08060081 CITY OF CUPERTINO
BUILDFNG.DIVIS:ON PERMIT co C.
BUII.Dlgf3,AD4 'E TEVENS CREEK BLVD APT ORION FINANCIAL SERVICES "78060081
OW gii LU.3A�MEE: b PERMIT ISSUE DATE
PROMETHEUS REAL ESTATE GROUP PO BOX 693 06/11/2008
NE: SANITARY NO. CONTROL N0,
ARCHITECPENGINEER: WSHR&DRYR RTROFTS, KTCH&BTH BLDG BUILDING PERMIT
INFO
O MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION lobDescription
U 1 Wrcby grim Nal 1 am licensed under provisions or Chapter 9(commencing "'"" '"""""" """"' '""""""""'
with Secuan 70f10)of Division 3 ofte Business and Profusions Code,and my lice..is
n in full to.And effect
j b i License Class Lic.6 '
Date Canuanor
e ARCHITECTS DECLARATION
1 understand my plans Shall W used as public records
leis
C
Licensed Pm,y Rnl
um3 OWNER-BUILDER DECLARATION
Contractor's
E 1 hereby.(Tiro Nal 1 1. .Bumph from the Cssions o t:Any c Law for mft
y
HO e o following team.. (anion Rn1.5.Business and Re.auiodi Code:Any city of county
_(Li
Which rcquirea a pmmit m ctinawcl alcor,improve,dcmnlW,m repair any sumturo
_I< prn
ioo its issuance.also MpdMS Ne appliamt for such permit to rile a signed statement££ thuheali mused pursuant tot oprovisions ofthe ContractorsTiceLaw(Chapmr9 Sq.FC Floor Area Valuation
y+�$ (commencing wit Section 7M)of Division 3 of the Business and Profusions Code)or
Nat he or exempt therefrom and the basis for dx alleged eumpdmt Any violation of
Section 7031.5 by an)'applicant four a perms subjects the applicant to a civil penalty,of APN Number Occu ane T e
Am come Co.five hundred dollars(55D0). P Y YP
❑L u owmr of die pmputy,a my maployeea with wagea u Heir vele eompenudon,
will do the wark.md teaWCIYR Is nolNlended MaffeRd for YlC(See.?D1d,BLLVae{a ns Required Inspections
and Professions Code:The CAnmeloh Licensen Taw donot apply as an owner or q p
property who builds or improv ter an,andwhodwassuch work Nmselfor through his
awe employers,provided thatmch improvements are not intended oroRcrtd forssle.IL
howev.to building or improvement Is mid within Arte year of compleum,to owam-
builder will haw to burden of proving Nat he did Ant build or improve for purpose of '
Call
❑1.as owner of Ne property,am exclusively'commons with licensed rontracWn to
construct to project(See.IMC,Business and Professions Code:)The Contrman',Li- .
cove law data not apply As am o vmr of properly who builds or improv Norton,and.
who contracts for Such prejecus with a eana umor(s)licensed pursuant m the Conmeuses
License Taw. ,
1 am esempt under Sec ,B @ P C for Nis moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1Mmbyd munderpenallyofperjuryatmofdmfolb ingtrlaradmts: -
❑1 have and will maintain aCerditom of Cement to self-ivu a for Workers Compen.
ration.As Provided fm by Section 3700 of Ne labor Code.for Ne perfamance of to
wart for which this famous[a issued.
❑1 have and will maintain Workeh Compevauon Insommee,At rtggred by Section
3]()0 a tc labor Coda for are performance of Ne wmk ft which this permit is Issued. '
My Workers Compensation lased.aoricr and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
rlhisuction reed mlhecompleted ift a Permit is foram hundred dollars(SIM)
or Saba.)
I comfy Nat in to pnfom.of the.,it far which this Permit is issued.I shall wt
employ any person in any mannerse u in become Subject to the Workcn'Compevxdon
Laws of Caliromia.Dam
Appl cant
NOTICE TO APPLICANT:IL after making Nu Certificate of Exemption,you should
become Subject in Ne Worker's Compensidon previsions of the Labor Cade,you mux
.J O foMwit Comply wit such provisions W
ions or NiS peit shall doomed revoked.
Z CONSTRUCTION LENDING AGENCY
[-+ t hereby Ain.Wt Nero iso construction lending agency for to Performance of
Ci dm work for which Nu Permit s issued(Sec.309?,Civ,C.)
QLenders Name
Z)z Lenders Address
U O 1 cmdfy that 1 law road Nis application and sum Nat to about infoomatiun is
I,!' torect l agree to comply wit All city ars county oo humor and sum laws relating N
.� building convection.and hereby auoorim representatives of this city in enter upon ted
above-mentioned propertycoast
for inspection purposes.
