0105-256 (BLDG)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
7 0WO C'39.Ia7MC 110CIVU
Date . �+ ! ti Signature of Contractor
LDER 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 withwages 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 (Seca 70.44, 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 Policy No.
STATE MMD on
(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: �" `2 a p -t )Applicant
Warning. Failure-to•secu'r"e 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.,
i 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(O.wner/Age ij� � - — DateF_.4 ed
- BUILDING PERMIT FERNY#
DATE - VALUATION - LOT 010.240% TRACT
JOB SITE
APN
ADDRESS
154J70'PF.19WX MO§.f.` 1
- -
OWNER
CONTRACTOR / DESIGNER / EN INE&x� , '
WM0 M-1
XW.M. t..1i ROOFO, DTC.
59 870x' ' DRACH
83 -Mrl 'RIMM! M.
LAQMT.i TrA Ok 92253
It IX0 C A 92201
(769):347.9869 M14 5978
USE OF PERMIT
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:.'r ..aY ..ivr..•.,,W.,3r,y.ry..p• n.:ti-
FRES 14IX No's°
. M AY - 2 2 2001
'CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
DATE FINALED
INSPECTOR
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
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.171
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
EMERALD HOOFING INCE
PHONE: 760-347-9869 83-600 PEACH
FAX: 760-347-9879 IlVDIO, CA. 92201
LIC# 770940
55820 PEBBLE BEACH
POA WEST, LA QOINTA, CA.
SCOPE OF WORK
Furnish all labor, materials, equipment and services necessary for completion of all roofing and related work
as specified in this document.
SPECIAL INSTRUCTIONS
1. Grounds to be kept neat, clean washed down daily.
2. 'All debris hauled away from jobsite daily.
3. All areas under construction to be marked off with safety cones and construction tape.
4. Hours of Operation: 7:00 a.m. to 4:00 p.m., five (5) days a week.
5. Job staffed with a diligent crew of journeymen roofers.
6. Obtain all necessary permits and inspections to be in accordance with the City.
7. Emerald Roofing to provide liability and Workmen's Compensation Insurance.
APPLICATION OF POLYURETHANE FOAM AND COATING
1. All loose gravel, dust and residue shall be removed using power vacuum equipment, power sweeper, air blowing, or
other suitable means.
2. All surfaces shall be primed with Neoprime primer at the rate of not less than % gallon per 100 square feet prior to
foam application.
3. Urethane foam shall be sprayed -applied to a nominal thickness of 1" (plus or minus % inch). Additional foam will be
applied in ponding areas to help disperse the standing water. The additional foam will not exceed 1" thick.
4. Coating shall be applied in two (2) separate coats. Acrylic coating to be 60% solids (plus or minus 2%)
a. The base coat shall be applied at a rate of 1.50 gallons per 100 square feet.
b. The top coat shall be applied at a rate of 1.50 gallons per 100 square feet with a combined thickness of 28-30 total
dry mils. During the final coat application #11 ceramic.granules shall be embedded into the wet coating at a rate of 40
pounds per 100 square feet.
POLYURETHANE FOAM APPLICATION
(Note) Apply black neoprime primer at the rate of % gallon per 100 square feet.
1. Application shall be by a contractor approved by the PSI and ECI and in accordance with the PSI and ECI application
instructions.
2. Substrate should have sufficient slope to eliminate excessive ponding water. Ponding water is defined as an area of
100 square feet or more, which hold in excess of 2 inches of water as measured 72 hours after a rainfall. If the
.substrate does not have sufficient slope, then ponding water must be eliminated by building in slope by the
application of polyurethane foam, channeling, and /or by the proper placement of drains.
3. Weather Conditions: The foam application shall not proceed during periods of inclement weather. The applicator
shall apply foam within the temperature and humidity and wind limitations specified by Foam Systems Inc. Wind
barriers should be used if wind conditions could affect the quality of installation.
4. Spray polyurethane foam thickness shall be a minimum of (1"inch). The polyurethane foam shall be applied
uniformly over the entire surface and the edges shall be feathered to produce smooth transitions.
5. The spray polyurethane foam must be applied in a minimal pass thickness of'h inch.
6. The spray polyurethane foam shall be terminated neatly a minimum of four (4) inches above the roofline at all
penetrations (except drains, parapet wall, or building junction). Foamed in place cants shall be smooth and uniform to
allow,positive drainage.
MAINTENANCE PROCEDURES
1. It is recommended that maintenance procedures, including annual inspections, be established with your contractor
for any roofing system to yield maximum value.
r
EMERALD 108FING INCH.
PHONE.760-347-9869 83-600 PEACH
FAX: 760-347-9879 WDIO, CA. 92201
LIC# 770940
55820 PEBBLE BEACH
POA WEST, LA QUINTA, CA.
PRODUCTS
POLYURETHANE FOAM
1. The foam shall be HENRYS FOAM #714 (ASTM E-108)
2. Physical properties of cured foam:
A. Minimum in-place density is 3.0 lbs/cubic feet.
B. Closed cell content is minimum 90%.
C. Compressive strength, parallel rise is minimum 45 psi.
D. The foam shall have a flame spread rating of less than 41 when tested according to the procedures outlined in
UL -790
SPRAY APPLIED ELASTOMERIC ACRYLIC COATING SYSTEM HENRYS #582 100% Acrylic Coating)
1. The coating shall be the spray applied elastomeric acrylic coating system, manufactured by HENRYS Incorporated. .
2. Physical properties of cured coating system.
A. The coating shall have good resistance to ponding water.
B. The coating system shall contain no plasticizers.
C. The coating system shall contain no migrating fire retardants.
D. The coating system shall have a class "B" fire rating over foam on a combustible deck when tested according to
the products procedures outlined in ASTM E-108. r
E. The coating shall remain flexible in temperatures down to below 30 degrees F.
F. Elongation, ASTM D-6083 is minimum 840% +/- 50.
G. Tensile strength, ASTM D-6083 is minimum 500% +/-100.
H. Shore a hardness, ASTM D2240 is minimum 50. ,
1. Reflectivity, ASTM E-97 is minimum 90%
SUMMERY OF MATERIALS:
NEOPRIME PRIMER...............................1/2 GALLON PER 100 SQUARE FEET.
POLYURETHANE FOAM .........................3LB. DENSITY FOAM- AT MINIMUM OF (1" INCH THICK)
ACRYLIC ELASTOMERIC COATING ....... :.3 GALLONS PER 100 SQUARE FEET. ,
CERAMIC GRANULES.......................:.....40LBS. PER 100 SQUARE FEET.
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