Vendetti--- CAI_I1 OR:NI A MAR 1 1 2019 ---
CITY OF LA QUINTA 0
HOME OCCUPATION OF A BUSINP9 N & DEVELOPMENT DEPARTMENT
h-
PERMIT# -"=HSPECTIOv DATE (J TIME I
Please read each condition listed on the attachment in this packet to see if the proposed home business complies
with the City's Home Occupation regulations.
NEW APPLICATION $105.00 LOCATION CHANGE $55.00
Applicant Names:
E,50 A
V ow D cT --r
Address:
57q'-1
S. VA-L-L�&y L-K! AQV1NTA,907-53
Phone:
Email:
o� 4-I
BIZ cLbbie.v6 4--&vx-�onl )-C , Com
l'} Eye of residence:
Square Footage:
'51N6L-C-
")Lq 40wC 6,000 Sq
Type of Business:
&H -r LA),4 f-D I
Brief Description of the Business Operation:
Location and Square Footage of Business in Home: (Ex. Bedroom 120 SF)
0 01)t? 00 (n I OCR soo S
Number of Persons Involved in Bu&ess:
z
Description of Machinery, Equipment, and Supplies Being Used:
com Pu I E PHOIJOS
I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS BY WHICH A
HOME OCCUPATION PERMIT IS ALLOWED.
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APPLICANT SIGNAT RE DATE
ca4pz � 'q
78495 CALLE TAMPICO — LA QUINTA, CA 92253 — 760-777-7000
WWW.LAQUINTACA.GOV
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, A SIGNED AUTHORIZATION FROM OWNER
OR RENTAL/LEASING AGENT IS REQUIRED,
N/,4
OWNER/AGENT 91GNATURE DATE
rqIA
AGENT COMPANY NAME CONTACT PHONE
PLEASE CONTACT YOUR HOMEOWNER'S ASSOCIATION PRIOR TO PAYING FOR YOUR HOME
OCCUPATION PERMIT. YOUR HOA MAY RESTRICT OR PROHIBIT A HOME -BASED BUSINESS.
IMPORTANT: FALSE OR MISLEADING INFORMATION SHALL BE GROUNDS FOR DENYING YOUR
APPLICATION; FAILURE TO COMPLY WITH THE CONDITIONS LISTED ON THE ATTACHED PAGE
SHALL BE GROUNDS FOR REVOCATION OF THIS PERMIT
I HAVE RFA
CODE COMPLIANCE USE ONLY
ATEMENT.
■ ■ a ■ a a ■ a ■ ■ ■ a a a ■ ■ ■ ■ m ■ a a ■ ■ ■ a a ■ s ■ ■ v ■ r ■ a ■ ■ r a
APPROVED DENTED SPECIAL CONDITIONS
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JLli
OFF ER DA JE
78495 CALLE TAMPICO - LA QUINTA, CA 92253 - 760-777-7000
W W W. LAQU I NTACA.G OV
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 760.777.7063.
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 are:
Carrier: S 1 AT E FUND
Policy Number:_M_ 5199
Expires: -%- ( - 1 q
A COPY OF SAID POLICY OR CERTIFICATE OF CONSENT SHOWING THE AMOUNT OF COVERAGE AND
EXPIRATION DATE FOR WORKER'S COMPENSATION 15 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
(10) days of the change in requirements.
APPLICANT SIGNATU E 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.
78495 CALLE TAMPICO - LA QUINTA, CA 92253 — 760-777-7000
WWW.LAQUINTACA.GOV
cvRo� CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
`�-
03/04/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT Jessica Martinez
NAME:
RISI, dba Pan American Insurance Services
PHONE (916)286-5960 (916)646-3996
A/C No Ext : , No
PO Box 13792
A -MAIL S: Jessica.martinez@relationinsurance.com
INSURER(S) AFFORDING COVERAGE
NAIC #
Sacramento CA 95853
INSURERA: Lloyds of London
15792
INSURED
INSURERB: STATE COMPENSATION INSURANCE FUND
35076
Truxton Logistics Corp.
INSURER C : Evanston Ins Cc
35378
P O Box 83104
INSURER D
INSURER E:
Los Angeles CA 90045
INSURER F :
COVERAGES CERTIFICATE NUMBER: 19/20 PKG BAU CRG 18/ REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
INSD
WVD
POLICYNUMBER
MMIDD/YYYY
jM LICY XP
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ® OCCUR
ccurrence
PREMISES iEs occurrence)
$ 50.000
MEDEXP JAoy oneperson)
$ 1,000
PERSONAL &ADVINJURY
1.000,000
$
A
IRPIGL18231
01/22/2019
01/22/2020
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 1.000,000
POLICY jg� LOC
PRODUCTS - COMP/OPAGG
$ 1.000,000
Bodily Injury limit(s)
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED 11NGLEUHIIT
$ 1.000.000
F a acciden!
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
IRPICL19026
01/22/2019
01/22/2020
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
HIRED NON -OWNED
PROPERTY DAMAGE
Per acciden
$
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DIED I I RETENTION $
$
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY YIN
STATUTE ER
EL. EACH ACCIDENT
$ 1,000,000
B
ANY PROPRIETOR/PARTNER/EXECUTIVE
FYI(Mandatory
NIA
1935199
07/01/2018
07/01/2019
E L. DISEASE - EA EMPLOYEE
$ 1.000,000
OFFICER/MEMBER EXCLUDED?
in NH)
If yes, describe under
1, 000, 000
DESCRIPTION OF OPERATIONS below"
E L. DISEASE - POLICY LIMIT
$
Limit
$150, 000
Contingent Cargo
C
MKLV41M0047093
03/05/2019
03/05/2020
Ded
$1,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
REGISTRY MONITORING INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS.
5388 STERLING CENTER DRIVE
AUTHORIZED REPRESENTATIVE
WESTLAKE VILLAGE CA 91361
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
HOME OCCUPATION CONDITIONS
ADDRESS 57945 South Vallev In H.0.2019-0027
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.
-111 1► ► Fail.A
C�
OFFICER SIGNATURE
3
DATE
Lo Quinta Municipal Codes: 9.60.110, 9.160, 9.210.060