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CITY OF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT
HOME OCCUPATION OF A BUSINESS
PERMIT# H 0 2 0 2 0- 0 04 2 INSPECTION DATE
TIME
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
Type of Business: —
College Funding Cons_u_ltin_g _
Brief Description of the Business Operation: -
Help students and parents to afford c,
Location and Square Footage of Business in Home: (Ex. Bedroom 120 SF)
Home office 121 Sq, Ft.
Number of Persons Involved in Business:
One
Description of Machinery, Equipment, and Supplies Being Used:
Office Equipment
I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS BY WHICH A
HOME OCCUPATION PERMIT IS ALLOWED.
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APPLICANT SIGNATURE DWX
ATE
78495 CALLE TAMPICO - LA QUINTA, CA 92253 - 760-777-7000
WWW.LAQUINTACA.GOV
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APPY.ICAI!f7' OI'HVR THAN THE PROPERTY M. FROM OWNER
OWNER, A SIGNED AUTHORIZATION
R ING AGENT IS REQUIR
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DATE
AGIsNT CQMPANY NAME — - -- • • - -
CdMTAC7--
P'I EASE CO4TACI' YOUR HOUEOWNFR'S ASSOCIATION PRIOR TO PAYING FOR YOUR HOME
OCCUPATION PERMIT. YOUR HOA MAY RESTRICT• OR PROHIBIT A ROME-BASED BUSINESS,
DMPORTANT: FALSE OR MISLEADING INFORMATION SHALL 8E C;ROiJNDS FOR DFNYINC YOUR
APPLICATION; FAILURE TO COMPLY WITH THE CO.NDfTIONS
SLISTED ON THE ,a4� ACHEL7 PAGE
HALL BE GROUNDS FOR RgVOCATION OF THIS PERMrr
I HAVE READ AND UNDERSTAND THIS STATEMIENT,
SIGNA IRI;
CODE COMPI,I,�NCE USE ONLY
■ . • ■ • ■ u M . w ■ a . • • • s • a a M 1 • i ■ s f f • ■ a • M i a • s ■ r ■
APPROVED-. DENIED
SPECIAL CONDITIONS
OFFICER - -
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78495 CALLE TAMPICU " LA QUINTA, CA 92253 - 760-777-7000
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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 cam lets and si n a
declaration that states the followin
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:
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
(10) days of the change in requirements.
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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.
78495 CALLE TAMPICO - LA QUINTA, CA 92253 - 760-777-7000
WWW.LAQUINTACA.GOV