08060080 CITY OF CUPERTINO -
RUILDINODIVISION PERMIT CONTRACTQRrINFQRMAwCiON
BUI1�51�fGASD TrEVENS CREEK BLVD APT ORION FINANCIAL SERVICES PE 08060080
OW .S AME: PERMIT ISSUE DATE
PROMETHEUS REAL ESTATE GROUP PO BOX 693 06/11/2008
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: NFO
WSHR&DRYR RTROFTS,KTCH&BTH 'BLDG BUILDING
PLUPERMIT M B MECH
UZ� I hmmy aLICENSED
rlm wsE mclichumil under ON ACnOR'PrD�wwuiv of Chapter 9(Commencing ^-�_^^..^ •�•� — ------ Job Description
n<in with Section 70M)of Division 3afthe Business and Profrssians Coden.amd my license is
-p H in full force and effect
�tqZ License Clan L'e.g
^ Data Contract.
ARCHITECTS DECLARATION
! 1 understand my plans shall be hand as public records
;yV
yoG Licensed Pnttesaianal ,
^
OWNER-BUILDER DECLARATION
2<f I hereby aRrsa that I am exempt fmm the Canusemr.License Law for the
E 20
following reason.(Section Hn 1.5,Business and Rofessons Calc:Any city of county
K which requires a peonit to moss et.alter,improve,demolish,or repair any structure
y Z_} prior N its o3indiCe,aim rtgWfell tC applicant Ter Such Permit to file a Signed SlaNmem
< mat he is licensed purwantto to provision of the Comscwri Llmnse Law(Chapin 9 Sq.Ft. Floor Area Valuation
z�� (commencing with Section 7")of Division 3 of On Business=it Professions Cade)of
— that he is exempt shcrefmm and the huts for the alleged mompton.Any violation of
Section 1031.5 by any applicant fora Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
ret more than Bt.hundred dollars(M), P Y YP
I,as owner of this property.or my employees with wages as their wee compensation,
will do don wort.and the n mosm,4 not mowed or offered bur safe(Sec.'IDaA.Bui;ness
and Profession;Cade:Ther Guarantee,License Law does nut apply w an owner of Required Inspections
propertYwW builds orimpmves the si who dmssmhwort M1imself orthmvgb his -
mad employees,Provided that such imprewh emu arenas intended oroResd foram.If.
M1owever,the building in improvement is sold within ane your of compleum,the Owner.
builder will have sire burden of proving that he did set build or improve for purpose of
sate.).
I.as owner m Ik property.w exclusively conuwting wide OmvW conmemrs in
mvhmm the pmjem(Sec.1014.Business and Professions Code:)The Contractees W. .
mom law does not apply to art owner of property,who builds or improver Hereon,and
who contracts for such projects wish amour cwrts)licensed pursuant in the Convector's
Lies ve Law.
❑I an exempt on&,See ,B k PC rorthis..on
Owner Dean
WORKER'S COMPENSATION DECLARATION
1 hereby affum under penalty of perjury one ordain fallowing declanthns:
I haw aM will mention.Ceniliateof Cement an selM1ensure forwoionscompen-
sauon.as provided for by Smtnn 3100 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as requimd by Semon
31000fthc labra Code.for the peRarmance ofthe work for whirli this permit Is Issued. '
My Workees Compensation hswsance canner and Policy number M:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section reed ret be compicted if the Permit u foram hundred down($100)
err less.)
1 unify thin en the prrfmmsme of de,wort for which His permit is issned,l shall not
emPloY any pemon in my mannered as m broom.wbjech m dm Whrtma'COmpw•..non -
taws of ci ifomia.Date
Applicant
NOTICE TO APPLICANT.If,after making this Cunifhcae of Eacmpdon,you ald,Z
become subject in the winter's Compme atan provisions of the labor critic.you mar
.,O formwiH
comply with such previsions a this permit shall W deemed mokcd.
Z N CONSTRUCTION LENDING AGENCY
[-+ 1 hereby affirm that Here is a eonsumtinn lending agency for the performanm of
11' tun work rte which thus permit is issued(Sm.3091,Civ.C.)
QLender's Name
z Lender's Addssa
V Q I centify,that I lure rod His application and sue thus dte above Woods en is
{T. F cmrecL 1 agree to comply with all city and county Ordinances and soon laws slating an
Q V Wilding cauuuction,and hereby aushots repswnutiwa of this city wemerupnn the
aMvamenuoned psp est for ivpeNon Purposes
F y (We)agree w save,indemnify and keep hermleas He City of Cupertino.&entre
hl Z incoitinnumm,Of did rata and examines which may in any soy carne against said City
t.)2 A eonwgm T of the granting of His permit
i-^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of APPhanVCOntrmmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will t e applicant err Tutus building mcupmtsws or bamle haurdons material
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safmy,
4Code Section 25532(a)t
CYa ONa All roofs shall be inspected prior to any roofing material being installed.
Will the applicant m future Wilding uxupant vac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardov it cmtsminant5 as defmned by the Bay Area Air Quality Management all new materials for inspection.
