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OwensPDD z � � U D JUL 0 1 2020 CITY OF LA QUINTA DESIGN & DEVELOPMENT DEPARTMENT HOME OCCUPATION OF A BUSINESS PERMIT# CI0 2 D02-0- 0040" INSPECTION DA '1'IME - 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: KeIII ()vjevl5 Add ress- IqV 8'S O-ey-zk, A lOLvj D1�. --La ()(Aivito' CA 92253 Phone: Email: $5$- keweos(D- metI ,coW Type of residence: Square Footage: IVOhnl✓ 2500 Type of Business: Brief Description of the Business Operation: oAkiwf, WXrk.e-h-vtj anal ���eG�' ► a► �ewtE % S�r�rr�eS 71'' b k5s, I V►e4' se-9 . Location and Square Footage of flusiness In Home: (Ex. Bedroom 120 SF) Des k oitkfrn MaSt�er f3edroovK 60 Number of Persons Involved in Business: Description of Machinery, Equipment, and Supplies Being Used: L a F top t✓o m pvt+-W, i vtterK e-f I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS BY WHICH A 140E OCCUPATION PERMIT IS ALLOWED, � 23 2D APPLICANT SIGNATURE — — DATE 78495 CALLI= TAMPICO - LA QUINTA, CA 92255 - 760-717.7000 WWW.LAQUINTACA.G©V IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, A SIGNED AUTHORIZATION FROM OWNER OR RENTAU/LEASINO AGENT IS REQUIRED. OWNER/AGENT SIGNATURE AGENT COMPANY NAME DATE 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: 1IvIPORTANT: FALSE OR MISLEADING INFORMATION SMALL 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. sia A CURE CODE COMPLIANCE USE ONLY a a a a a a a a a a a a a a a■ a■ a a■■ a■■ a■■■ a a a a a a APPROVED___ OFFICER DENIED DATE SPECIAL CONDITIONS 78495 CALLS TAMPICO - LA QUINTA, CA 92253 - 760.777-7000 WWW.LAQLJINTAGa,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 760,777.7063, Every employer who applies for any license or renewal of any license for a business issued pursuant to Section 317101 of the government code or Section 7254 of the Revenue and Taxation Code, shall complete and sign a declaratlon that states the followLnj�: WORKER'S COMPEKATION-DECLARAT-ION IIhhereb�y affirm under penalty of perjury, one of the following declarations: F= 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_J 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 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 planner 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. (f APP1 ICA T SIGNATURE DATE WARNING, Failure to secure Workees 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..--- C,UINTACA.GOV