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0308-368 (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 710940 C39 HCC 1113012( Date ?T - ,�'4- .� Signature of Contractor R - .1 _ 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 OTAT£ FUND Policy No. 1640954-2003 (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 with those provisions. Date: 5 i"G -r;", Applicant 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 160 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`I -L BIJ1LINNG PERMIT PERMIT# DATE VALUATION LOT 0-318 TRACT sq,7i oo 5 � JOB SITE APN •J ADDRE - �r1r ('f3malwMI) - OWNE CONTRACTOR/DESIGNER/EN (NEER 42-600 C.Al2OMM, COL17.2r PALM DFM r CA 92211 USE OF PERMIT MYMi!.A1. D R00FC2 GP INC. 93-600 600 (M ST. IWDIO CA 92,201 (760)347-9869 f. BJJ3 5978 R&ROOFWITH .POL5i'`URZTHANF FOAM &Ct?AT04A VAWATION 9.761).00 1.s p},{� ,�7�r,/�.y y;��� �+/� ��y,,�,��yEWMAIW cogr OF CO�TS"T.1�UCi%0N, 9,760.00 .rAntU fT' EE,&TfASLLY.7.f7.f.C1 REROOF FEE 101.000.410•000 $3t9,OD .� AUG 2 9 2-0073 FCITY O: LA QU6 , sm-'rC3TA:C:, Nt'1I+1mUcnow Am PLmi CkTECK $140,00 LESS PRE-FAIDERMS S0100 r01AJ, tW`;i" P'.f;;'ES DUE bi©irli' $30.00 RECEIPT IDACE 'U 1 I BY r LA [SATE NAL! I INS(ECTOR/ 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 I 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: EMERALD ROOFING INCE uo#n8s48 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 14 M $9,760.00 15 M $18,370.00 Emerald Roofing Inc. 0 1:58PM N0. 318 P. 3 ,1rd Form of Simplified Agreement Between Epoch Construction and Subcontractor AGREEMENT made as of the twenty-first day of August in the year 2003. BETWEEN the Contractor. Epoch Construction, Inc 7062 Convoy Court Saar Diego, California 92111 f 858-560-0698, 858-560-0699 fax and the Subcontractor: Emerald Roofing Inc., license 93 600 pewh. Street-. fro 1c. '! R rc-S Trig., Oa4f,�� �c.�.�, 1��,-t� Ccs.. 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 Il 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 (�S). Installation shall be complete including all necessary tile roof access, roof -top equipment suppo 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: Subcontractor (sipadae) Printed Name and Title Building 13 M $12,660,00ea Building 14 M, $9,760.00ea Building 15 M $18,370.00ea EPOCH CONSTRUCTION Gary Harden, President Printed Name and Title Gcncral Conditiow are included in this Agreemeot by attachment (baciside of this document or page 2)