFt: 0
Zoning:
Finaled:
Valuation: $0.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings:0
No. Stories:0
No. Unites:0
Details:
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
Lauren and Tom DelSarto
80916 Spanish Bay
La Qulnta
CA
92253
OWNER
THOMAS DELSARTO
92253
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT#
CHECK#
METHOD
PAID BY
LTD
BY
CBY
HOMEOCCUPATION
101-0000-42447
0
1 $70.00
$0.00
ID
Total Paid for HOME OCCUPATION: $70.00
$0.00
TOTALS: $70.00
$0.00
l INSPECTIONS
PARENT PROJECTS 11
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
BOND INFORMATION
ATTACHMENTS
Printed: Wednesday, August 06, 2014 3:23:47 PM 1 of 1 C#?t"'C` ors ,",
http://laquinta. crw. com/trakit9/DocumentV iewer. aspx?&report=/Documents/PERMITS /Per... 8/6/2014