08060162 BUILDING DIVISION PERMIT PERMIT N0.M
TEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08060162
OWNtt�AME: PERMIT ISSUE DAM
. PROMETHEUS REAL ESTATE GROUP PO BOX 693 06/24/2008
5PNE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
WASHER & DRYR BLDG ELECT PLUMB MECH
REiPRF Tips, it�cpeiiii&BEt
LICENSED CONTRACTOR'S DECLARATION
who I bacclary,alEma flod I.licensed tradurpoonsimacdChaptar9(commencing Job Description
in full fame and Cff=L
U..0.-Um.S
Dam.Comaimunar
ARCHITECIS DECLARATION
I understand my posts thall W cassed so Public mormal,
Located Paufasemoul
"Wi
Nz OWNER-BUILDER DECLARATION
I thereby affirld Oat I am commin facts me Cootractmeti License Law for the
EMC following ricauson.(Section 7(n 1.5,Business and Profession Coic:Any city or county
which requires a permit to enestact.Wall.Milan,damolide.or repair any sureacture
prior opt its issomea.mal,mcpaimat flociappilicaral for such Permit to filea signed sumennom
(bit he is licensed pursuant to the provisions;Of the Communes License,Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with section 70f)))of Division 3 of the Business and Profession Code)or
Oat he is Comandift Materials and the thadis for the alleged commotion.Any violation of
Section 7031.5 by any applicants Far,permit subjects the aptalicitaft to a civil penalty of APN Number Occupancy Type
non a.mom five handled dollars(S5O4
0 I."owner offtpmpmy.wmy=ploymwish wags mthekwiccmpeuadm,
wiIldoft"rk.andmesvuctumbwtinwn&doraffcrt forsale(sec.TB14,Busicon,
and Platfoask.Cods:The Camuwmre Lamm Law does no,apply W am comer of Required Inspections
prepacry who Wilds eximprows themen.tod whodaceswhwmkhimwfmthrough his
own employers,provided Oat each improvements are not intended arroffered for saft.11.
Inewaver,dm building or imprawaseart issold within am year o(compladess,the comm,
bottom will MOM On Modest of pravirt,Oat Ire did rem Wild or improve far purperm of
sale.).
0 1.as onsner of the imapen,mat exclusively contracting wits It...d cormommura to
commuct the project(Sec.7044,Business and Professions Cade:)The Contrassud'A Li.
comen,Law does not apply to an Manor of property who Wilds or improves,themon,and.
who contracts for such pmjccu with a concoachar(s)Iscxansiod Pentium in do Cordaticher's
LIM.Law.
0 1....Map,under So, _,B&P C for this anown
Owner Dam
WORKER'S COMPENSATION DECLARATION
I thereby affmat under Penalty of perjury am of the following limitations:
iI have and will commah..Cerifficame.&Cmamrt to seff-misom For Worker's Carolina-
mean,.seconded for by Section 37M Of the Ldmr Code,far the porforcom..[the
modc for which this permit is issued.
0 1 have and will maintain Worldo's Compensation Insammax,as required by Sudan
37W.1 the Lmor Conn.for We poolaromme,Of the wants far which this permit I.issued.
MY Worker's Ccoarramesticto Inam.caurricir and Policy lumber mc:
Cartier: Policy N.;
CERTIFICATE OFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nois section rad Out he completed if the Permit is Went,hundred dollars;($100)
or 1.)
I QCMfY Oat in the performance of On,work far which this Permit is issued.I she]not
cauffloy any prosom in any Muslim,an as to bacento subject in the Workers Computation
Law,of California Dam
Applicant
NOTICE TO APPLICANT.It,after midant this Certificade of Exemption.You should
became subject.the Wmlwr,Componsomfir.provisions of Me,Later Cuba,you roue
wJ O foodawtilt comply with such provisions or this Permit"I x cleared revoked.
z 0 CONSTRUCTION LENDING AGENCY
1 booday allion that them is a construction lending agency for the perfuranisca,or
ftwork for which Ods Permit I$issued(Sec.3097,Co,C)
Lender's Name
Z:) z Lasider'sAddress
J 0 1 reardlY Oat I have mad this application arrand sum MOM the move information is
II. P COMCL I agme,to comply with all city and courdly ordinances and sum Is"actaidag to
C U building comasnuedon,and hereby anthorce representatives of this city us conecar upon the
above-socandoned property for inspection purposes.
(We) jame 1.saw,indemnify and keep harmless the City at Caliendo. thad,
Ec,l liabilitica.judgments.crous ad expresses Which May in My way Value�MML and City
l)Z in comsequance of the granting of this Ismail.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:s Date
SOURCE REGULATIONS.
Sigrodure OfApplicauntAColumeor Dam Re-roofs
FIAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy or I'mum building Pat It.orbsoulla laucammus arimardal
as&flood by Use Cupertino Municipal Code.Chapter 9.12.mal ft Health and Safety
Code,Section 23532(it)?
[:1 Yen 0 NO All roofs shall be inspected prior to any roofing material being installed.
Will the applicam,or future building acculeall use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
4
it huandow aur cormationam;ad diciflemri by the Bay A.Ail Quality Manag-MCM all new materials for inspection.
Danict?
[3y. nNu
I have mol the heatalmansecrials requirement uredurchapoorti.95 ORImCalifor,
-is He.["SiduLyCode.Sets.25505.25533 wO125514.Itureloossac!thisaff0s,Wilding
does not currently haw a tonann,Oat it Is MY mormardbilitY Le Malty the=UWL Of the
Signature of Applicant Date
OnMel ormumirimd agent Dam All roof coverings to be Class'{."or better
CITY OF CUPERTINO
• 8 ITEMS OF 40 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901021 . 112
DATE ISSUED. . . . . . . : 06/24/2008
RECEIPT # . . . . . . . . . : BS000005194
REFERENCE ID # . . . : 08060162 '
SITE ADDRESS . . . . . : 20350 STEVENS CREEK BLVD APT 1
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
113SEISMICR VALUATION 3 , 900 . 00 0 . 50 0 . 00 0 . 50 0 . 00
IELECINSP HOUR 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
IEPERMITFE 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 ORIONOSUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 6/23/08
APT 112
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN# : 369-01-02(IL/• //,R 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
Workers Comp.# : 238-0002445-07 Carrier:STAT/E FUND Exp. Date: 4-11-2009
Cupertino Business License#: �9. & r7 f— a(/74 3
CREDIT CARD INFORMATION
Credit Card
Name on Card: Orion Financial Services Inu
Expiration Date: 01/10
Visa ❑ MasterCard ❑ Discover ❑ American Express ■
•