DiWic"
❑Yca C:1 No
1 haw mail the hervdnus materials squiremcnts under Chapter 4.95 of the Cdifow
nu Health@SafctYCOd,ScNma255115.25533and25534.1andcnendtdtifdte building
docs awl cunenty haw a mhanL that it el my nespovibility w nouly the omop ct err she
requitemenowhmhin=bemetaiorwwuv ofaCwraamoracupa . Signature of Applicant Date
Owner or mhonred agent Dae' All roof coverings to be Class'J?."or better
CITY OF CUPERTINO
• 8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901026 .APT205
DATE ISSUED. . . . . . . : 06/11/2008
RECEIPT # . . . . . . . . . : BS000005083
REFERENCE ID # . . . : 08060080
SITE ADDRESS . . . . . : 20350 STEVENS CREEK BLVD APT 2
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS REAL ESTATE GROUP
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE 150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
RECEIVED FROM . . . . : ORION FINANCIAL SVC
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
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0. 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 530 . 80 0 . 00 530. 80 0 . 00
•
OM00090
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORIONCcDSUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date:3/4/08
APT 205
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100,, �t
APN # : 369-01-026, t-Yr 1 Zc' Project Valuation: $3900.00
Blg. Permit Information: Bldg. ■ Elec.■ Plumb.■ Mech.■
JOB DESCRIPTION
Washer and Dryer Retrofits; Kitchen and Bath cabinet and counter-
top upgrade. Ductless split system;HVAC Retrofit.
CONTRACTOR INFORMATION
• Company:ORION DEVELOPMENT Phone:(916) 789-8484
Contact Name: STEVE WHITESIDES Fax:(916) 789-1051
Address: P.O. BOX 693
City, State, and Zip:Roseville. CA 95678
State Contractors License: 747992 Exp. Date:9-30-2009
Worker's Comp.# : 238-0002445-07 Carrier:STATE FUND Exp. Date: 4-1-2009
Cupertino Business License#: 5tP 4
CREDIT CARD INFORMATION
Credit Card 9
Name on Card: Orion Financial Services Inc.
Expiration Date: 01/10
Visa ❑ MasterCard ❑ Discover ❑ American Express ■
•
' PFnn,R
OWNER'S NAME: ,
�� 0c
PFRMR MSM DATE
4 F::
SM ARY NO. CONTROL NO.
ARCHITECT/FNGINEEA:
BUILDING PFAMR INFO
HIDG lO MECII
O p LICENSED CONTRACTORS DECLARATIONNrcbu, C� O
i:=U w Ihon7 affirm Lha l,m IK mJue0cr WPitimf mycM&,. 9f,,yH on, Job Description
_ WsulRm lmnnr DnidDnldrule Hwflrcb aM Pmt'o,¢Cnde.lvd mrrmMi:
in full lomc 7
Ano clre B 2
CIA,, .4 7 9 9
-n D.. ('1ml,abw
-A ARCHITF-LTS DECL.ItAT10N
s I uMwaund my;lam shall M u,M u wNic mn,rm
LWcmcd Prufcumnal
0-
OWNER-BUILDER DECLARATION
<'e I bu.cey,?m mal I,m—PP,room Jc GMWMIoh Lion¢law(M Je
no 101M.....Aon,I$ l un 710 L1.Buumblgi and Po(uoon,CoEe:A, or mun,y
zWniob r[Vm,r1 a A—o W CMnrW],lll[f,iminmC,WnnW1,A,W R1in NY WOCeue
i pnubm.,AbA,A1wP MP,alM,,,j"Pl for aixb p.milbfik atl;lntvmrlMt
�
Mal dia rrn,�d purmanaAAMe mosinm of tuo C,mra,ler&L cne uW(aw�IQ9 Sq.Ft.Floor Area Valuation
Isom rm,w.hS coon70W)N Division l a We Bloo.A,,Prof®w co,,)w
3 bn ken l.,beClro.W be bun for d5 Aib,po uunP.M,my vbAlaa.a
Scion 7031.5 by any applicant(w a pumil Wbic=,B1c appliwi b,cvB porgy a
not male ban fiw huMmo dmlars(SleBL APN Number Occupancy Type
❑1.u ownu of Inc P,Dpcny,w my employ...W,1vl;rs u Web mk cnnpp,uJM, .
Will oo"'Wwt aid ma avucmrt 1.rot monde"w eReaed for de(Sr M4,film—
Ano PmIculMa co lu:T)u cenvvane,Urm.m UP,mn M1!pm to p e.mQ of -
P,bcnY who build,w Required Inspections
meows Wucpn,aM wM doe„uN wk 6iwelforwwyb hu
bvR=1,10 o-s,wu.ld,d JAI Wchimprovem,.AA rtA mM,A,,d oroRaM rack V.
hm. .,m,budding w.mpm mem i,sob widun oo,yMr of wlnplalo.L Ju bAm A,
W il4r will haw 1k burden Df pmvin;WI bu did rot drib a impm c for pwp.s a
uk.)
t�i,i ovrc.W do pown,,m uclmivuy couva ,wish li^- u wmr.nm m
,onRmcl we Amyx,(Sec.7044.Bubo.,..aM I lWa4om CMc)The CMRHMre U
luc
I-a.dW nn apply A an--D(Polum ly WM build,M impoq oubbo 4 And.
