08080225 CITY OF CUPERTINO >r
BUILDING DIVISION PERMIT O igT12A TQR3I1 Ia't?I,tMA' C) ` '"
BUILDIytG PQ - PERMIT NO.
%.�.»�ES 'ITRVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08080225
OWNER'S AME: PERMIT ISSUE DATE
I1ROMETH1?US REAL ESTATE GROUP PO BOX .693 08/28/2008
lip NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INTO
WASHER & DRYR BLDG ELECT PLUMB MECH
0 0 0 0
3
8z LICENSED CONTRACTOR'S DECLARATION r
�d I hereby aflkm met I am licensed niter provisions or chapter 9(commercial, _ -- lob Description
with Section 70M)ofDivision 3 of IM Business and Professions Code.and my licemcB
^ in full form and effect.
,nZ Lkenm Class Lie.is
g Dow.Conuwmr
iARCHITECTS DECLARATION
1 undetmnd my plans Mhe all used as public records
6
SC Licensed Professional
7N OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from On Contractors Liewm Law for the
CAO following mason.(Section 71131.5.Business and Professions Cade:Any city or county
$9 much requires a Fmmit m construe,ailu,improve,dcmolmh,or mpoir any structure
iy prior to its issuance.also requires the applicant for such permit m rite asignad statement
y�< that he is llcenmd pumuant to um provisions ofwc contractors License Law(ChaNar9 Sq.Ft.Floor Area Valuation
t2 (commencing with Section 70M)ofDivision 3 ofthe Business and Profusions Cade)or
a Nat he is exempt mamfrmn and the bash for the alleged smarties.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom then fin hundred dollen(550 y. P Y YP
❑Luownmoftliepmpeny.mmyemployeaswlthwguutheirmleeompemdon,
will do the work,and the suumum is netimended"offered far We(Sm.7044,Business Required Inspections
and Prafessiona Calc The Contractors License es Law donot apply bean owner of 9 P
property who builds or improves thereon.and who does such work himself m through his
awn employces,provided that such improvements art nothmended oroRered forsate IL
however,the huileing or improvement is sold within mm year of completion.the awner-
bullder will brave,dm human of proving Nu he did not Wild or improve for putpom of
ale.).
❑1.as owner of the property.am exclusively connecting with licensed convecmn as
constmct the project(Sec.7044.Business and Professions Code:)The Cwtrwmr's Li-
man law does not apply to an owner of property who builds or improm momor,and
who camncm for such projects with a conummr(s)licensed punuant m dm Contractors
License Law.
❑I an,exempt under See ,B&PC for Ws mown
Owner Da¢
WORKER'S COMPENSATION DECLARATION
I hereby afffrmunder penalty of perjury one of the following ds it om
I ham and will maintain a comillmw of comm to x117-Insure for workers Commit.
salian,u provided far by Section 3700 of the Inbar Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Competition Insurance,u required by Section
3700 of the labor Cade,for the performance of the wort for which was permit is Issued. '
My Workers Compensation man mar ca,exmer and Policy number am:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This woman need antic completed if the Perish is far ora hundred dollars(SIM)
or ken)
I certify that in the peau..a.of the wart for which this permit is issued,I Nell not
employ any penan in my manner=u in became subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL after making this Certiffem of Exemption,you shouki
become subject in the Workers Competition provisions of Ne Lobar Cade.You must
O forthwith comply with each mo wh m or Nu permit shall be dimmedvok
reed.
,Z, CONSTRUCTION LENDING AGENCY
Ihemu affirm that Nem is a construction kMin e
F Y g gamy for the performance of
!Yi the work fur which this permit u issued(Sec.NMI,Clv,C)
Q Leaders Name
ervine.
Lettdera '
�z Adaroas
U Q I mistily that 1 haw read that application aM mw that the shave information is
w E cmrect.I agree to comply with all city and county andmances and ahem laws minting to
Q k�'J! building construction.and hereby author=representatives of this city in enwr upon the
above-Mummund property for inspection purposes.
(We)agree to...indemnify and keep Iteration the City of Cupertino against
fq Iiabiliausjudgmma,cam and expenses which may In my way accrue Midmisaid City
t.)Z in coasegwnee of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signuum of ApplicasUConRDOr Dam
HAZARDOUS MATERIALS DISCLOSURE - Type Of ROOF
Will me pikers norun=Muni building ocoupant ewrc m handle Hardom mawriil
as de.Sec by the Cupertino Municipal Code,Chapwr 9.12.and the Health and Safety
Cat,Section 25531(e)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or Now building occupant nue equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haurdnu air contaminants u dc0ncd by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yu No
I have mad the ha ummum..data mquimmenu under Carter 6.95 of the Califor.
rtes HexiN&Safety Cade,Sam.26505,25533 and 25534.1 undc rand ft dune building
Jou net cmmntly haw a knew,that It u MY mryonrhilitY m notify the occupant of the
roquiwments which Must WMet Our toiaauwmof.Contrition ofOccupancy. Signature of Applicant Date
Ownerorautharineda,.( DewAll roof coverings to be Class'A:a'or better
CITY OF CUPERTINO
• 8 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp; Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901021 . 515
DATE ISSUED. . . . . . . : 08/28/2008
RECEIPT #. . . . . . . . . : BS000005929
REFERENCE ID # . . . : 08080225
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 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
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
I.MPERMITFE FLAT' RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
I.PLMBINSP HOURS 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVD0C 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 1, 592 . 40 AMEX
---------------
TOTAL RECEIPT 1, 592 . 40
•
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORION(O)SUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 8/27/08
APT 515
Owners Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN # : 369-01-02 + +J j Project Valuation: $3900.00
Blg. Permit Information: Bldg. ■ Elec.■ Plumb.■ Mach.■
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 Carrler:STATE FUND Exp. Date: 4-1-2009
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card#
Name on Card: Orion Financial Services Inc
Expiration Date: 01/12
Visa 0 MasterCard 0 Discover 0 American Express 0