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BUILDING DIVISION PERMIT
BUITIMTES�.TEVENS CREEK BLVD APT
U 3
ORION FINANCIAL SERVICES
PERMIT NO.
08060085
OWNL AMUE:
PERM]TISUEDATE
PROMETHEUS REAL ESTATE GROUP
PO BOX 693
06/11/2008
NE:
SANITARY NO. CONTROL NO.
(916) 789-8484
ARCHIIECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACrOR'S DECLARATION
Chapmr
Job Description
p
I berchy trim Net 1 em Hemmed under provisions of 9 (commcncinp
with Scmlon 70M ofDividon 3 of the Bud. and Professkns Code. and my license t
WSHR&DRYR RTROFTS, KTCH&BTH CBNT&CNTRTP UPGRD; CTLS
in full
Lle.g
SPLTSYS, HVAC RTROFT
Dam Contractor
ARCHITECTS DECLARATION
1 urmdmsund my plans shall W ..it u ruhllc records
Liccnu0 Pmfcssionel
OWNER -BUILDER DECLARATION
I hcrthy aRrm Nat 11. exempt from the Cantons License taw for mW
Co
following roeoe. (Saute 7031.9. Emission; and Professions Cade: Any rimy or canny
which requires a premia o ronswn, alcor. improve, demolish. or repair any swcturt
'
prior ra its issuance.al.W requires dm applicants for Such permit In rile a Signed.Wlemcnl
he is licensed to the of Comustori Use= Law
Sq. Ft. Floor Area
Valuation
that pursuant revisions the (Chapm9
(commencing Section 7000) of Division 3 of Ne Business and Professions Cade) or
$ 3900
with
that he u exempt INaefrom and t m basis for the alleged exemption. Any violation of
yp Number
36901021 A
Occupancy Type
P Y YP
Sema. ?031.5 by any, applicant for a permit subjects the applkans to a civil penalty of
Mt come than five hundred dollars (gsO).
.'4
❑ L u awmr of elm property, m my wployva wild wages u Um'v sok campenuuon,
Required Inspections
will do rhe wook oil the ummure is not rounded or offered for aak(So,. 9044, Budness
Nd Pmfe{dam Cade: The ConUYmes t.KLM1X law dent but apply on N awMf of
q p
property who Wilds orimproves thereon, and whodoessuch work himself"nough his
awe employers, provided that such improvements art not immodest maQcrtd fmsam. 11,
however, the building or improvement t sold within one year of a mpkuom the owner -
builder will have the Wren of proving Nat he did mot build m improve fm purpo¢ of
sale.).
0 1, as owner of the property. w reclusively arrow Ging with licesucd conuaMrs b
construct Use project Sam. 7044. Business and Poksdons Code:) The C000actors U
came Law den eat apply m an owner of progeny who Wilds or impsuves Ummon, and,
who amwa x for such project with o cmamosegs) licensed pursuant m the Canosalors
License law.
❑ 1 sur eaempl under Sec , B & P C fm this reason
Owner Data
WORKER'S COMPENSATION DECL ARArION
10 1 hereby affirm under penalty of perjury, arc offt following declarations:
,
❑ I haverend will maintain s Cmufeme of Conaenl o sel6lmum far WarderSCompcn-
mi., u provided for by Section 3700 of the labor Cade, fm the perform. of the
work for which this permit is issuml.
0 1 hue and will maintain Workers Compensation Insurance, a3 acquired by stairs
37W cruse labor Code. for dm performance ofthe week for which Nu permit u Issued.
'
My Workers Compensation Insu.. carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(L7mu recur rce-0 not W comyleod flue permit t franc hundmddeBasRIO)
or las.)
1 cenfy, Nor in the perfomame of the work for which this permit t issued. I shall nm
employ any Nunn in any manner o u o become subject o the Worker' Compensation
Laws of Califemia. Dam
Applicant
NOTICE TO APPISCAN .. If, after making Nu Ccnifino of Exemption, you should
become subject o the Workers Compensation pmvisions of the labor Cods, you mum
comply with such pruviuona or this permit shall W dammed nvsked,
CONSTRUCTION LENDING AGENCY
1 herby alTom Nat Umrt to com radon lending agency, far the performanam of
iso work for, which tht permit is wood (Sec. 3097, Civ. C.)
Landers Name
"
Lenders Address
I unify that 1 have rtW this applicuimn and sae duras the above iefumution is
correct. 1 aprte o comply with all city and county indentures and sum laws raiding to
Wilding conmrucuon, and hereby oNariu represcnuuvra of Nu city in actor upon tam
.
HWve-mentioned progeny for inspection which
(We) agree to save, indaunry and keep harmless the City of Cupertino against
m
which may in any way eccrM againstslid City
in fdicroanandof this na
in cansryvence of the granting of Nt permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Dale
SOURCE REGULATIONS.
Re -roofs
Signature of AppliaRDao
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Willy Wildingp.,ttoem hand
Cupentno(uu
ich eallousmaorial
by the Cupertino Municipal Code. Garter 9.12, and Um HnIN and Safmy
u ds.
