08060082 CITY OF CUPERTINO # �•'.,tem., i- f c. "%h-"* "` z°*'.•'"x�."''
BUILDING-DIVISION PERMIT CO1I'RAGTOR IN2�'ORMATION
MIFT NO.
""I '' �THRTTEVENS CREEK BLVD APT ORION FINANCIAL SERVICES P 08060082
OW AME: PERMIT ISSUE DATE
I?ROMETHEUS REAL ESTATE 'GROUP PO BOX 693 06/11/2008
NE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
WSHR&DRYR RTROFTS,KTCH&BTH BLDG ELECT PLUMB MECH
0 0 0 0
wap LICENSEDCONURACIOR'SDECLARATION IobDescri tion
iI F 1 busbym W
affuar 1 am li¢nsril under Provisions of Chapum 9(mmmrx(ng ""�""'• •"•� " "'"'""""" p
with Section 7")of Division 3 of WC Business and Professiom Code.and my license is
^ N in full form and cffecL
j v�? License Class Lle.
oH Dam Comnnnr
eARCHITECTS DECLARATION
G.
U 1 undersand my plans shill k used ss public records
S C Licensed Professional
3 OWNER-BUILDER DECLARATION
I hereby from that I am exempt from the Conuacmrs License Law far the
OO following moon.(Section 7131.5,Business and Profcmom Calc:Any city or county
C
$ which mquiru a Permit to cmrvrua, JuG.improve.demolW.Or repair any swuum '
u prior m its issuance,also requires Wm G
e applicant for such permit lc a signed statement
Malar he is licensed pursuant to tis provisions Of the Commasrs Liummm law(Chapmr 9 Sq.Ft.Floor Area Valuation
11- (commencing with Section 7M)of Division 3 of WC Business and Professions Cale)or
— that he is casmpt thrscfrom and the basis for the alleged uempuon Any violation of
Semon 1031.5 by any,applicant for a permit subjects the applicant in a civil penalty of APN Number Occupancy Type
Get more Wan row hundred dollars(SM
P Y YP
I,uowwr of Je propury,amy wployw with wagussJev role mmpewun,
will doth.work and theswcmre is not intended oroRered forsale(Sec.7 ,Businw
and Profession Codc:The Conummfs 4^^w Law don ser appy m se owner of Required Inspections
properly w he bui Ida or i m proves Wescan.and who does such work himsel f or though his
ownemployres,provided than such improvements are iron intended croRsrM foraLe.U.
however,the building or impmvsment is sold within one year of mmplcdm,the owner.
builder will haw the WIQut of poring cost he did has build Or improve for purpose of
ale.).
I,as owner of she property am exclusively conbauing with licensed convenors m
murrucr Je peivet(Sc.7044.Business and Professions Cale:)Tis Con ossm'.U.
cove Law does not apply to an owner of property who Wilds or improves thereon,and,
w W contracts for such projects with a tonvmtar(s)licensed pursuant to the Convactor's
Lus.Law.
❑I am corrupt under See ,B At P C for this recon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Je following declamations:
❑I haw and will for by eCervi(roof the Labor
fa Wodmfa C,of the
worse,r provided far mi Section 3100 of the V Wr Code.for she pcsformance of the
worse for which this permit is issued.
❑I haw,and will maimk Worker's Compussusn Imuran¢,as t q.imd by Section
3710 of the labor Code,for the performance of the work for which this permit is issued.
My Worlue s Comptma ton Insouciance arrics and Policy number tic:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissoctinn wed not LccomplemJ ifthe permit isforone hundred dollars(SIM)
or less) ,
I ccrufy that in the Mr....of Wo.,it for which this permit is issued,I shall not
employ anypermn in any mannose as m become subject in the Workers'Compsmauon
Laws of"foo ice.Dam
Applicant -
NOTICE TO APPLICANT:If.after malting this Cerufiam of Exemption,you should
become Subject m the Worter's Compensation previsions of the Labor Crede,YOU muss
.J z forthwith comply with such provision or this permit shall k deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Fed thereby aM,.that Were isa onesmctinn lending agency fm the pRurrG.of
�i Jen work for which this permit is issued(Sec.3097,Civ.C.)
Lender's Name '
z Lemba's Address
U O I certify that 1 haw read Who application and sum Wu Use show irdormation is
!` comet 1 agree W comply with all city and county Ordinances and sum laws relaung m
-C)SU^ Wilding covsuuction,and hereby malaise ormarnuuws of this city w Grow upon We
how-mentioned property for O.N.e purmwhich ms.
F y a (We)agree to saw,indemnify and keep harmless the City of Cupertino against
h inconsequence of the
expcnpenoiLhmay in any way ancmc agilnuild City
C)z m consequence of Je granting of Nu D W IR
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicaHDate Re-roofs
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Willy the Cupertino
future Wilding=Upset Chaptsmrcorand the
Heardousmaterial
u defused by Je Cumruno Mumripil Cade.Chapter 9.13.teed tis HaIW and Safety
Code.Section 25532(a)?
❑Ter ❑Nn All roofs shall be inspected prior to any roofing material being installed.
41 Will We,applicant lir future Wilding war ant um lit If a roof is installed without first obtainingan inspection,I agree to remove
Ire e P culminates Qu or JMana whim p
Ducahanrdnm air cmuminants ss JcfineJ by the Bay Arca Air Quality Management all new materials for inspection.
Disuicrl P '
IYn 0 N
I haw read We hxssrdous materials requirements under Chapter 6.95 ofJm Califor-
ciaHealWASafeyCade,Sections 255(15.25533 and 25534.1 mdcrsund dm if the Wilding
does not currently haw a roman.that It u my responsibility W notify Je wcupent of We
require==which most k met pior to ksusrec or a ceniream of Dempanq. Signature of Applicant Dale
Owner or aumorixJ agent pareAll g
f coverings to be Class'W'or better
' � roo
CITY OF CUPERTINO
• 8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901021 . 215
DATE .ISSUED. . . . . . . : 06/11/2008
RECEIPT # . . . . . . . . . : BS000005083
REFERENCE ID # . . . : 08060082
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
IELECINSP 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
•
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORION(a)SUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date:3/4/08
APT 215
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-02 / , oZ/5 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 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#: q'6(P U��� — L/ 7 �3
CREDIT CARD INFORMATION
Credit Card# . _
Name on Card: Orion Financial Services Inc
Expiration Date: 01/10
Visa ❑ MasterCard ❑ Discover ❑ American Express ■
•
OWNER'SNAME: Oy V
- - _ PEIOR TATE -
NE:
SAb1rTAAy ND. CON Iol.,
MCMITECfIFNGINEER:
BUIIDIhIG PFY4RiNPo
HID
�iD NLMB ME61
..o LICENSED CUNiRACIDRS DECLARATION � Q
0 0
I hcrcbY affirm wl 1 vn IimArcd vamd Waa'iaima a pup¢c 9(®ammleng Job Description
;� Wim Salla T(rbl)aOiviaidn]alfe Bralnurard Pafrscdr¢rade.and my ficacig
-Z in full I.and alas. B 7,47992
Lk».Clea tic,a
Dad GsDSM
ARCNIl bb d T DF�l.MT10N
1 pndas.m my plant d,m1 W d,w u wak.ad,a.
U
T Lda»d Pnnr�nnna
'j OWNER-BUIIl1ER DEL TION
2 1 hereby alTrm mal I am-and fWM Nc caddmMWj UW liar did
00 ldllmnnp maud.,rsccdun ylp I.S.Bcnnma aM pmfedmu Cade:wny ary m marry
vnicn nwar,4 a pcmn w Cnwrv¢,al¢r.ma m,MnWiN.m mryr»y pNJurC
iT mlW mad usuamc.alae
_ Iammudnng maimlrvnom fm nlcb pnmil»Ek•Byrd
l mtldmab p .. m dr dCmi x. (CaalallmpC
Sq.FL FIODC Area ValuationWim 5m,m
7 )ditipm]a We Bl6.iand Padi®bbb qm
mn k n.avnN u.ocfm.aud da,Lasa for de adava eavnpdan Any vfdlauam a
Smim 7011.5 by any applicant fur a p n subjc=me applidnl W a cyd Pesky at
nm mar.man f,K hdMmd dmlan 55 APN Number
IQI.unWmlmuc'rpony army unpldyaa Wim uaynu dukalemnpavdma . . Occupancy TYPC
lab me.mK.nd Ina awuum n as mlbndrn m.ffaed[mama(Sec]f W,Buvv�
»d Pmlecsims C.&;TId Cdnuama(a Liv Lata ma ma appy m ad ammo a ,. Requited Inspections
proarny Wna Wilda W unpmmn. mmean.and Wb ddesaua bbb kbimvrfm N»uLh bia ..
a.n ampluy=.p,orucd mal such kam mabb.u vc at Im,^a^d melfmaL rm rale IL
b--r.dd mudding m imps cmvd is aide—W.a—year aumloadma m dWom-
Wildcr.ill Iurc»1 bufaem of pmring mal.did nm Wild m improve fm pmpd¢a
.k.)
