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MAY 12 2023 DD - CALIFORNIA -
CITYOME OCCUPATION OF A BUSINESS
DESIGN & DEVELOPMENT DDEPARTMENT E
PERMIT# INSPECTION DATE 01 « 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 $117.00 LOCATION CHANGE $57.00
Applicant Names:
Lucy Bruchet
Address:
54539 Shoal Creek,
La Quinta, CA 92253
Phone:
Email:
760-285-3454
ccgardenindio a@gmail.com
Type of residence:
Square Footage:
Condominium
1990
Type of Business:
Education Services, Administrative
Brief Description of the Business Operation:
Homeschool Group Organizer for Homeschool families to educate as a community using the
Classical Conversations Curriculum.
Location and Square Footage of Business in Home: (Ex. Bedroom 120 SF)
Dining Room 120 SF
Number of Persons Involved in Business:
1
Description of Machinery, Equipment, and Supplies Being Used:
Laptop computer, color printer, b&w printer, office supplies
I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS WHICH A HOME
OCCUPATION PERMIT IS ALLOWED.
Digitally signed by Lucy t 5/9/2023
Date: 2023.05.09 16:18:34 34-07-07'00'
APPLICANT SIGNATURE DATE
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
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 that states the
following:
WORKER'S COMPENSATION DECLARATION
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� 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.
Digitally signed by Lucy t
Date: 2023.05.11 19:33:21 21-07-07'00'
APPLICANT SIGNATURE
5/11/2023
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.
IF APPLICANT IS OTHER THAN THE PROPERTY OWNER, A SIC-1NED AUTHORIZATION FROM
OWNER OP. RENTAL/LEASING AGENT IS REQUIRED.
OWNER/AGENT SIGNATURE DATE
AGENT COMPANY NAME 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.
Digitally signed by Lucy Bruchet
iA#Uot Date: 2023.05,09 16 19:07-07'00'
SIGNATURE
CODE COMPLIANCE USE ONLY
APPROVED DENIED__ SPECIAL CONDITIONS
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OF CER
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