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HOME OCCUPATION OF A BU�SI�NESS 3
PERMITJ�-��L�NSPECTION DATE_l fW vJ TIME — I,_ ✓O��K/ aJM
1
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:
Address:
Phone.Emall:
7 (a) qgL4 /
riaence: Square Footage:
Type of Business:
Brief Description of the Bus€ness�pelty�tlan
¢c�de�,�r� �'c7 e�fe✓�+s =rU ��o��c�e �eRV�n9 �I,nK-5
me: (Ex, Bedroom
Number of Persons Involved in Business:
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------ r, p4mova"wri[y auto Qupplles tieing Used:
I HAVE READ, UNDERSTAND, AND AGREE WITH THE ATTACHED CONDITIONS WHICH A HOME
OCCUPATION PERMIT IS ALLOWED.
IX
APPLICANT SIGNATURE
DAT--��
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 �he last section on this page: "I certify that
If your business is peing operated from your home in La Quintal 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 Cade acSection 728a of the
Revenue and Taxation Code, shall [ n l
ka9yinm
ORKE'SA
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.
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
tentyil) 9%ys of the change in requirements.
2-_23
APPLICANT SIGNATURE DATE
WARNING; FalIure to secure Worker's Compensation Coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to S100,000, In addition to
the cost of compensation, damages, interest, and attorneys fees May be assessed to
you as provided In Section 3706 of the tabor Code.
IIOMF 0CCUeA1iON CQ 1T-1ONS
ALL HOMF OCCUPATIONS SHALL COMPLY WITH THE FOLLOWING CONDITIONS:
I the estublishment and Londuct of a home occupation shall bean incideaccessory use and
shall not change the principal character ar use of the dwelling unit involved.
Only i esidens of the dwelling Unit may he engaged in the rlDfne occupation
1 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 toe off-street parking is used. The home
nccupatl4ryR roll not occupy more than twenty-five percent of the combined floor area of the house and
garage.
4. A home OCcupcation shall not be co cted within a detached accessory structure, although materials
may be stored in such a structure.
S. 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 resid Ce, either by color, materials, construction, lighting, sounds, vibrations or other
choracterlstics
6. Electrical or mechanicai equipment which creates interference in radio, television or telephone
receivers a causes 9 tuations In line voltage outside the dwelling unit. shall be prohibited.
7, the home occ lion 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 n ore 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 Oily permit for o
home occupation if the director determines that any of the performance and daveto pment standards fisted in
subsection C of this section have been or are being violated, that the occupation authorized by the permit Is or has
been Condurted in violation of any state statute or city law, or that the home occupation has changed or rs different
:ram that authorized when the permit was issued.
Special Conditions:
BY SIGNING THIS DOCUMENTI AGREE THAT I HAVE READ, UNDERSTAND AND WILL COM WITH CONDITIONS.
1f l� _
OR
OfFiCLft 51GHATtj . __-- _��-
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DATE
Conditions Per Lo Quinto Municipal Codes: 9 60.110, 9.160, 9.210 060
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CONSENT TO INSPECT PRIVATE PROPERTY
Name: j �, Telephone Number: &)
Property Address: CQ I `b�"
4ff Z r
PLEASE INDICATE IF YOU ARE: /\ TENANT PROPERTY OWNER
The undersigned herein consents to the City of La Quinta, Code Compliance Division Inspector(s) right of entry
to inspect all Yard Areas, building exterior(s), and/or interior(s), Including audio and video recording as needed
to determine whether or not said property complies with local and state codes.
The undersigned herein states that e ' :n lawful possession or control of the property designated, or has
the authority to act in the o er(s), t nt(s). and/or occupants(s) behalf and in their absence.
Signature: T� Date: ']
Nombre:
Direccion:
PERMISO PARA INSPECCIONAR PROPIEDAD PRIVADA
Telefono:
FAVOR DE INDICAR: _INQUILINO PROPIETARIO
Por este medio usted da permiso a (el) 0 a (los) inspector(es) de Division de Cumpliminetos del Codigo de la
Ciudad de La Quinta para entrar a esta propiedad para inpeccionar todas las areas de la propieda incluyendo
los exteriores de todos los edificios, y/o interiores. Tambien incluyendo la grabacion de audio y video Como se
requiere para determinar si dicha propiedad esta en acuerdo con las leyes del Codigo local y estatales, Por este
medio de este documento usted declara que tiene posesion legal, o tiene la autoridad o consentimiento del
propietario(s), y/o ocupante(s) en su ausencia.
Firma: Fecha: