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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
770940 C39 We 11/3UJ2t
Signature of Contractor x�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
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 workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
()' I have and will maintain workers' compensation insurance, as required by
SeRon 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier rA°r Mjtg) Policy No. 1640SS4•2003
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply withse provisions.
iDate:- g Gi tom. Applicant—
Warning:
pplicant Warning: Failure to secure Workers' 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 as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the .City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) _ __ Date
PERMIT#
BUILDING
PERMIT
DATE VALUATION LOT TRACT
JOB SI
ADD SS :r�►-ice c �v :c�wE.�Oi�
APN
,
OW R
CONTRACTOR / DESIGNER / EN (NEER
POA WEST aSTIDWW., ASI OCIATION
MMAID ROOI+MC1, U41C.
$2.600 CA12U:G UTE COVIi'T
93•£00PItACTI ST.
PAI:M I?1!,:3M CK 92211
it 10 CA 92201
(768)347-9869 0331. 5978
USE OF PERMIT
OBN&Al.B1%T3D+TCi
R&RC1tVVinTH PIDL'YURZTHANZFOAM 1P-CO.1TINO
VA.l.MAT.ION i 2660.00 Ls
E&MAT D COST 01' COP1'MUMION
12,669.00
PIMMITMWASTARY
RZROOF FER 101-000.418.000 $30.00
AUG 29 2003
CITY OF LA QUINTA
FINANCE DEPT.
Std -TOM, CONSTRUCMN}SND PLAN CT11n: X
$30.00
:f.EUS PRE -PAIDEM
$0,00
7.'MAL PY.11b ' F`KS DDE HOW
930M
RECEIPT
DATE
BY
D firINSPEVO
/- �t.r C --P,'�(
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole'
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
EMERALD HOOFING INCE
L16#71.34.
PHONE: 760-347-9869 83-000 PEACH STREET
FAX: 760-347-9879 INDIO, CA. 92201,
06/06/2003
EPOCH CONSTRUCTION
7062 CONVOY COURT
SAN DIEGO, CA. 92111
PH# 858-560-0698
FAX# 858-560-0699
ATT: GARY HARDEN
Re-roofing- Polyurethane Foam & Coating
RES: #2
Thank you for the opportunity to submit a proposal for the referenced property.
PRICES ARE PER YOUR SPECIFICATIONS: PRICE INCLUDES 10 YEAR MANUFACTURES WARRANTY
WARRANTY REQUIRES 1.5 INCHES OF FOAM
13 M $12,660.00
14 M $9,760.00
15 M $18,370.00
Emerald Roofing Inc.
J
[:58PM NO. 328 P. .3
1rd Form ofSimplified Agreement Between Epoch Construction and Subcontractor
AGREEMENT made as of the twenty-fust day of August
in the year 2003.
BETWEEN the Contractor: Epoch Construction, Inc
7062 Convoy Court
San Diego, California 92111
858-560-0698,-858-560-0699 fax
and the Subcontractor: Emerald Roofing Inc., license?
93 600 Peach Street-
_at:11C ! `'t X03
760-347=9869, 760-347-9879 fax
The Contractor has made a contract for construction dated August 4, 2003
With the Owner (or its' representative):
PGA West II Residential Association
c/o Monarch Group
42-600 Caroline Ct, Suite 101
Palm Desert, California 92211
For the project entitled: PGA West II
The Contractor and Subcontractor agree the scope of work is as follows:,
Provide all labor and materials necessary to provide �5 inches of polyurethane foam
and coating to all roofs at all Legends buildings (iS). Installation shall be complete including
all necessary the roof access, roof-top equipment suppo
Installation shall cavy a 10-year warmty with certificates provided to Owner prior to release
of final payment.
Subcontract Value shall be by Building Type:
Building 13 M $12,660.00ca
Building 14 M $9,760.00ea
Building 15 M $18,370.00ea
Subcontractor (siv=b=) EPOCH CONSTRUCTION
Gary Harden. President _
Printed Name and Title Printed Name and Title
t.
General Conditions are inch d,ed nn this A greemeot by attachment (baciaide of this document or page 2)