.no comnc,a for lMJu wojcus wid a cmuauw(c)li¢nxJ gvmalu b the CuolalnoY,
Lire—Law.
Ulm.acmm undo Su. ,B h P C for Wit rnuAla
0.rc. Dale
WORKERS COMPENSATION DECLARATION
I hAn by afro Doll,wnRly of pmyury o1c of tM 1,MA,b,JMJa,a4onc
.D and will mlmum,Cmlrlcam of Comc.0 mxu.mmu,for Wor,,z Camp
A,Al wo•m d Im by Seww 37M a We labor Coes for We Pufom PA,a We
Wa fm GMC
'hu"'on,rcmil is 1IIu,d.
D 1 MR AM,will malnlam vb.Cl (:wnr`Cpylmd I,19La .ae A bi"by Sromo
)) .fbe U. e,fa be pwlomallcea dW a for wnitll Wu pmma -A
a"n.
• Mr wba ' CmnE a Insenll¢nA,. POl.,..w Non
IE TA FUND mM
Pais Na238-0002445 07
CERTIFICATE OF EXEMPTION FROM WORKERS'
j COMPENSATION INSURANCE
f)hn,u'm.n—0.hD,oul lccd if Inc Immo,iso,orc nuwM dd11n(SIBO)
rc W,.I
I ccm(y MAIL..1M ye.Inrmanee of b,ww,for Which on.pemil is i,axd.I yAlI Rw
,mpl0y An, ..,..by mN.cr m„b MCMC Wbjc.W Jb WwkmCwvprnvM9
L-A.,DI Califomu.D,u
Applin
NO E TO APPLICANT:If.af.e,matin;Ju,omilf.M of EAo.,Aj ,y,N ,Mb t
Mcwnc Whya'110 1h[won,.Compcualibu PrWillon.a be lahp CMo you,mm
�� fonhmin.lmply wlh aucb p.nrui.w m Me,;omit mall W demnod mok,d.
'� ST
CONRUCN
TION LEDING AGENICY
-� Ihcreny,RumM-1oubcU acomuv.ion kolin;a;Pllq for ur purwmM¢a
Y> M,ora 1.-bi.mo Dann uA,md 1S IBPI.Civ.C.) '
Q Una Namc..__
7 Z
O anly'mal l n,rc rrad W,,pplalloe W,Ale ba We lhp a dfomlYm IS
1.1-1 1 A".1. ."y nm all mly W county wdi..aM Nb do Mllingb
jU buibma,onv bon.,.knee"..,.lePrta Mou or Mia el,rm Wvupm ole
,buw-mnmmcd lugc,ly fp i" K pwpoyes
I WO C.to uvc..M,mv/y aM,ocp normo,Me City a Cupcklb]Lain,
y li Inil cl.iudc .a'D.D.M,.pu.iu .r iD ram,C,pivp yWcly
Z Havoc • ;,arv1NOf Nrc WITlf w1L N9H-PO{yr ued by: IIa[e —�(� ,'� 8-
SOURCE TIONS.
Re-roofs
si,Aoxnc rAwli a i/Com .w roofs
of Roof
HAZARDOUS MATERLS IADISCLOSURE T
W01 We applbpl w fumm Nildin;ueupmt ape whaMk hlmdwm malad
u Mfl-d by tM Cupm1M Municipal Coh.(]Mpb'r 9.12 aM Jc Hu1W aM Sarmy
cmR.Sr,nn.lsv_Ia17 All roofs shall be ins p y g g installed.
❑,., Nu petted prior to an roofing material bei.
Will bp.,pla,nl w 1Dmrt bui,Jin p nl yrlpm,a p J r orb eh If a roof is installed without fust obtaining an inspection,I ap ee to remove
;oceu us
nmmu of conAmlmnu as J,finAl by dC Ray Arta Ai.Quality MalajemW all new ma s for inspecti n.
OYu, No
f
• Ina.c,s IuaamlAsmacriaU rcyummcnu uwmf]upv 495 atM fSRfpry /� a
. II4slmkSaf Code Sotiw yl .s 5)3 .I ul.dvaaM Uu)HJc 4ddmt
do Dm ly ba my IY b MdryM t9 tls
dol wh Calif" SignatureofApplicant Date
Wbu w„]bora a;,Dl All roof coverings to be Class "B"or better
I} Community Development
l}}`���'• 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
:UPEkTINO
Building De otment
JOB ADDRESS: 20380 STEVENS CREEK BLVD PE #
CUPERTINO, CA 95014 0 E0 `0 ooI o
OWNERS NAME:PROMETHEUS REAL ESTATE GROUP PHONE #(916 ) 789-8484
GENERAL CONTRACTOR STEVE WHITESIDES FAX #(916 )789-1051
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
x Heating SAN JOSE AIR
( 1408 ) 286-2047
Insulation
Landscaping
Lathing -
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
• Owner/Contractor Signature ate D