(]I.av wrist tl LL pnd m,am ucluairdy,,abmal Gm y adaaaNa td
rmsvum lnc pmlaa(Sm.IOad,Busim arv]Pavf=imn code)T.caadlai f'Li-
mc Lar doer nes apply n an ares ormdpvey rW Wil,m ifmb a genas va
WM w La.,fm an S pay.Qa WiU a Cmvaum(s)I'amsaed pvmaN b We Cnwndfl
u VW.
�Iam.acmN anam Sa. ,HkPCfmlmsmm-
O.nu Dam
WORKERS COMPENSATION DFfIrRAT1ON
I hucby rfilm um.,awry a p .0 da dI me fabving daYrationc
aani Wdl mvnuina CMIIaLb of cd,duard 10 finam fmaWbaCumpa-
ss an"dad fm by Uman])OB df me labor Com,for dk pe faimm.a abe
bus ran.hdn mu Ic,m1 u"aucd.
• 0 1 Wa.am will mamdam Wo S cpmmwl»d)wdana.u aryubrd by slaipd
37W of lnc Labor ci Cfor dc pufmmv of dna vmk far Wbi this gonad k im A
My WM r'v Cmn 4ua Inuua�n,riu and Polity numbs K
e,mel:Mrf FUND pp)iLy Nil 38-0002445 07
C RTIRCATE OF FXFUPTION FROM WORKERS
j COMPENSATION INSURANCE
nba ss bbn zea mn bi:—leled ifineI d is fm orc hundrtil daraa a loo)
m.,
I sentry Nan m tld l nlmmaac a ur Wdua fm Which mu fumll u mrcQ I Well am
unplay any pc.n many mama»as b hand aubjen W me Wmtuf Campntoddn
U, l or Califomn.Dan.
Applip
NOTICE TO APPLICANT:If.ar.mating dds Canino.a Fawp ibk ya al»uld
trmm.zul Y m lm--2 i Corm. Udn mwiriw a dC fabm cddL ydP mvG
�Z faMWnn cnmMy Wam alien lran,; u.mi.leaid aeon be aamra.Yatr6
-a CONSTRUCRON LENDING AGENCY
N i hcmny afn,m gal lfdrt u a cdmuadd cdbanding agdar fm Ibc pufonnaaaa
lid wda
O Nw .. oris m.mm--'Iis arra ISee 3M.Civ.C.)
LCWcla _
Aodr=
Z I lrnau's nmrus ,
l 1 abd mal I lure red dnia a I am,
,i�' Y pp do bm yl au mmdo.. lefmwlimu
i aplre ld emnply nm all my am emnay drdiwru and au¢Moa Haling»
jU Wuamgammdamn.ani aWWmmyaampuu pmsautiac drm:a armada apmm
,.U m-m.aamda fddrc•Ir for intmaba m Pmpmu
G (wet aelu In sass.macvdnify and amp nalml[La d.My a CupeGnu agaiam
y WI iInct.)ubg .case am upuuct Iy id yatar agim said Gy
inwmwm t Fiamnal K
'-' APPLICA N N WITt All.Nf)N-POIyT sued by:%Vi� Date
SOURCE TIONS. O O
Re-roofs
Sgmlurt of ApplicaHAC RDm D
I .lb aNlOUSilding a, lau.lISVRE Type of Roof
witddapC.WuImum Wilding .clam 9,1 madd Id hawduuijSr.y
u seeks b'Ik Cupmnro Municial Code.O.pua 9.12 W dr Fido add Lfny
Cwd.knnm 35532(1)?
!]ym
N. All roofs shall be inspected prior to any roofing material being installed.
WlU me apMYam W swum building maupam las cyu,pmam m dcvi¢.a Wbidb If a roof is installed without first obtaining an inspection,l ao ee to remove
>Amnw am anmmmanu u lklndd by may a BAura MIDdaliy Manag aaM all new m s for inspecti n.
• I..
e10 We� f4
Maus cc
[un°u°N'nUm`mlmcdm Sd coWde>aSa»nluimsI ms 2a5d.i1
ardewry.dImuMOummpvnd iN9e5aedllbee haHfdon
.Y533lu,
IY [.Ile
m'i
/] Signature of Applicant Date
Wnp pr>dlliwlpcdapanl All roof coverings to be Class"B"or better
Community
Fli Commu Development 10300 Torre Avenue
6^^ Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building De artment
JOB ADDRESS: 20380 STEVENS CREEK BLVD PERMIT#
CUPERTINO, CA 95014 (�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:
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 Date