0308-373 (RR)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 0391110 11/30/2(
Date SZ`? ` 6 Z Signature of Contractor 0 _
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
Section 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 STATE FUND Policy No. 1640354-4093
(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 with those provisions.
Date:u -`�- - = 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, indemnity
& 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.
Sinnature 1t )wnar/AnPnt1 .--^----- Date
BUILDING PERMIT PERMIT#
DATE "`VALUATION -y, LOT TRACT
9,76(1 G'0
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JOBS
° ss -,79-713 76s N01i''MwooD
APN
OW
CONTRACTOR/DESIGNER/EN (NEER
PGA WEff R-EMENITIAL ASSOMATIOM
ENMALD ROOFNG. INC.
42.600 CAROLWE E tJ(JURT
83-600 PEA.CEI S'.
PALM D133 RT CA 92211
WDIO CA 92201
(760)347.9869 M&O 5978
USE OF PERMIT
C3EAtF,12AL. I3U1MINf G
R&ROOF WITH POLYURETHANE POAIgI &COATING
VALUATION 91760.00 LS
E-`2MMXM COST OF CONM3:ti'3C9 ON
9,7C�.flO
PERMU ITE STIMUR r
UROOF "IF, I OJI.00I -418.000 530.00
p a
'
D
A11G 2 9 2003
Or LA
FCUt1;6TA
CITU . dae. t! OggT.
tr
MB TOTAL CONMRUCTION AND PIAN CI-MCK
$30.00
I_M3 PRE -PAID FXES
50.00
WXAL Pfs'I1 Wf EWES I7ULP NOMI
RECEIPT
DATE
BY
TE FI ALED
INSPE
JX
C1. }�/,r 3
e/_/
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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
/
EMERALD ROOFING IHC.
PHONE:760-347-9869 83-600 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
y
14 M $9,760.00
15 M $18,370.00
Emerald Roofing Inc.
%1-
With
;
[:58PM
N0. 328 P. 3
.,,rd Form of Simplied Agreement Between Epoch Construction and Subcontractor
AGREEMENT made as of the twenty -fust day of August
in the year 2003.
BBTWEEN the Contractor. Epoch Constxuct7ion, Inc
7062 Convoy Court
San Diego, California 92111
858-560-0698, 858-560-0699 fax
and the Subcontractor: Bmerald Roofing Inc., license -7 70 91�0
93 6GG Peach f o x I `t (O3
760-347-9869, 760-347-9879 fm
The Contractor bias 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 Il
The Contractor and Subcontractor agree the scope of work is as follows:
Provide all labor and materials necessary to provide LS incbea of polyuretbxane foam
and coating to all roofs at all Legends buildings (�). Installation shall be complete including
all necessary the roof access, roof -top equipment suppo ,.,,.. _.R, '- __ .,,,'�
Installation shall carry a 10 -year warranty with certificates provided to Owner prior to release
of final payment.
Subcontract Value shall be by Building Type:
Building 13 M
Building 14 M
Building 15 M
Subcontractor (sisnzwm)
Printed Name and Title
S12,660,00ea
$9,760.00ea
$18,370.00ea
EPOCH CONSTRUCTION
Gary Harden_ President
Printed Name and Title
General Conditions ate included in this Agreemeot by atrachment (backside of this document or page 2)