08060159 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTR.ACTQR INFORMATION,
PERMIT N0.
Bu1LgM7toT'Es PEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08060159
OW AME: PERMIT ISSUE DAIS
PROMETHEUS REAL ESTATE GROUP PO BOX 693 06/24/2008
NE:
SANITARY NO. CONTROL NO.
ARCHMICf/ENGINEER: BUILDING PERMIT INFO
WASHER & DRYR BLDG ELECT PLUMB MEC"
e O p LICENSED CONTRACTOR'S DECLARATION
r6 u I hereby affirm that I ern limnned mtder prorisube of Chapter 9(commencing ^^^ lob Description
Z with Sttuon71110)ofDivWon S offt Business and Profcssimu Code.and my license is
< in full tomo and effirm
j b License,Clans L ic.0
l;, Dau Contractor
FF ARCHITECTS DECLARATION
W U
ca
1 moorsond my plans shall lis used u public retards
Gt' Licensed Professional
3 OWNER-BUILDER DECLARATION
ai<� 1 bcreby affirm that 1 am exempt from the Conuan e's Liccnm Law for the
p O following won.(Section 7071.5,Business and professional Code:Any city or county
5 m which rtquiros a permit in cnnsnn,alar,imi mere,demNLsh,or repair any structure
Z„ prior m its issuance.aboutrequires de applicant for such permit to file a signed statement
< that he is licensed pursuant m the provisions of the Conmeam's Liaeau Law(Chapter 9 Sq.Ft. Floor Area Valuation
Y1- (commencing udth Smuan 70D0)of Division Sof the Busincssand Professions Cade)or
_ then im is exempt therefrom and the bub for the alleged exemption.Any viols dcom of
Section 7051.5 by any applicant for a Permit subjects the applicant to s civil penalty of APN Number Occupancy Type
not mart than ftw hundred dollar(g5=
❑1.0 owrcx of the properry.mmy wployw with mgesute'v sok canpewdon,
will do umwork.and the swcmm u omimeMed m mf(ered f..We(Sec.70".Business
and Profession;Cade:The Comnmbel Lisvtse law docs Irl apply m an owner or Required Inspections
property who builds our improves beton,and whodorasech work hirnselforthmugh his
own employee,provided thatsuch improvcmcnts are not intended oroDered for Sala IL
hvvever-the building or improvement is sold within one year o(compkuon.the ownv-
builder .will law the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as awrer of an,property am exclusively contracting with licensed ronsrxfers on
construct the project(Sec.7064.Business and Professions Code)The Conuacmes V-
cove law does not apply to an owner of property who builds or improves therms.and. ..
who contracts for such projects with a comrmmr(s)licensed pursuant m the contractors
License Law.
0 lamucmptunder See .B&PCforthismssmn
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby Niw under peWty of perjury one of me following declvatiow
I1%,mmd will munuin a Certificate of Cement m self-insure for Workets Cmnpen- –
cation,as provided for by Section 37W of the labor Code.for the performance of the
work for which this permit is issued.
0 I have and will maimum Workers Cempensasien Insurance,as required by Section
3700 often labor Code.for the performance cross work for which this permit is WW& '
My Workers Compeuatiob Inmrana carrier and Policy number are:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(hbsectum need not d:completed if lhC permit Is forcru hundred dollars($100)
or leu)
1 canifv that in the performance of the work for which this permit is issued.I shall not
employ any perwn in any meaner an as b beeves subject to the Wmkeri Compewuom
Lam a(California Dau
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should
become subject m the worker;Compensation previsions of the Lahr Code.you run
.J O foMwith comply with such provislnv or this permit shall he doemed rewkcd.
zd l; CONSTRUCTION LENDING AGENCY
I-+� Ihemhy afRnm that them is a construction lending agency for me performance of
C the work for which rob permit is issued(Sm.3097,Civ.C.)
�W A Lenders Name
Z) z lenders Address;
U O 1 certify Nat I haw mad this application and some that the sinew infovouon is
Is, cmrecL 1 agree m comply with all city and county ordinances and sue lam relating to
C) building consonance,and hemby authorise mpmsenuuves ofmhel city to cater upon ft
�'I,d above-menuaned.u.em for inspection which ms
LL (We)egme to saw,indemnify and keep homeless the City of Cupertino against
f/1 Iiabilitks erre of u.cmu and expenses which may in any my attroc against mid City
U vZ A APPLICANT
of rhe granting of this permit
^d APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature,of ApplicanUCom Dam Re-roofs
HAZARDOUS MATERIALSDISCLOSUREsham o SURE Type of Roof
Will du a Cupertino
no(alum dulling occupant came or handle h allovdmaterialS y
u defined io to Cupertino Municipal Code.Chapter 9.11.and the Health and safety
Code.cannon 235324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yv ❑No
Will the applicant or comm building occupant me equipment er dcvicm which If a roof is installed without first obtaining an inspection,I agree to remove
mit haraNnus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Dacia]
O Yes ONu
I haw mad the huaNeus materials requirements under Chapter 6.95 of the Califon,
nia Hctlth&Se<ly Codc.Sccuov25NT5.25533and25534.lundcrsonl Natifte building
dens ret currently haw a awn.that it is my rupbtability he notify to occupant of the
requiremcnta which most W met prior to imuame or a Certificam of Occupancy. Signature of Applicant Date
Owner ofeuthomedagent Dam' All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 8 ITEMS OF 40 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36901021 . 508
DATE ISSUED. . . . . . . : 06,/24/2008
RECEIPT # . . . . . . . . . : BS000005194
REFERENCE ID # . . . : 08060159
SITE ADDRESS . . . . . : 20350 STEVENS CREEK BLVD APT 5
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
•
ado
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORION@SUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 6/23/08
APT 508
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN #: 369-01-029/, 4'05 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.# : 238-0002445-07GyCarrier:STATE FUND Exp. Date: 4-1-2009
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card# :
Name on Card: Orion Financial Services Inc
Expiration Date: 01/10
Visa O MasterCard ❑ Discover ❑ American Express ■
•