Se
cWe.semienzss32(.)?
❑Yes E] No
All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant ar fuwm building aceupam iso eyuipmenl or devians which
If a roof is installed without first obtaining inspection, I
g anns agree to remove
P
emir hvardnor air conuminanu as defined by that Bay Area Air Quality Management
all new materials for inspection.
Diulo?
C] Y. ❑No
I have mad the harvdcusmueruturequhemems underompler695 ofthe caliror-
maHealth @Safety Cods. Sections 25505, 25533 and 25534.1 undersand NatifUm Wilding
"
does Mi aumntly have a meant this it is my maramlbllltY an multi, the cartoon of Ne
mqulmments whim mem be met prior to Issuance of a Cenurcam of Occupancy.
Signature Of Applicant Date
, All roof coverings to be Class '%W' or better
Owner oraathmiaadacanl Dam"
CITY OF CUPERTINO
• 8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
•
•
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36901021.418
DATE ISSUED.......: 06/11/2008
RECEIPT #.........: BS000005083
REFERENCE ID # ...: 08060085
SITE ADDRESS .....: 20350 STEVENS CREEK BLVD APT 4
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
•
0
oko(o 00S15'
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
Re Address: 20350 STEVENS CREEK BLVD Date:3/4/08
APT 418
er's Name:PROMETHEUS REAL ESTATE GROUP
ie No.:(408)253-7100
#: 369-01-02 (.w p Project Valuation: $3900.00
Permit Information: Bldg. ■ Elec.■ Plumb.■ Mech.■
JOB DESCRIPTION
Washer and Dryer Retrofits; Kitchen and Bath cabinet and counter-
top upgrade. Ductless split system;HVAC Retrofit.
CONTRACTOR INFORMATION
Iy:UKIUN UtVtLUYMtN I Phone:(916) 789-8484
Name: STEVE WHITESIDES Fax:(916) 789-1051
State, and Zip: Roseville CA 95678
Contractors License: 747992 Exp. Date:9-30-2009
Comp.# : 238-0002445-0(7�Carrier:STATE FUND Exp. Date: 4-1-2009
Business License #: / V S te % - a
CREDIT CARD INFORMATION
Card It
on Card: Orion Financial Services lnc.
Expiration Date: 01/10
❑ MasterCard ❑ Discover ❑ American Express ■
A
NAME:
I ler[by affirm Nal I. tic-tKd uoner pmvidou of OKpva 9 (cmommcn,
with$e11m17M)) N Dwi.idn 3 Nd., BN .find PuAreddR C< and my H. i,
m full lona cf "
Li[xn.e cls..andB �, 7.47992
mu Cm.DEa
ARL I out
OF1]-ARATION
ono -Dant m
I any Plam,ndl k uK4 u Pum -moth
OWNER-BUIIDER DEL Iw nON
I Fxrxny a?rm Nal I am [itmpl fNm no con.w. EIDDD,D Lw, fm ft
fanii rusnn. (SubcAn 7121.5. 8uxiau[ and Inofminm Cndc: An, ety v [Autoy
vnicA rcymru a Pvmn ua [muvuy alto, imworc dontaids. m 2ryv'r xny ymcLut
pnm
... D uancc. alsormuir- the a v^idam for DKA prmit b me • ri'dul D,tmlml
Iha1 dx it nanxxJ Pururam m AN: pm of NI: ConnI,Wa lic,ns Uw (Clupb9
Icmnmaern,
..In S Ion 7002)N13iem. J a Ibc Burnes and PtdfrmmD Cock)m
Nal k .i ,r -.w NKmfmra Dd 14 huu for Nx alkicd'.—pum. •An)' riplatim a
SIon. 7031.5 by any applies fm, pemns il wbjcIII applitsnl W a IiW pm,hy N
.. o.. Nan fiw, huMmd dour, fL51D).
I. v nwm. M d.e propcny, m my unploy-a with wa,e u Wcu idle®petvlipy
esti do Nx'D" Cti I: xvunurtDrotiUun dr Awd fes I *MAid BIm,[ta
an0 Pmles�.. L'odc: Tl.c Conlr>am's Lie^ -Lar doe mI apply K u dvrrc a
prowny wnD dribs w Imwors Ifcmn, and who doe[rvm wrk himzeVmlNmt,ll AK
own rmploYru. PrD..dcd Inal,.rcn imProvcmcnu m<mt in.... -v maR-rd fmal� 1{
how r,illIwi Winiwd-ofImeNitmb withinot yurofidADnirwIypave-
Wildcr will Irarc Nc durdu of pmrini Nal IK did not driW m implw[ fes pmppK of
FUNIN
❑ 1. At oi Al Nc porion', At. ecluirrcly unn"vinL with li 1 mnuaem, rn
spa IM Pmjet (Scc. 7(44, Bu'..-.. ub Naas i. Codc)Tm Ctodmepl, 14.
ri.[faw dor:..w Apply r.. m.,ry or pmpin,,.nn mllm r u Awov Nxmre and.
