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CITY OF LA QUINTA H E OCCUPATION OF A BUSINESS
DESIGN & DEVELOPMENT DEPARTMENT
PERMIT# &U , ?Z - C: Cl: z tw INSPECTION DAT
TIM
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:
Phone:
Email:
Type of residence:
Square F otage:
Type of Business:
Brief Description of the Business Operation:
Location and Squarb Footage of Business in Home: (Ex. Bedroom 120 SF)
Number of Persons Involved in Business:
i
uescription of macninery, Equipment, and Supplies Being Used:
I
I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS WHICH A HOME
OCCUPATION PERMIT IS ALLOWED.
APPLICANT SIGNATURE DATE
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, A SIGNED AUTHORIZATION FROM
OWNER A5-IkG P�{aFNT IS REQUIRED.
NATURE
COMPANY NAME
440j__f / �' 2692-zi—
D-Aff-7
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
APPROVED
OFFICEA
I HAVE READ AND UNDERSTAND THIS
STATEMENT.
SIGNATURE
CODE COMPLIANCE USE ONLY
DENIED SPECIAL CONDITIONS
DATE
HOME OCCUPATION CONDITIONS
ADDRESS 520Z1C A'VD
ALL HOME OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS:
1. The establishment and conduct of a home occupation shall be an incidental and 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.
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 conducted 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 residence, either by color, materials, construction, lighting, sounds, vibrations or other
characteristics.
6. Electrical or mechanical equipment which creates interference in radio, television or telephone
receivers or causes fluctuations in line voltage outside the dwelling unit shall be prohibited.
7. The home occupation 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 not more than two students are present at the
residence at the some 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 WILL COMPLY WITH ALL CONDITIONS.
r•
PRINT NAME
OFFICER 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
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 complete and sign a declaration ha sJp&eg the
following:
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.
u 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.
,�A wa_jv�\�) 9 - �
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.
AC-C)R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIODIYYYY)
04-01-2022
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(les) 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER HAMt:: Carlos G Torres
J J Insurance Services & Associate's Corp. PHONE 760-772-4455 FAX LAMNei; 760-772-4470
dba: Carlos Torres Insurance Services Solutions A_QOttss: brookesins@yahoa.com _
77920 Country Club Dr Suite 6-2 INSURERS AFFORDING COVERAGE NAIC Y
Palm Desert Ca 92211 INSURERA: Scottsdale Insurance Company 41297
INSURED
INSURERS:
Edward Warner INSURERC:
dba: Warner Turf New & Used Equipment INSURER D :
53025 Avenida Martinez INSURERE:
La Quinta Ca 92253 INSURERF:
COVERAGES CFRTIFIC:ATF NIIIMIRFR oc►nelnlu ullaan�a-
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 OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
-CONDITIONS
1NSR TYPE OF INSURANCE AOAL;SUeR POUCYEFF POLICYEW
lN9Q POLICY NUMBER LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
EACH OCCURRENCE
$ 1,000,000
pRE SESaEa occurrence)$
100.000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
A
X
CPS7538479
03/09/2022
1 03/09/2023
GEN'LAGGREGATE
GENERAL AGGREGATE
$ 2,000,000
LIMIT APPLIES PER:
POLICY [K jE O- � LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMSlNEDSING L IT
Ea ident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY ,AUTOS
BODILY INJURY Per accident
( )
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY D GE
(Per ac*ent
$
UMBRELLA LIAO
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
DED I I RETENTION
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PAkTNERIEXECUTI VE
OFFICE WMEMBEREXCLUDED?
N/A
T T
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
IF yes, describe undar
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached It more space Is required)
r Nira,�l l Ii I IUIr
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Evidence of Insurance Only ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD