DeJardin4 Qaigra
isW oj1P4 D :%M' —R-
HOME OCCUPATION OF A BUSINESS
PERMIT# V IU�4 INSPECTION DATE �� I TIME mi
IW
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. LOCATION CHANGE $40.00
Applicant Names:
Christina Ba.ine DeJardin
Address:
51325 Via Roblada, La. Quinta, CA 02253
Phone-, Email:
344-433-5744
Type of residence: Square Footage:
Single Family home 2300 sq ft
Type of Business-.
Law Flrm
Brief .Description of the Business Operation:
Provide legal services remotely to clients
Location and Square Footage of Business in Home: (Ex. Bedroom 120 SF)
Master bedroom - approx. 200 sq feet
Number of Persons Involved in Business:
1
Description of Machinery, Equipment, and Supplies Being Used: - - -
computer equipment, cable modern, printer, office supplies
I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS JOY WHICH A
HOME OCCUPATION PERMIT IS ALLOWED.
APPLICANT SIGNATURE DATE
78495 CALLE TAMIPICO — LA QUINTA, CA 92253 - 760-777-7000
WW W.LA UINTACA.GOV
"' V
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, A SIGNED AUTHORIZATION FROM OWNER
OR RENTAULEASING AGENT IS REQUIRED.
��&2 64il
OWNER/AGENT S -ki AM V DATE
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 READ AND UNDERSTAND THIS STATEMENT.
SIGNATURE 49
CODE COMPLIANCE USE ONLY
i i i i i i i i i i i i i i i i i R i i i i i/ i i i i i R i• i i R i� i i 11 G A v■ G Y 11 Y m o G i n� d a r r M :� a x n G n R G g r R J W fl a r W Y II O
APPROVED
DENIED
SPECIAL CONDITIONS
t�
DAT
78495 CALLE TAMPICO - LA QUINTA, CA 92253 - 760-777-7000
W W W. LAQUI NTACA.GOV
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 760,777.7050.
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 followin4:
WORKER'S COMPENSATION DECLARATION
! 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: Employers Preferred Ins. Co.
Policy Number:
EIG274395100
Expires:
11/15/2019
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, !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 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 $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.
DELPH-1
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
1111 G1'LGM1G
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 certiticate does not confer rights to the certificate holder in lieu of such endorsement(s�. T
PRODUCER CONTACT Josie Noreen
NAME;
Ahern Insurance Brokerage PHONE rAx '-
9555 Granfte Ridge Dr., #500 (AIC, No, Crl}:
San Diego, CA 92123RSS; inoreenaahmnlnnufancecom
Tamara L. Bartels, CIC —
_, IN�4URER(4�] AFFORDINGCUVERAr3£ NAIC M
INSURED Delphi Law Group, LLP
6965 El Camino Real, # 105472
Carlsbad, CA 92009
_-- -- _ INsiLR@R_A_Sentinel Insurance Company 11000
INSURER B r Employers Preferred Ins. Co. 10346
F:
rn11r0Af2CC f-co'ricrhrtTC LH miLo CC• nCklWlrnhi •trtr,ea r_n.
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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE 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.
_
INSR LTR TYP'F OF INSURANCE �AQDL �IiUB RESLICY NUMBER POLICY EFF .POLICY EXP LIMITS _
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
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'725BW2501CC
11115/2®1$
11/15/2019
EACH OCCURRENCE
DAMAGE T(1 9iENTC
- lEarr om=
_$ 21Q®0,000
_ --—1,®00,000
_ 10,000
M0_ onso
__1L8�ni
HSONAJURY
TT 21000,000
G N L GfiEGATE
PROLtUOTS.0QhJP PP-
P1AGGREGA
_
- LIMITAPPLIES PER:
POLICY j }i1 I,OC
4,000,00_0
.4 _ 4,000,000
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AUTOMOBILE LIABILITY
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UMBRELLALIAB OCCUR
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ES"RIpTICiN OF OP RATION' t .Inw
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IEIG274395100
11115/2018
11/15/2019
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DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, AdJlticnal Remarks Schedule, may be attached if more apace is required)
Re: 1901 Camino Vida Roble, Suite 101), Carlsbad, CA 92008.
Certificate Holder is named as an Additional Insured as their interests
appear per written contract. Waiver of Subrogation Applies, 30 days notice
of cancellation applies.
Hanella, LLC
1901 Camino Vida Roble
Spite 206
Carlsbad, CA 92008
ACORD 25 (2016/03)
SHOULD ANY OF THE ABOVE DESCIZII: QU POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRhSENTATiVL
0 1988-2015 ACORD CORPORATION. All rights reservad.
The ACORD name and logo are registered marks of ACORD
CONSET TO INSPECT PRIVATE PROPERTY
Name: Telephone Number, Sqq _ H 36— 5'7 ` q
Property Address:
Vi(A F'nwa
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PLEASE INDICATE IF YOU ARE: TENANT PROPERTY OWNER
The undersigned herein consents to the City of La Quinta, Code Compliance Division Inspector(s) right of entry
to inspect all Yard Areas, building exterior(s), and/or interior(s), Including audio and video recording as needed
to determine whether or not said property complies with local and state codes.
The undersigned herein states that he/she is in lawful possession or control of the property designated, or has
the authority to act in the owner(s), tenant(s). and/or occupants(s) behalf and in their absence.
r
Signature: �� ' Date: /
PERMISO PARA INSPECCIONAR PROPIEDAD PRIVADA
Nombre: Telefono:
Direccion:
FAVOR DE INDICAR: INQUILINO PROPIETARIO
Por este medio usted da permiso a (el) O a (los) inspector(es) de Division de Cumpliminetos del Codigo de la
Ciudad de La Quinta para entrar a esta propiedad para inpeccionar todas las areas de la propieda incluyendo
los exteriores de todos los edificios, y/o interiores. Tambien incluyendo la grabacion de audio y video como se
requiere para determinar si dicha propiedad esta en acuerdo con las leyes del codigo local y estatales. Por este
medio de este documento usted declara que tiene posesion legal, o tiene la autoridad o consentimiento del
propietario(s), y/o ocupante(s) en su ausencia.
Firma: Fecha: