JansenP.O. Box 1504
78-495 CALLS TAMPICo
LA QUINTA, CALIFORNIA 92253
Q�
1111411,10
DESIGN AND DEVELOPMENT DEPARTMENT
(760) 77 7-7 000
FAX (760) 777-7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS
FEE $70.00 INSPECTION DATE:- 1 S
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 ail owners, partners, and/or corporation officers ���\ V�'� �1•� N, _
�10X*7-0-07
PROPERTY ADDRESS:- hVi.�n� A �t'�Y�D PHONE: �1q)
MAILING ADDRESS: (IF DIFFERENT FROM ABOVE)
PROPERTY OWNER: VMAk
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.):���. _
TYPE OF BUSINESS:
BRIEOVm v"
F DESCRIPTION OF HOW THE BUSINESS WILL OPERATE: iw�Yw_1..y� Wt_ [ yl
NUMBER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE): ,1'5�1 S
LOCATION ANQ SQU OTAGE OF AREA OF BUSINESS ACTIVITY IN HOME (EX. BEDROOM -
125 SQ FT.): ��� 1 .. �66
S%1
DESCRIPTION OF AC Y, QQU�IP�nI1��ENT, AND SUPPLIES BEING U ED IN pUSINE55
OPERATION: ]M4 � , C 1v4� faYl,M. f Akl W-0 NIf W r� WAWA- eAh,,DYRIAA WA-Lri
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
C U A' 1111 ALLOWED. (CONDITIONS ATTACHED).M1
',
VCA
WANT' [GNA'i�TItE DATE
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
RENTAL/LEASING AGENT IS REQUIRED.'
F�c�
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OWNS AGENT' SIGNATURE
. � \0
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1 / �� �
i
AGENT
CONTACT PH. #
DATE
E"ORTANT: 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. # - k ,17- DATE 2 I
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
dt'glamtim.that Slam lic f Il
WS COMP!1 5ATION DECLARATM
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 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, 1 will provide the City with a
policy or certificate copy within ten (I0) days of the change in requirements.
AP LICANT S NATURE
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
ADDRESS 51580 Avenida Alvarado H.0.2017-0078
ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS:
1. The establishment and conduct of a home occupation shall be an incidental and accessory use and
shall not change the principal character or use of the dwelling unit involved.
2. Only residents of the dwelling unit may be engaged in the home occupation.
3. A home occupation shall be conducted only within the enclosed living area of the principal dwelling
unit or within the garage provided no garage space required for off-street parking is used. The home
occupation shall not occupy more than twenty-five percent of the combined floor area of the house and
garage.
4. A home occupation shall not be conducted within a detached accessory structure, although materials
may be stored in such a structure.
5. There shall be no signs, outdoor storage, parked vehicles or other exterior evidence of the conduct of
the home occupation. Neither the dwelling nor the lot shall be altered in appearance so that it appears
other than a residence, either by color, materials, construction, lighting, sounds, vibrations or other
characteristics.
6. Electrical or mechanical equipment which creates interference in radio, television or telephone
receivers or causes fluctuations in line voltage outside the dwelling unit shall be prohibited.
7. The home occupation shall not create dust, noise or odors in excess of that normally associated with
residential use.
8. No sales activity shall be conducted from the dwelling except for mail order sales. The dwelling unit
shall not be the point of customer pickup or delivery of products or services, nor shall a home occupation
create greater vehicular or pedestrian traffic than normal for the district in which it is located. Exception:
Musical instruction and academic tutoring where not more than two students are present at the
residence at the same time shall be permitted.
9. Medical, dental or similar occupations in which patients are seen in the home are prohibited.
10. All conditions attached to the home occupation permit shall be fully complied with at all times.
Revocation or Suspension of Permit. The director of building and safety may revoke or suspend any permit for a
home occupation if the director determines that any of the performance and development standards listed in
subsection C of this section have been or are being violated, that the occupation authorized by the permit is or has
been conducted in violation of any state statute or city law, or that the home occupation has changed or is different
from that authorized when the permit was issued.
Special Conditions:
BY SIGNING THIS DOCUMENT I AGREE THAT I HAVE READ, UNDERSTAND AND WILL COMPLY WITH ALL CONDITIONS.
N FFI R'SIGNATURE
tA\ %Z
SIGNXTURE DATE
Conditions Per La Quinta Municipal Codes: 9.60.110, 9.160, 9.210.060