08050227 CITY OF CUPERTINO
BUILDING DIVISION
PERMIT CaNTRACTORINFURMATION
BUILDING ADDRESS:
PERMIT N0.
20350 STEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08050227
OWN AME: PERMrf ISSUE DATE
PROMETHEUS PO BOX 693 05/29/2008
NE SANRA RY NO. CONTROL NO.
(916) 789-8484
ARCHTIECOENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
C= t�
3o0LICENSED CONTRACTORS DECLARATION
W n I Taow Tachy ailuro t1 am 11¢mednd
under pm.;ai me of chapter 9(enmmenemg lob Description
-°J with Section 7")ofDidsion3ofthe,Businesianal Pmfess(omCode,and mylicenes,is WSHR&DRYR RTROFTS, KTCH&BTH CBNT&CNTRTP UPGRD,
n y In full rme.and effect.
D tab License Clesa Lle.g DCTLSSPLT SYS,HVAC RTROFIT
n=❑ Date Common
pp 7W7W ARCHITECTS DECLARATION
r'2 k I understand my plans mail be used as public records
5yU
G Licensed Professional
y3 OWNER.BUIWER DECLARATION
i I I herebyolirm that I am exempt from the Conlnnar's License Law for We
0 O following mason.(Sccdon 7031.5,1 at.u and Prof.....Coh:Any city Or county
5$ which requires a Permit to cnnnntel alter.impror,demolish,or repair any swnum
Z< prior to its Woman.also requires the applicant for such permit to file a signed statement
axe thu heis licensed pursuamlethe provisions ofthe Cmurescus'.U..Law(Chapter9 Sq.Ft. Floor Area Valuation
X�j (eommendaSwith Section7000)of Mi ion3of We Buai end Profcssiom Crh)or -' $3900
5 that be u evmpt Werefrom and the beds for the alleged eaempdon.My violation of
Section 70313 by any applicant for a Permit Whew the applicant to a civil pwlsy of
nor Wort than five hundred dmtlars(sSBo>. 3 6 9 010 2 6!1RInber Occupancy Type
❑1,as mwher of the property,or my employees with wages ss Weir We compensation,
will do the wart.and the swnure is not intended or offered for We sne.7W.Business
and Pmfessiom Code:The Commences Liccre Law dw trot apply to an owner of Required Inspections
property,who Wilds orimprmes thereon,andwhodoessuch work himselfmr though his
awn employee,provided that such improsemrnu tae not amended oronered formin,IL
however,We Wilding or improvement cold within one yev of emopktimn,ted owner-
builder will have the Wrdrn of poring that he did no,Wild or improve for purpose of
oleT
1,u owner of We property,am exclusively contracting with licensed contractors o
construct ban project(Sec.70aa.Business and Professions Code:)The outnumber.Li-
cense Taw dors nos apply o so own o of property who WtWs or improv thereon,and
who comru s far such pmjeM with a com ucto,(s)Ecmsed pursuant he We Conuatmes
Licmua Law.
W
❑1 aexempt under gee ,B is P C for tins recon
owner Date
WORKER'S COMPENSATION DECLARATION
i hereby alarm under penalty of perjury one of We fallowing hclaraom:
Ihave andwild main taineCern 37M ofComem toCode.fort a Wmkehcaof the
Won.u gichhi for by Section 3700 of doe Labor Code.Ina the per(orman¢of We
work for which this permit is ivuN.
❑1 have and will maintain Workees Compeossuon Insurance,as required by section
3700 of the labor Codc.for thc performance of the work for which this Permit u issned '
My Worker's Compensation Insurance carrier and Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thu section heed trot be completed lithe Permit is fmrene hundred doRua(5100)
or lass)
I certify that in to perfurmancc of the work for which this Permit is issued.l shall not
employ any person in my mannerso u an become subject to lbe won=,Compensation
Larva of Caliroria.Date
Applicant _
NOTICE TO APPLICANT:If,after making this Certificate of Eaemption,you should _
become aojen to the Worker's Compensation provisions of the tabor Code,yW mus
.J O foMwith Cmr1tY with such Prvisimu mr this permit shall be doomed rtwkd.
