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CALIFORNIA -- D
S�P172020
HOME OCCUPATION OF A BUSINES
CITY OF L�QUINTA
DESIGN & DEVELOPMENT DEPARTMENT
PERMIT# �� ZODO ZO —6 c, 1INSPECTIONDATE 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
Applicant Names:
Bella Golden
Address:
54391 Avenida Rubio
Phone: Email:
760-4.85-1713 bella@goldeninteriordesign.com
Type of residence: Square Footage:
single family home 11300
Type of Business:
Interior Design
Brief Description of the Business Operation:
Space planning, drawing cabinetry designs, and specifying materials for residential homes.
Location and Square Footage of Business in Home: (Ex. Bedroom 120 SF)
Spare room 110 SF
Number of Persons Involved in Business:
1
Description of Machinery, Equipment, and Supplies Being Used:
Computer, printer, filing cabinet, drafting supplies, product samples
I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS BY WHICH A
HOME OCCUPATION PERMIT IS ALLOWED.
V- - A-- � q -Me202-0
APPLICA P&S1G ATfJ DATE
78495 CALLE TAMPICO — LA QUINTA, CA 92253 — 760-777-7000
WWW.LAQUINTACA.GOV
I, Susan Golden, owner of the residential property at: 54391 Avenida Rubio in La Quinta, CA authorize
Bella Golden to operate her business, Golden Interior Design Inc, from this residence.
Susan Golden Date
Z02-®
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Contact phone number: 760-485-1714
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, A SIGNED AUTHORIZATION FROM OWNER
OR RENTALILEASING AGENT IS REQUIRED.
9-16-2020
OWNERIAG T Sl NATURE. DATE
Golden Interior Design 760-485-1713
AGENT COMPANY NAME
CONTACTPHONE
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.
S[GNA
CODE COMPLIANCE USE ONLY
a■ a a a a■■■ a ■■■■ a■ a■■ a a■■ a a a a a a■■■■ a a s a r a
APPROVED DENIED SPECIAL CONDITIONS
OFFICER
DATE
78495 GALLE TAMPICO — LA QUINTA, CA 92253 — 760-777-7000
WWW.LAQUINTACA.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
ri
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 rom2letp. and sign a declaration that 5tates the
followung.
I hereby affirm under penalty of perjury, one of the following declarations:
0 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, I will provide the City with a policy or certificate copy within
ten(10) days of the change in requirements.
Ov,1o'ZUZO
APPLIC T 5IG TU DATE
WARNING: Failu�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.