Liu-
0
iu [ommcu In srKA wdy,^• wiN> eonuwodx) liw.ed pumuLd b Nc Cdopa-oY,
Li-^."
0 1 un -cmm undo 5-. . B k P C fm IAi, m1fCo
Owrl[r D.
WORKEIIS COMPENSATION DEC ON
I busby affirm undo I-ILI of lit oI a RI followvl, Gllantium.c
andll mnum a C-Jf ofComam
malt.irDurcforwmbmn
',Cpal-
mss .+ m
Ino"Ited for by Scrum 57W of dK tabor Cmc for dK p-fono. a Ibe
ort fm rd[n DI Ivmi1 u lssucd.
•D 1 mvt aM will maintain Warkfh CImp IAL lnyddd , u rtgpbn� by $•Nm
�37MWW, tabor Coo, for um '-loan. ortlIior� lm wM,A Nu pemh ul d
My wmti�rTAE ItoF Dun.
nmrraM Poliry numbm,...
cam-: PDIiry,238-0002445-07
CERTIFICATE OF EXEMPnON FROM WORKERS
j COMPENSATION INSURANCE
ffhux¢t.m.ad row M conArkA:d if IY re nn u For _hundrttl dating MILIM
m l[ix1
I unify DIX In tM mrlemua¢ a I work fm whicb Iles , -mil u moe61 Idol,, odd
rmplq>n, lK.nm any manrcr on u m h DAI..bjln b 11CWWkIrVCmnNleyon
laws of C>lifornra. O.K
AgJio
NOTICE TO APPUCANr: If. ALL. matin, Nix culiftole a U.pYom yon IdmuW
Eu'mr..ubjcs..d the wort-'. C.nitonvum pwitlon. W RK "W Cock lou mond
� Z fr n),Ai cnmwy wrth such .,W. a Nis Rlmit.ha11 I d¢med o ntt
�� CONSTRUCTION [FENDING .AGENCY
-N herunY aRum Nal Nucson.
c,nAI. kndin, a,olcy fm IIIc III. a
IM .>ax I- -hreh In. Dunn Is rincd IS S . Cn. C.) .
— Q IFndch N>mc ..._
=z
I. A, Adrlr-[
Q Rnily W I Ilavc r[ad Ni. applipno t Aird NL NC ah]K In gni 1,
mTIM I1[ID[amply rrN all Dly and CWndr mdi,,A tind WK hwi NaYnL IO
�V Wildinmrne
mo..on.>nowi ainh.,. mPrusenwi.e a Nu AD, Idiom Ne l
U alto-[- ...rens rmmerly fm imr ItA.. puspldi 1/\
(Wc).rims Inn u and -ruin, and Itup hvmlu; Brc city N Cupatind niddd
y hahirbn.lr.a ,'/^Ufyry�lK�Ap6alrvAand.w•._. to An y,emK ayiml sad aq
mcnreK9ucoE{f/.+nnare\vin/..rc,J,DA, '
•-r wPN.ICn NO N 3 wA31 NSMI-PO14tT Asued by:
I HAZARDOUS MAT IAIS DISCLOSURE
Will Inc applxwll or lot= Wilding [-¢Want mrt mdMl, haurdmK mauial
u d,filed by Ile Cuwnr. MUD¢Iri>I Com, wP[w 9.12 and We HuIN alb Wny
Cmc. Scar. 3553�a1'
C)yu rj1 Nu
will m[ apw¢anl w Idum Wilding u,.A uK c9inpmeu m Alini Mich
aaa.onu. rr cnmammanu An J,Gncd ny Nc Bay Nu Air NAily Mmtipdmmd
pr- �NND
• ... Iha.c r[d naramrrxItrcyurrcmvl[[undcrOKP.E9SofWcCa4fm-
,it H -TNR Sd Code S -v[ IMS", .7533an 5554.1 mmsulW lha lfYe Mrildini
Ne. rot [ IY "> I -r> CNa r my "ry m MY(5• Ire l Ih
moonl-. wn' lP Cadfum (''`KD_all
wnm YI aeNml>md sari
Re -roofs
Type of Roof
UM
Pt]o6lr 6ytlEDwTE
Job Description
UCOupancy
Required Inspections
0
Dam (a —/ Q - o
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without fust obtaining an inspection, I ao ee to remove
all new matevials for ins=tion.
of Applicant Date
All roof coverings to be Class 'B•• or better
I _
CITY OF
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: 20380 STEVENS CREEK BLVD
CUPERTINO, CA 95014
PERMTT#
0, (' (� Do��
OWNERS NA vM:PROMETHEUS REAL ESTATE GROUP
PHONE #(916) 789-8484
GENERAL CONTRACTOR --STEVE WHITESIDES
FAX #(91 6) 789-1 051
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information:
69 /10 d
ate
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
69 /10 d
ate