Z'y CONSTRUCTION LENDING AGENCY
[—m Iooby salon tht Won is a comlruclinn lending agency far the Perfurmam cof
tY, the work for which this pnmir Is issued(Sec.3097,Civ.C.)
4 Lcndees Name '
z Larches Address
U O 1 certify Nat I lure read this application and We thu the move infomuuon is
^ COMM 1 agree to comply with ill city and county ordinul¢s and state laws rtledng to
.� Wilding corstrucuon,and hereby mthmrr representatives of this city to cover upon We
W cove-mentimnndproperty for inspection which ns.
(~ LL (We)agree Io sale,Indemnify and I¢ep IYfmbou We City of Cupertino agtimll,t ,
Z incoiseenum c orthecmvang eapempormiL may in any way accrue egaims Wd City
U z A PLIC sence orthe N Sthu permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PoINTIssued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApphcanUConvanmr par
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding oceupsmeore or handle hanrhus..,,W
u defined by the Cupertino Mumcipal Cmdc.Chapter 9.11.and the Health and Safety
Cale,Semon 15332(1)7
Yes 0N All roofs shall be inspected prior to any roofing material being installed,
Will roc applieam or future Wilding occupant use,equipment or devics which If a roof is installed without first obtaining an inspection,I agree to remove
emlt Imoodous air contaminants as dc(mcd by We Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ON.
I have read thehanrdous materiabrequirtrhenu undcrClupter6.95mfdte Czlifnr.
nu Health&SefelyCude,Su9om 15505,25533 anal 25534.1 urAcramed IM ifft Wilding
does out currently have a luum that it n my mapoWbilily,to mortify We occupant of the
rquimm mss which mush be mel prior W issuance of a Cortifi ato of Occupancy.
Signature of Applicant Date
Owner or amhonred agent pate- All roof coverings to be Class'R!'or better
CITY OF CUPERTINO
• 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
-' COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901026 .APT503
DATE ISSUED. . . . . . . : 05/29/2008
RECEIPT # . . . . . . . . . : BS000004925
REFERENCE ID # . . . : 08050227
SITE ADDRESS . . . . . : 203A STEVENS CREEK BLVD APT 5
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER PROMETHEUS
ADDRESS 1900 S NORFOLK ST #150
CITY/STATE/ZIP . . . : SAN MATEO CA, CA 94403
RECEIVED FROM . . . . : ORION FINANCL SVCS
CONTRACTOR STEVE WHITESIDES LIC # 29564
COMPANY ORION FINANCIAL SERVICES
ADDRESS . . . . . . . . . . : .PO BOX 693
CITY/STATE/ZIP . . . : ROSEVILLE;.- CA 95678
TELEPHONE (916') 789-8484
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- --- ----------
------- ---------- ----------
IBSEISMICR VALUATION 3 , 900 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1ELECINSP HOUR 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1MECHINSP HOUR 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00
1PLMBINSP HOURS 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
ITRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
---------- ---------- ------
---- ----------
TOTAL PERMIT 530 . 80 0 . 00 530 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 530. 80 AMEX
---------------
TOTAL RECEIPT 530 . 80
o8co � oaa�
• CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORION CDSUREWEST NET
Jobsite Address: 20380 STEVENS CREEK BLVD Date:3/4/08
APT 503
Owners Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-021(/,A>°T.5 e3 Project Valuation: $3900.00
Blg. Permit Information: Bldg. ■ Elec.■ Plumb.■ Mach.■
JOB DESCRIPTION
Washer and Dryer Retrofits; Kitchen and Bath cabinet and counter-
top upgrade. Ductless split system;HVAC Retrofit.
CONTRACTOR INFORMATION
• Company:ORION DEVELOPMENT Phone:(916) 789-8484
Contact Name: STEVE WHITESIDES Fax:(916) 789-1051
Address: P.O. BOX 693
City, State, and Zip:Roseville. CA 95678
State Contractors License: 747992 Exp. Date:9-30-2009
Workers Comp.#: 238-0002445-07 Carrier:STATE FUND Exp. Date: 4-1-2009
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card# : 311'1 3(o3)i1 q 51 Dzq
Name on Card: Orion Financial Services Inc
Expiration Date:
• Visa 13 MasterCard 0 Discover 0 American Express