�,t y (We)agree to save.indemnify and keep hamlets Ne City of CuPeruno against
CP)Z "AsincoiuesunceofJodgrocals.to gaming expcvcawhich mryin my way attrue abAivfmid City
V APPLICANTCUNDERSfANDS Agrainting of 'ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
gtmurt
Sof APPlianVCo--1 Dam -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future Wilding weepmtmro or handle huallous material
u defined by ft Cupertino Municipal Cade.Chapter 9.13,and ft Real And Safety
Cab, tion Sec35533(x)?
❑mYes ONO All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant Orlando humans occupant ate If a roof is installed without first obtainingan inspection,I agree to remove
pp g P Wuipr Qu or Vmar Management
P
mit harardnv air contaminants u defied by to Bay Arta Air Quality Managcmcnt all new materials for inspection.
D'suict?
❑Yes ❑No
I have read to huagmu materials nequimmcnts under Chapter 6.95 of ted Califor.
ns HmIth&Safety Coale,sets.35505,25533 and 25534.I mgcrsund Na ifdic Wilding
does not cumntly have a aunt Nat it is my mpovtility to iwdry the aceupmt or de
tequbcmcnu which mux W met Prior As essumce-(a centric.or occupancy.
Signature of Applicant Date
Ownelmm1b.d.dacent Dam All roof coverings to be Class'RA'or better
CITY OF CUPERTINO
• 8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg .
COPY # 1
Sec: Twp: Rng: Sub: B1k: . Lot:
APN . . . . . . . . : 36901021 . 207
DATE ISSUED. . . . . . . : 06/11/2008
RECEIPT # . . . . . . . . . : BS000005083
REFERENCE ID # . . . : 08060081
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 2, 123 . 20 AMEX
---------------
TOTAL RECEIPT 2, 123 . 20
•
l0 kOCo ooc I
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORION()SUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date:3/4/08
APT 207
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN# : 369-01-OW I • A 0"1 Project Valuation: $3900.00
Big, 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 WHITESI DES -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
41
Cupertino Business License#: r�YJp V F� 2Lf7 Q
CREDIT CARD INFORMATION
Credit CardRogow
Name on Card: Orion Financial Services Inc.
Expiration Date: 01/10
Visa ❑ MasterCard ❑ Discover ❑ American Express ■
•
- PERAarryq�U (� UV
OWNER'S NAME: �/
. ._ PEmIIr ffiTIEDATE
NE
SANn'ARY NO. CONTROL NO.
/JtCHRECT/FJJGINEER:
BUUt OjNG P,,MM,,FO
? BLDC ELECT PLUMB
MECVI
..o LICINSF-000NniACmR'S DECIJ.RATION n�� 0 Q
I ashes,arum that I am(To-l unEcr proviss.or Ehaply 9 tcmomurcn{ Description
cllptlon
<� riN S¢tton)fKdl)n(Diviaion7o(dte Buprrsa eft Ppofcvwd Coda mE mYGrrnmu
�V.
in 7.47992
Co.
ARCHr1EC7S DECLA.RA=N
`s i I urmwstana my plans as,ho spry u ryrhla;arauds
-u
I' Lrcvctl Prnfcurnnal
Oj OWNER-BUILDS RDECUMTON
ee eI hcmhy arS,... I lScscmpl s am Nc con.cmmooss C s lien s Lar for Nc
O¢ wn"'p r,as,a ham"s RD I.S.BhJ., am Pr,ashons Cos,,.Any city m cmamY
nice,pros a least hoc th, .)ter.immoue emaaah.m,shay w sans Jam
zi pow nnslssmrcc.also rcRuire lho appliom fm such pmmilurilesc,rcdsoalmlmd
- hal rc hheenscl"—am nthe provisions athe Cwhmmofs Beene lar( 9 Valuation
-D maria Sq.Ft.Floor Area
(comcst.LAvith Sews,a anot o(Oivui fer ofshec,se, sand Pmf®mm Code).
3` Nat h<u c.esspr pree(mm res ths suis for IEc pie„s uempdm,sa viey of
Smion 103 1.3 M any applirutl for a permit ssElmu on,applidnl to a evB mk
psey of
"it mwe Iran FAw mn,mtl,alara 105001. APN Number Occupancy Type
p 1.as mwncu of be property,w my unp,,.with water as Use.pole mtprnvdoq
ll as the work sera she mwcwm a Mt thm ,d abmolf,sed for scam(Sm,TW,
(S ,Bram. . .
and Pmleastrms Cods:)n,Conu.cmrk Lime Law avis,m appy is m ah,rm d Required Inspections
prolsnywno shifts wwpmvm l}pis.andrM doessusL yykhimseRdrlryovtb hi3
w,unployra.Pmvrded that such iia swe......00s inl,nWca moRecE[as as,IL
news ,the ow din,or rmprhremM is sold within arc y,av hrmmpl[aip0.Ips pwpz. ”
suilocr will mwe uh.Shan.of proving Nat as fW no]Why at import for pmpom a
plc.)
❑L as owns,of rho propmt,.m uausi.cfy mmurtin,`uilh)imn-,mnvaoms m
conslrua the paten(Su.)ON,Bmirras Ina Pmfetumu Code)TLe Cumpatmh L4.
--Law a—.w apply w.n nww orphpmzy wet hallo>hnpp•v 0amr,use.
.he cwhn[u ret au Js .is.with a conuapw(s)Iimsms,p sees.to Oe Cavy 1M3
U.....law.
U l am.acmm hndw Scc .B h P C fm Nis,,asap
Dwms Dam
wORKFRS COMPENSATION DECLARATION
I lcaeay affirm om,r permlry of pmyory ons of dm follow,,dmluaGos,
wand.111..'rut,a Cedf pool Com,...V-)mum fmsavha l.Cpmyco-
as onewdsh fw by Snuon))00 of the lessor Case.for tho pefmmurm a Ne
"rt(or which this fumil 15 rashes.
• TC)I hart aM will maimar,Wu s Cornpcny Bm Laimam;u negW d by Session
37w or the Door Code,fm the p,,aa,rce dor rum,,fm whial Nu pgmu u i®rd
MY won, C �'E"a" UND mrmmam Ppr Y nrmmm„t
lame: 1wicyNo_238-0002445-07 _
TF
OF E)EMPr1DN FROM WORKERS
j COMPENSATION INSURANa
(This reorwrc pox rte ewnPlered ifthe pahnit u ret mis nunarcd.Man M100)
rh I,YI
I comfy Nal In m,pefinrmance a the whore for which this pzaaail is icueA l Shag am
employ any person to any manner m ae Is nmmte suhjm melte vai aa,Cwopiama am
uws of Cairo....Dar,
Replica,
NOTICE TO APPLICANT:IL If.matin,this Cordfamm d Exemption,ym shoals,
4c.,hwby[I to the Worlp a Cempwmation pMissim of i e 1JGY Came,YW soup
.Z foMwnh cnmpry with such w-urns m Nu Epson mall GC meshed r,gkeL
0 CONSTRUCTIONI DUNG AGENCY
yN IhcmDY affha NV Neve is a,wasrunimo Ynsirs few Ne
of
- ,ItcmY pcRmmpr¢
Y>loss w
I Na wham this pons,,la muco IS¢lsa).Civ.C.) .
-� linmr' rm.._
i Z I IcrWUY Amnuz .
l¢ns, Nat l hav,seas,Wo. )'
i Y pp rarw aM muleNe show,iMmmalis
Tome.1 adrm m chmplY wsN all city and county oainvte.erns mm lava oam),nf is
�U aMai,ptornhhcuon,arW rtemsha ao .. osmosis,
sof Nu errymwcuim sD<
„V .pons-(W0.re he.,
Insinspeevonpuny ha
Iwa,pt�m n.e,irrdrma�rr and,,pop,.,micas here cry d r+mmuma arra
'q incirreahisi .emu ma eaprnsm ryio ya-vue aim stlo Gry
J Z I.PPL`MJCA rc t ,PZ5.-DS Nrc av n Au Ngw-hors,, sued by. Date
SOURCE ,ONS.
a Q Re-roofs
Si,nawrs of Al]pllomsConrraiw D
HAZARDOUS MA)FAIAIS DISCLOSURE Type of Roof
Will ine apVhpnt w fusion,shilsin,n¢upmt pons ear candle hanrdwm mafvial
u acfoca by he Chpenrho Municill Code.Chanter 9J2.asset site Nd*seed Safety
Cash.Sceuon)55]21,11
❑r„ N. All roofs shall be inspected prior to any roofing material being installed.
Will Inc albicant or J.ho,Wilsinc mc.wn..evhirnncN or Rha,,,which If a roof is installed without fust obtaining an inspection,I agree to remove
aranm ah carnia shame u Jested by N,Bay Area Au Oeafly,Malsacnomd all new maI s for inspec[i
n.
dye �No
IhI11 Naaarwa'."Lls,eyvrmmemu unset Omptm 690aNe CaBfpn / ['
• HcsINLSar Colt S¢9um 255 533 .l urrdmamW lha�tllud.neI�hnnT(6r1,
lean rot[sur IY watet Nar mY tYbroay%
°" vin Tar SignatureofApplicant Date
W e w aamwncd]pent All roof coverings to be Class "B"or better
Community Development
I„ 10300 Torre Avenue
.Fh ' � Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
0 Building Department
JOB ADDRESS: 20380 STEVENS CREEK BLVD ] PERMIT # Q ro O oil CUPERTINO, CA 95014 6 0
OWNERS NAME:PROMETHEUS REAL ESTATE GROUP PHONE #(916 )789-8484
GENERAL CONTRACTOR STEVE WHITESIDES FAX #( 916 )789-1051
I am not using any subcontractors:
SignatureDate
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 Sigriature bate