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DEC 0 2 2022 01 IFOR,I,,--
CITY OFLAOUII�TOCCUPATION OF A BUSINESS
DESIGN & DEVELOPMENT b
PI l45I W2,��02-00 INSPECTION DATE
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 $109.00 LOCATION CHANGE $57.00
Applicant Names:
Address:
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Phone: 3 1 ` "1 `Z- `'� Email:
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Type of residence: Square Footage:
Type of Business:
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Brief Description of the Business Operation: Z[
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Location and Square Footage of Business in Home: (Ex. Bedroom 120 SF)
Number of Persons Involved in Business:
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n of Machinery, Equipment, and Sup
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Being Used:
I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS WHICH A HOME
OCCUPATION PERMIT IS ALLOWED.
APPLI IGNATURt DATE
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IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, A SIGNED AUTHORIZATION FROM
OWNER OR RENTAL/LEASING AGENT IS REQUIRED.
OW 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.
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
CODE COMPLIANCE USE ONLY
APPROVED DENIED
❑PFIC"ER
SPECIAL CONDITIONS
IZ-t-202Z
DATE
HOME OCCUPATION CONDITIONS
ADDRESS 5 4 lip 2-0 'U k Z
ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS:
1. The establishment and conduct of a home occupation shall be an incidento nd 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.e/
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 ducted 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 resi nce, either by color, materials, construction, lighting, sounds, vibrations or other
characteristics.
6. Electrical or mechanical equipment which creates interference in radio, television or teleph e
receivers or causes fluctuations in line voltage outside the dwelling unit shall be prohibited
7. The home occLXation 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 of 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 WI L COMPLY WITH ALL CONDITIONS.
P NAME OFFICER SIGNATURE
SIGNATURE DATE
Conditions Per La Quinta Municipal Codes: 9.60.110, 9.160, 9.210.060
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
f �
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 lete and sign a declaration that states the
following:
�+ i. ►. aV K!REW Pt.i i
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.
0 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: 9
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.
1
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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.
CONSENT TO INS- PECT PRIVATE PROPERTY
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Name: \ Telephone No: Cpb V-3 ll� - -1 Z a,,2
Property
Address: 'j' (o ' � %�c� ►� G�'G't �.. � �� � �
PLEASE INDICATE IF YOU ARE: , TENANT I PROPERTY OWNER _PROPERTY MANAGER
The undersigned herein consents to the City of La Quinta, Code Compliance Division Inspector(s)
right of entry to inspect ail Yard ,areas, building exterior(s), and/or interior(s), Including audio
and video recording as needed to determine whether 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.
Signature:
- pal � ®ate:
PERMISO PARA INSPECCIONAR PROPIEDAD PRIVADA
Nombre:
Telefono
Direction;
Por este medio usted da permiso a (el) 0 a (los) inspector(es) de Division de Cumpliminetos del
Cadigo de la Ciudad de La Quinta pars entrar a esta propiedad para inspecdonar todos las areas
de la propiedad incluyendo Jos exteriores de todos los edificios, y/o interiores, Tambien
inciuyendo la grabacion de audio y video coma se requiere para determinar si dicha propiedad
esta en acuerdo con las !eyes del codigo focal y estatales, Por este medio de este documento
usted declara que tiene posesion legal, o tiene la autoridad o consentimiento del propietario(s),
Ylo ocupante(s) en su ausencia,
Firma:
- Fecha: