0308-367 (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
7709 ! 0 C39 WC 11/30/2(
Date 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).
( ) 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. 1640854.. 003
(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 which4his 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: 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 & ach 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, & s all, 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 N�uilding
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent).` Date, k U.ta
BUIDING PERMIT PERMIT#
T 7
DATE VALUATION LOT TRACT
$18,37U.00
a
JOB SIT
ADDS S %�' 670 NOMUWOOD
APN
_
OWN --
CONTRACTOR / DESIGNER / ENGINEER
T OA WE ST RF_=_1WTTAI. ASSOCIA1110Iq
EIvUMAM ROOMNG, :SNC.
42.600 CAROLINP, COURT
83.600 PEACH Ski'.
PALM .17tES'MW CA 92211
11 3.0 CA 92201
(760)347-9869 C Lf# 5978
USE OF PERMIT
Gi: W -R AL BTUI DINC4
fZP,RCXFWIfH POT..YURETHANg FOAM &COA` INN
N{Ar,,ca.ATION 181rro100 LS
ES"11l►;rk,.gi']f'KD COSf 01,' COITTERWHOK
18,370.00
3.' MT IT?. SUMMARY
RFROOF FRE 1+31.00/1.413-000 330.O�J
D
AUG 2 g 2003
CITY OF LSA QU:., T. 4
FV.Ak.Z,E
r:T
mra-'TUTAt. trommut—mom AND iutN cm-Tz,
$30.00
Z.F.�.�,9 PIR &1 A D M3
$0,00
TOTAL P>PWATtr F".1; :L1'NOW
RECEIPT
DATE
BY
TE FI LED /�
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 4
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
p I
1:58PM NO. 328 P. 3
,,rd Form of Simpl ied 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
Sam Diego, California 92111
858-560-0698, 858-560-0699 fax
and the Subcontractor: Emerald Roofing Inc., license '7'70 cKO
93 600 Pewh Street -fro Lac 1 Cr rc�
CO- . q2 -z 6
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 Monarcb 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 .45 inches of polyurethane foam
and coating to all roofs at all Legends buildings (45), Installation shall be complete including
all necessary the roof access, roof -top equipment suppo sem, ' --- T"- M--"5
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 (sipatue)
Printed Name and Title
$12,660.00ea
$9,760.00ea
$18,370.00ea
1
EPOCH CONSTRUCTION
Gary Harden. President
Printed Name and Title
GencrW Conditietts are inchMIAd in this Agteemmt by attachment (back -side of this dacument or page 2)