08060163 CITY OF CUPERTINO �xsur. ,
BUILDING DIVISION PERMIT CONTRACTOR INFQRMATION a
lx>,�iv",:,,^;•x}'.. 5a:"%w
BUIL INS ADDRESS: PERMIT NO.
,0 50 STEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08060163
OW AME: PERMIT ISSUE DATE
PROMETHEUS REAL ESTATE GROUP PO BOX 693 06/24/2008
NE: SANITARY NO. CONTROL NO.
ARCHTIEC(ENGINEER: BUILDING PERMIT INFO
WSHR&DRYR RTROFTS;KTCHN&BTH BLDG ELECT PLUMB MECH
4Cp LICENSED CONTRACTOR'S DECLARATION ,- ICIhIIe$Crl nOn
4U I Manby affirm that l am[amused under provisions of Chapter 9(eommencing '"-''-^^ "^'-'- "-'-"' "-- P
ZW with scenic.70f1B)af Division 3 ofthe Busa.and Prefessiore Code,and my license is
<s in full force and enecc
License Ons Lee.If
n F c Dale Contrumr -
q ARCHITECTS DECLARATION
WU 1 uMmuand my plans shall be used u Public records
gC Licensed Professional
5 OWNER-BUILDER DECLARATION
s�i f I Msehy affirm Nat 1 am nempn from the Cmuanors U"..Law for Ne
O o following on.(Section 71131.5,Business and Pmfcsd.m Codc:Any city or county
K$0! which requires a Permit to com ucL cher,improve,demolub,or mhur try swctum
°zY prior to its issuance.alm requires tcapplicant for such permit to Ole a signed stammers
< Nat he is licensed pursuant to the provisions of On Contractors UCC=Law h0upler 9 Sq.Ft.Floor Area Valuation
x�$ (commencing with Section 700(1)ofDivision 3ofineBusiness ondPrufeuionaCadc)or
^ that ha Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects she applicant to a civil penalty of APN Number Occupancy Type
nm more than five hundred dollen(UM). P Y YP
0 I,u swans of tit property,m my employees with wages u their sok campenudon.
anal Pr thework and the he Comuantksended Law Oufo sok(pec.s Ofd,Buser of
and Professions
who W Cade:The Cantrador',ammo Law does rot apply to an her or Required Inspections
property who .provided Oat such
who are not
oroffonr Woughh.
own employ=.Provided Nen such improvements art tat arofintended car,Reed for ale owner-
builder
the Wildingmimprovemang seto withine, yearofcomemefortheowner-
builder wiB have do burden of proving than he did rot Wild or imOrwe for purpose of
0 L u owner.(tie property am acluively contracting with liceued mnuacton to
murmer On Project(Sec.7064.Business and Pm(asiom Code:)The Contractors U.
cove Law does not apply m an owner of pmpeny who Wilds or improves t em.n.and
who contracts for such projects wish a contractods)licerued pursuant to she Contractors
Lice.taw.
O l am exempt under See .B At PC for this msson
Owner Date-
WORKERS
aeWORKERS COMPENSATION DECLARATION
I hereby afftm under Penalty of perjury one of the following declmadons:
1 haw and will maintain a Certifaae of Consent to self-iesum for Worriers Compen.
sation,a provided for by Seecon 3700 of the War Cade,for the Performance of the
wok for which this permit is wood.
O 1 base and will maintain W.,l efs Compensation Inas...,as be Rued by Secomn
3700.f she iaMr Genic.for the performance of the wort for which Nis permit is issued.
My Wohers Campensmon bs..artier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not M completed if the permit is foam hundred dollars($I00)
or less.)
I mortify Nat in the Performance of On,work for which this Permit is issued.I shall not
employ any Person in any reamerm as b become subject no the Workers'Compensation
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:If,after making this Cori fee,of Esempti.n,you should
become subject m the Workers Compensation previsions of the Labor Codc,you most
.J O forthwith comply with such provisions o Nu permit shall W themed m
uted.
z r CONSTRUCTION LENDING AGENCY
r I hereby affirm Nat there its construction lendingfor Nc Performance of
C4 Ne wort,for which Nu .agency
D7 lenders Name
Permit u usual(Sec.1097,Cir.C.)
V O 1 Certify shat 1 have read Jus apphcuio.and sue this the show infom,tiun is
w f eollem 139=in comply with at]city and cowry ondRo mtl and scale law]RINng to
.�V^ Wilding conation.and hereby setW ire rtprvenutives of Nixity m cntmup 11 On
CL7 aWwtim jOinedproperty for inspection purp=which- l
t•,t LL (We)agree to save.indemnify and trop harmhss tie City of Cupertino against ,
Iiaconseq judgmenhecoauand of thisesmit. may In my way aa7m against said City
Uz in comequcnce of the dnnnin6 of Nu permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicanUConuactor pee
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or to,=Wilding ompatuore or handle hemdoa motorial
u de0ncd by the Cupertino Municipal Cade.Chapter 9.13.and On Health and Safety
Code.Section 25532(x)7
ecYes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or forum Wilding occupant use equipmcm car devices which If a roof is installed without first obtaining an inspection,I agree to remove
Di it ho7�ous air contaminants u dcfimd by the Bay Area Air Quality Management all new materials for inspection.
❑Yes ❑Nu
1 have mal One huakous malerials roquiremenu under chapter 6.95 of she Califs
niaHWsh&SofciyCodc.Srodorts25505.25533a n53.l�Naifdc Wilding
docs not currently host a moans Nat it is my ro hnnumbitiry to unify On occupant of the
requirements which mus,W met prior us iso.of a CvriOcam of Occupancy.
Signature of Applicant Date
Owncr or aulhorimd agent Dam All roof coverings to be Class'nQ 'or better
CITY OF CUPERTINO
• 8 ITEMS OF 40 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901021 . 204
DATE ISSUED. . . . . . . : 06/24/2008
RECEIPT # . . . . . . . . . : BS000005194
REFERENCE ID # . . . : 08060163
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
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
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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 2, 654 . 00 AMEX
-------------
TOTAL RECEIPT 2, 654 . 00
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORIONnSUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 6/23/08
APT 204
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-02ff I. 2D4 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.#: 238-0002445-07 Carriier:S`T/ATE FUND Exp. Date:4-1-2009
Cupertino Business License#: a95 0 '7 ��/��� 414- 2 y7�3
CREDIT CARD INFORMATION
Credit Card#
Name on Card: Orion Financial Services Inc
Expiration Date: 01/10
Visa 0 MasterCard 0 Discover. 0 American Express ■