Clone a simple script

Looking for someone with excellent php/mysql skills to create a script that has similar functions like this one [login to view URL] 1) Requires ability to create a default location on Google maps 2) Type in address into pop up form field. once address is typed in and the enter button is hit, the location shows up on google map. 3) Simultaneously the pop up flips over into another form field that requires a) name b) email address c) Verify Email address d) check box for email permission and e) Phone Number. 4)All fields must be mandatory 5) Admin panel must password protected and contain: a) Ability to change password b) Ability to change admin email address c) A list of people that have submitted requests with the latest one at the top and a the ability to sort individuals alphabetically by last name and location d) Require the ability to email notifications to groups of people that have requested evaluations in a specified geographic area in text and/or html format. The max deposit on this project will be 10% of your bid price