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0308-374 (RR)F- 04 N w o0� W oZ � O I I— 0 Iw— a fn Z Cl) U7 N O0) UQ Z Lr) ; 0 X W LL .mUU •O a rn H 't Z_ Cb 5 N d R 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 77CI940 C39mc ] liY3'Of2{ Date - CO Signature of Contractor 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). ( ) 1, as owner of tlie'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 STATF 1•' WD Policy No. 1640854.2003 (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 witkLthose provisions. •Date: 2 —;PQ Applicants •1 ^=-- �*•-w_...._. 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 subjebt 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 PER � �� DATE VALUATION LOT TRACT JOB SITE ADDRESS 79 -4saL=�s?swtiwnmom APN - OWNER CONTRACTOR/DESIGNER/EN (NEER PGA WM R1*:MHNnAL r SS(K:l'.Ftt770N IMMAL D R00FT1 13 INC. 42.600 CAROLINE COURT 83-600 PEACH ST. F P&M i3IMM CSA 92211 INDIO CA 92201 (760)347-9561 CEL41 59'713 USE OF PERMIT 0SWR A.i_ 131)111)IN RE -ROOF WITH POLYURETHA14 F07+A &COA.TINQ VALUATION 18,:fi .00 ul ESTI !!Y/.4TKD COST OF M1V'SMX711014 18,170-00 PERAIM, YKE S LIAO"RY REROOF° FSIs l {1I-E)II()•'.4.1 S-i1L10 g3A.Ali . p€. uV AUG. 29 2J... 8UJ8­'r0TJ+L COAF:3TP.U'MON ANDPLAN CITWX $30.00 LESU PRE -PAW FIKES Moo T01AL MAW IMS DUE NOW 3301M i . RECEIPT DATE BY TE FI ALED INS OR 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 Cay M., I I l3tyl2C Date `e '2c+ -e_�- Signature of Contractorz 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 perfgrmance of the work for which this permit is issued. '(> r) 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 STATF FUND Policy No. 1640$5 2003 J (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: � -4 --Z Applicant *w-- / 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 t 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 v & 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 e 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. tyC '-1, I Sig6ature (Owner/Agent) Date^f ~ BUILDING PERMIT PERMIT DATE VALUATION LOT TRACT JOB AD ESS �) .. 35-675190WITWO0.0 APN - - OWNE CONTRACTOR /DESIGNER / EN INFER PGA WEST IMMY TIAL ASSOC 1M.011 IWMZATP, Roos. m4, mc. 42.600 CARO12NE 0,YURT - 83.600 PT`.;. MI ST, PALM. DB SMZ'T CA 92211 MDTO C:A, 92201 (760)347.9869 CB1.; 5979 USE OF PERMIT f3l .;ftAL BMD190 RE -ROOF WITH POLYURETHANZ Pl1.PiAH c4: COATINO VALUATION I d,3:,+t1, 00 1..1 ESITl1+ATND +COhT OF C ONSTMIC:N'3.ON PRIZAMI TRE Stl14iJ]"RY REROOF FEE $30.00 . AGG 29 2003 CITY OF LA C%U:.JA SUB -TOTAL C0NnRLr'C 0.1,T AND PLAN r- K $30.00 LF -23 PRF. -PAW FM S0,(►L! -701A), P11.3alff.IMS DUF Now $30A) RECEIPT DATEBY TE FI ALED INS OR 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 Unes 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 I 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: EFAERAIN INFING INOW PHONE:760-347-9869 83-600 PEACH STREET FAX: 760-347-9879 INDIO, CA. 92201 06/06/2003 F EPOCH CONSTRUCTION 7062 CONVOY COURT SAN DIEGO, CA. 92111 Y PH# 858-560-0698 FAX# 858-560-0699 ATT: GARY HARDEN. Re-roofing- Polyurethane Foam & Coating RES: #2 A 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. • f 5aPM N0. 328 P. 3 Mrd ,Form of Simpl fed Agreement Between Epoch Construction and Subcontractor f; /-AGREBMENT made as of the twenty-first day of August in the year 2003. BETWEEN the Contractor: Epoch Construction, Inc 7062 Convoy Court Sawn Diego, California 92111 858-560-0698, 858-560-0699 fax r and the Subcontractor: Emerald Roofing Inc. license -7 -71 q1+0 7 Po mak. l R (Q3 760-M47-9869, 760-347-9879 fm 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 Monarcb Group 42-600 Caroline Ct, Suite 101 . Palm Desert, California 92211 For the project entitled: PGA West H The Contractor and Subcontractor agree the scope of work is as follows: Provide all labor and materials necessary to provide 1L5 inches of polyuret =c foam and coativag to all roofs at all Legends buildings (*). Installation shall be complete including all necessary tile roof access, roof -top equipment supportl Installation shall cavy 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 (ssgmtoe) $12,660.00ea $9,760.00ea $18,370.00ea EPOCH CONSTRUCTION Gary Harden. President Printed Name and Title Printed Name and Title , General Conditions my included In this Agreemea by attachment (bacWde of this document or page 2)