08060160 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAC_T�OR IiVI`�ORMAT-10 ,`
BUILy Iq ryADDpRESs: PERMal NO.
I,US.7S STEVENS CREEK BLVD APT -ORION FINANCIAL SERVICES 08060160
OW 5 AME: PERMIT ISSUE OATS
PROMETHEUS REAL ESTATE GROUP PO BOX 693 06/24/2008
NE:
SANITARY NO. CONTROL NO.
ARCxITECl/ENGINEER:
BUILDING PERMIT INFO
WASHER & DRYR BLDG e1Fcr PLUMB MEcx
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION ' JbDescriP[ion
Vz I hm Wo
emby afr t 1 are loomed under Proo
vista s of Chapter 9(mmmoming ^^^
n< with Section 7")of Division 3 of doe Business and Pmaksolons Code.md my licence is
s In full force and effxt
p Z Liemsc Class L4.Ja
^p Dao Contractor
tq-7W ARCNfrECI'S DECLARATION
WU 1 undersand any plans shall c used ss public records
C Licensed Professional
S OWNER-BUILDER DECLARATION
I I barony aRnm Nm 1 am exempt from the Contractose Law far the
p O following maron.(Section 7831.5,Business and Prorwomes Code:Any city at county
C
9 which requires a permit to contlrvcl alter.improve,demolish,or repair my structure
= an prior at im issuance.also requiw the applicant forsuch permit to file a signed statement
'x< thu baa licensed purauml to me provisions of Lite contractor's Liana Law(Chapter 9 Sq.Ft.Floor Area Valuation
'Ha (commencing with Section 7000)ofDivusian 3 of the Business and Pmfraions Code)or -
e g— Nat he is eaempt therefrom and the loris for the alleged eamption Any violmam of
Section 703"by any applicant far a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not Mort dun five hundred dollars(5300). P Y YP
i,u awns of tha properly,re mY of intendedwith wage n Ness ale compensation,
will Pr the work,and e-The Co e ra not intendede Law cid fs act a(Sec.7040,Business
and anywsam Cade:Th Caiaboams ndwho Law sacs ret apply lf an ower of Required Inspections
propertywhobuiproorireprow thereon,andwho doessuch marded
or.ffar through his
ownemploy.;provided p.impmvemmis. not inteededmoffered for ow e.
howeveWilder sheave that oimpmvemmtusoldwithinam Xan of mmove faron.thepose of
builder will have Ibe butdm of provin8 Ns he did not dtilo or improve for purpose of
a4.). '
1,as owner of the property,am aelusimlY wa using with li...d contractor to
.moon time project(See.7044.Business and Praftled ns Cade:)The Cootrameas(;-
came Law docs not apply a an owner of property who builds or improv themon,and.
who conbaca far molt projects with amnuactm(s)licensed pursuant to the Contractors
Licence Law.
❑Iamexemptunder Sea ,Bk PCfmlhiamaan
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hemby alrmm under penalty of pe0ury aro of dre fallowing declaudom:
1 haw and will Malawi.a Certificate of Coment to alt-insum for Workers Comport.
ation,as provided for by section 3700 of the labor Cade.for the performance of the
work for which thus permit is issued.
❑1 have and will maintain Workers Compensation Imurmce,a molested by Section
3700 of the Labor Code.for to performance of the wort for which this permit is isad.
My Workers Compenatian Insuanec carrier and Policy number aha:
Carrie Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thiauction need manecomplamd if the permit Bfuronc hundred dallas(5100)
or leu)
I cmtify dot in the perfomaue of the work for which this Permit is iv tied,I shall not
employ any person in any Mannar an as to become subject to the Workcn'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL vPer making this Certificate of Eacmpfion,you should
become subject to the Workers Compensation provisions of the labs Code.You most
.J O forthwith comply with such provisions or this permit afoul W dcemod corked.
'Z,.n'pn CONSTRUCTION LENDING AGENCY
[r I hereby affirm that them isoc..fian kadingagenc,far the performance of
C > the work for which thus pemdt a Issued(Sec.3097,Civ.C.)
44 Lattice,Landers Meme
.7. z Lenders Address
U Q 1 certify Nu I haw read this application aha mace that the above information is
U. P correct.l agree to comply with all city and.ant,oNimaces sed are Ian relating at
0 U building construction,and hereby amborire representative of this city to enter upon the
4 ahove-m jud,humed Prop aryest for impomion pugncea
(We)agree to save,indemnify and keep homeless the City of Cupertino against
F Z incoifim,jWgmenhecasumd expenw which may in any wyaamc against said City
Uz AcPLIC NT of the RSTAgraunfingof this pmrnil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: - Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Shgnatme of ApplimR OUtor DateHAZARDOUS MATEft1ALS DISCLOSURE Type of Roof
Will the applicantorInure building occupant sore or handle Health
Material
u deflactiSac io do 32(a)?m Municipal Code,Chapter 9.12,and the Hulth and Safety
Code,Section 25512(a)?
❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupantLice Nuipomm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it h.,N m w em uninms u defined by the Bay Area Air Quality Mmagcmcnt all new materials for inspection.
Oiauicl7
Oyes 0N
I haw mad the harsrdausnuwH.0 requirements under Chapeo 6.95 of the Califor.
nia Health h Safety Code,Sections 25505.25533 and 25534.1 understand that if ft building
dues ret currently have a.oral,dw it is my mspomihilihy to notify the accupe t of the
requirements which rue bC met prior to issuance of a Cadfmaw of Occupancy.
Signature of Applicant Date
Owner ar mthmacd agent Daw 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 I . . . . . . . : 36901021 . 514
DATE ISSUED. . . . . . . : 06/24/2008
RECEIPT # . . . . . . . . . : BS000005194
REFERENCE ID # . . . : 08060160
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
IMECHINSP HOUR 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
IMPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
IPLMBINSP 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(c SUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 6/23/08
APT 514
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN # : 369-01-026( , 5 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.# : 238-0002445-077yyCarrier:S/TATE FUND Exp. Date: 4-1-2009
Cupertino Business License#: 7� �0 7
CREDIT CARD INFORMATION
Credit Card#
Name on Card: Orion Financial Services Inc.
Expiration Date: 01/10
Visa ❑ MasterCard ❑ Discover ❑ American Express ■
•