EvansP.O. Box 1504
78-495 CALLE TAMPICO
LA Q,UINTA, CALIFORNIA 92253
af&m CEIVED
OCT 4 2017
CITY OF LA QUINTA
COMMUNrM1*V15UD1? dW0 0
FAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSR" I
I��.Oo INSPECTION DATE: �� I D
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
4 C, Hn► r/AN 5
PROPERTY ADDRESS:
MAILING ADDRESS:
PROPERTY OWNER:
5,L233 5 0 i N 1 V 4 5 T h -,L 1-14 . PHONE:
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J o H N" 1�- ,Y A, s
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.):
TYPE OF BUSINESS
760. 2402.. 1999
DIFFERENT FROM ABOVE)
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BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE; 1-1`I`I "" 2n' _ S''� L 1
Ain4—F. D JSi'c) prI Lek &,A1XTh
S
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): 2-°1- "
LOCATION AND SQUARE FOOTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM -
125SQFT.): STKPY oteP +g'"o A,ry 4&AAe4e A STbPIA C,V j�-lZZ-ejxf
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
OPERATION: H h v r, TD O i s lj 4h S M A,1 I P6v.er f a o S.
I HAVE REA { RSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
HOME OCCUPATI L ? OWED. (CONDITIONS ATTACHED). 1-7
4
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APPLICANT'S A DATE
IF APPLICANT 19 (OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.
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OWNER/AGENT SIGNATURE
AGENT COMPANY N
IMPORTANT: FALSE OR MIS
YOUR HOME OCCUPATION;
ATTACHED PAGE SHALL BE
BUILDING AND SAFETY
APPROVED V
!"
OFFICER
DATE
CONTACT PH. # DATE
LING INFORMATION SHALL BE GRO DS FOR DENYING
URE TO COMPLY WITH THE CO IONS LISTED ON THE
UNDS FOR REVOCATION OF PERMIT.
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I.D. # s -
L
SPECIAL CONDITIONS
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, I
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 camplete and siva
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:
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.
APPLICANT SIGN
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
9e worker's compensation provisions of Section 3700, I will provide the City with a
olk or certificate copy within ten (10) days of the change in requirements.
DATE
0, 5, 1-1
WARNING: Failurq to secure Worker's Compensation coverage is unlawful, and shall subject an employer
to criminal penaltic and civil fines up to $100,000. In addition to the cost of compensation, damages,
interest, and attn.rney's fees may be assessed to you as provided in Section 3706 of the Labor Code.
HOME OCCUPATION CONDITIONS
ADDRESS: 52238 Shining Star Tr H.0.2017-0060
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
CONDITIONS.
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PRINT NAME
SIGNATURE
READ, UNDERTAND AND AGREE TO COMPLY WITH ALL OF THESE
OFFICER SIGNATURE OF APPROVAL
DATE
** OFFICERS SIGNATURE INDICATES HOME OCCUPATION APPROVAL