08080223 CITY OF CUPERTINO
BU74DING DIV, PERMIT COk R"xxotTNm,UI,t1�'1t1�ION. ,
' id,a.-,... .
BUILDING ADDRESS: PaRMIT N0.
20350 S'I'EVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08080223
OWNER'S PERMIT ISSUE DATE
V:MMI-:THEUS REAL ESTATE GROUP PO BOX 693 08/28/2008
NE SANTrARY NO. CONTROL NO.
ARCHITECLIENGINEER: BUILDING PERMITINFO
WSHR&DRYR BLDG e1Fel' PLUMB MECH
0 0 0 0
3
8z LICENSED CONTRACTORS DECLARATION r
fi Ihereby afferent hat 1mIiceaeNunder previsionsofChapter 9(commencing ^--^^ ^^^ O Description
with Section7IX )of DivWon3ofthe Buzinevand Professions Code,antlmylicenseb
in full force and effect
:oz Licenm Class Ue.g
Dam contrenur
ARCHITECTS DECLARATION
I understand my plana Nall W omit as public records
k� Licensed Pm(essimud
OWNER-BUILDER DECLARATION
i hereby aRrm that 1 am exempt from 1W Convenors License law for the
O o following ansa.(Sadao 7031.5.Business and Professions Codc:Any city or county
$� which repuires a permitm construct,alter,impmw,demolish,or repair any stratum
Zi prism its issuance.alsorequima the applicant furmch pernitm file asignedstamment
met he is licensed Pursuant to the provisions of the Contmtoi License Law(Chapter 9 Sq.Ft.Floor Area Valuation
$ (commencing with Section 7000)of Division 3 of the Business and!Professions Coek)or
e3 that W u exempt therefrom and the basis for the alleged exemption.Any vloladon of
Section 703 1.5 by any applicant nor a permit subjects ren applicant to a coil Penalty of APN Number Occupancy e
ret mare than five hundred dollars ISMP Y�yP
0 1,u owrws of the pmp wy,a my mployem withverge u ftk mlecampemdon,
wIRdOdrewark,andmeswnumurwtinundedooffercd(unarm(Sm.7014,Bu must
and Protea ens Cane The Continence.Lt.Law dee ret apply m an onmor of Required Inspections
prop oy who Wilds wimmonviesthereon,and who daonauch wok himselfommugh his
over,mPloyoe,provided that such improvements tie net intended unaffected for sale If,
however,the building or Improvement is sold within arc year of completion.the Owner-
builder ,will haw the Mmden of paring drat he did ret build or improve for purpose or
sI..).
0 1.as owner of the popaty,m exclusively ccotnning wire licensed contractors be
cormtmt dre project(Sec.7044,Business and Pro evdans Cade:)The Contrmmrs U-
.Law dao not apply to an owner of p Open who Wilds or improves thermos.antl,
whmccotrmts for such pajecu witha contnmor(a)Iicenmd parsons to tiro Convinces
License law.
0lm ompt uncia See ,B&PCforthtarocon
0. Dart
WORKERS COMPENSATION DFLIARAM
1 OuebY alfim under pensiry of perjury arc Of the follOwin{dalentians:
I have and will maintain aCeuftate of consent in mil-inmm(or WorkeraConp7t-
s1ico,as pmvulml for by Section 7700 of the labor Code,for dui performance of the
wart for which Na permit u named.
0 1 have and will maintain Waftes Compensation Insurance,as required by Section
3700 a the lobo Cade,for ted arfomanco Ofine work for which rets preen is Issued. '
My Worker's Comp:nsatico Insoance artier and Policy number am:
Carrier: Policy N.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Crhu satin send nonhccmnpleted lithe permit Is foo.huntheddollen($100)
or leu)
1 cenify mat in the performance of the wart for which this permit Is Waited.l shall not
employ any person in my mammrm as to become subject to theworkaY Compensation
Laws of Califomis.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Famption,you should
becsne subject m Uro Wodrers Compensation pmritions of the laho Code,you mum
.J Z farbwith comply with gait provisions o mu pemit shall W domed revoked.
z O CONSTRUCTION LENDING AGENCY
.�.a Ihemb aRnm NU Nen u a construction lendingagency> me work for which min m ler 1W performance ar
path le bussed tsa.X197,civ.c)
Lcode's .
Z) z I<weraAd"Add=
U O I certify that I Mw read this applicaion and suite the the show itdorreadco is
ML^ cmmct.1 a{ree m comply with all City and cmmty Ordinanw and sum laws reluing to
�0 rV' Wilding construction.and hereby authoda representatives of this city to cola upon me
above-mauaned property for inspection purposes.
(We)ago to saw,indemnify and keep harmless ted City of Cupertino against
rn Itabilides,jodgmenu,cots and expenses which may to any way oma against aid City
U Z In catuequurre of ted granting of this pTmtL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
SitSig..of AppliaRue
D '
xnznRDOUDDus MA7ERIAL9 occupant
'Type of Roof
Y�n ft a Cupid a man Wal i o .Chmare a hmdm h.�eaaa mamrid
a de.sec o me eupenia Municipal Cade.Chapter 9.13,and the Heldr and S+fcry
Code.9mmn zsslz(.)± All roofs shall be inspected prior to any roofing material being installed.
Will me applicant un future building Occupant um equipment or dcacea which If a roof is installed without first obtaining an inspection,I agree to remove
I ❑Yo ❑No t hsaalloua air contminsou a defied by the Bay Area Air Q IBLY Managmcnt all new materials for inspection.
Dim ct7
Dye ONO
I have mad me heratdoua materialrtquiremenuumderCbapGQ93 of the Csiifor-
ma HealN&Safety Code.Sadan 35505,25533 am135534.1 unMmand thmifthe building
dm ret currently hew a tensnL the it u my teporembility in testify da rampant of the
mquiremennwhich in=he=tpa m uuamcoracmtillcateoroccopanry. Signature of Applicant Date
Owner or sutWrbcd agent Date All roof coverings to be Class rna,or better
CITY OF CUPERTINO
. 8 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN 36901021 . 306
DATE ISSUED. . . . . . . : 08/28/2008
RECEIPT # . . . . . . . . . : BS000005929
REFERENCE ID # . . . : 08080223
SITE ADDRESS . . . . . : 20350 STEVENS CREEK BLVD APT 3
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 FINC'L SVCS
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
IELECINSP HOUR 1 . 00 122 . 38 0 . 00 122 . 38
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
7.MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
].PL,MBINSP HOURS 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
7.TRAVDOC 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 G v
• E-Mail ORION(U)SUREWEST NET O 0
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 8/27/08
APT 306
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-02 � O Project Valuation: $3900.00
Big. 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 Carprier:STATE FUND Exp. Date: 4-1-2009
Cupertino Business License#: /J510
CREDIT CARD INFORMATION
Credit Card# :
Name on Card: Orion Financial Services Inc.
Expiration Date: 01/12
Visa ❑ MasterCard ❑ Discover ❑ American Express ■
•