08080226 CITY_'Ty OFCU
PERMIT "CTOW';
BUILDING Divrsiom
BUILQi �TD!l ss� PERMrrNO.
STEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08080226
Z WM
S AME: PERMIT ISSUE DA
)ROMHTHEUS REAL ESTATE GROUP PO BOX 693 08/28/2008
Sq IFNE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
WASHER & DRYR PLO
LMECH
LICENSED CONTRACTOWS DECLARATION lob 0ilc;nptlon
I hereby adarm that I.licensed under provisions of Chapter 9(commencing
with Section 7000)of1livision Sof the Business and profession,Code,And my license is
in full force and effect.
z License Class Lk.
CC DAM.Comrsumir
ARCHIMECT'S DECLARATION
gig I understand my pins shall lac and AS public record,
Licensed Professionalss OWNER-BUILDER DECLARATION
NI I hereby M.that IEm Marept room the Conaramun's License Law for the
a following reasson.scinion 7031.5.Business Add Prolculons Code:Any city or county
132 which requires. manni 1.construct,sm,improve.&..]Lh..repair my summmue,
t2 prior 0 its issuance.&Im required;the applicant fare permit tLeese agned SWCOMM
that he is licensed pusamant to que provisions of the Continuum's icLaw(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Sadon 7000)of Division 3 of ft Business and Professions Code)or
the,he is ens thomform and the basis for tho Alleged exannopman.My violation or
Scefics.7031.5 by A"Applicant far a permit Subjects Re Applicant in.civil penalty Of --;TN-Number Occupancy Type
nuisance Man five hundred dollars(M),
0 1.As owner of the property.or my employees with wages As their sola comptonflea,
willds ftworLandmasncume Istuntimendedoraffeed foraske(Sec.7044.Busies,
And Prefessi...Code The Contemor's Licence Law does An,apply in A.Owner of Required Inspections
pope soy who Wild,aim proves tmemon,and woo ckcssuch work himserwthrough his
am employees,provided that Such Improvement,Am not intended Mroffered Image.If,
however,due Wilding orimproonconscam Is Sold within am year of completion,the owner-
' builder will ham the burden of proving tat No did Out build or Norman for purpose of
smic
C]1,As owner of the property,am exclusively cannoning with licensed comma men in
constract the project(Sec.7044.Business and Frolicsome,Coca:)The Continues U.
come Law does not apply in an owner of property who builds or Improves cancan,ami,
who contracts for Such paijecut with a contrammr(s)licensed punched M the Commutes
Licenst,Law.
[3 1 a.esemp,under See B St P C for this mason
Owner Dam- L
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pcousty of penjury one of the following dularramors:
I hum and will maintain a Certificate of Consent An ulf-Insure four Whumnes Campos-
Milan,a provided for by Section 3700 a the Labor Code,for the performance of the
work for which this permit is issued.
E]I have and will maintain Worker's Compensation Immusucco,As required by Section
3700 of me Laccor Cram,fordo Performance of Me mark far Which this Forroft IS issued
My Wmine,Compound..Inumarms,and.,and Policy runnbc,Are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
r7hissecdon and noWcompleted time purwftliformmhmndetl Oil=(SIM)
or back)
I unify cast in the pormormance of Mr,work for which this permit is Issued.I shall Out
employ any paccam in my Summer An u As become subject So me Workers'Comparescuman
Law,of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cadillac:of Exemption,you should
became subract to the Worker's Composition previsions of the Labor Code,you must
z forlawim comply wit Such provisions or this permit shall be deemed rewind.
z 0
CONSTRUCTION LENDING AGENCY
1 hembir.M.ftt then is.,mramnactimn lending agency for tim Performance or
Cri> the Amok lar which Oda permit is issued(see.3097,Civ.C.)
Lender's Name
Leaders Addamar
U Q I cerdly that I haw mad this application And smus mal thc Show inform don is
COMCL I agree in comply with All city and county animmods and state laws relating ad
Wilding construction,soul hereby authrodare reprmsentatives,of this city in Omar upon ft
' ' uspecdon purposes.
('W'c)agree to saw.indemnify Add keep harmless the City of Cupertino against
,A liabilities,judgments,con,and expenscut which may he my my seem ASaWL mid City
IJ 7 in consequence Of me gramOS Of this parroll.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, Re-roofs
Signature ofApplicauctControunwr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliance An future buildings. or handle hazardous material
As defined by ft Cupteftints Municipal Code.Chapter 9.12,and ft Health and Barely
Code,section 25532(a)?
Y. ONO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or deviceswhich If a roof is installed without first obtaining an inspection,I agree to remove
4
It ItV'�' Gutt air contortionist As dclined by the Bay Area Air Quality Management all new materials for inspection.
District?
0y. ❑No
I have mad die harardon manarials requirements under Chapter 6.95 of the Califor.
nia Health&Safety Code.Sections 255DS.25533 and 25534.1 understand that ifft building
does no,tourartily haw.meant,last it's my responsibility in notify the oectmant Of the
requirements which most bc=(poor in Issuance Ora Cerifflame of Oempancy. Signature of Applicant Date
Owner.,..th.d,..d agent Dow All roof coverings to be Class'}W'or better
CITY OF CUPERTINO
• 8 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
.Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36901021. 118
DATE ISSUED. . . . . . . : 08/28/2008
RECEIPT # . . . . . . . . . : BS000005929
REFERENCE ID # . . . : 08080226
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 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
---------- ------------- ---------- ---------- ---------- ---------- ----------
13SEISMICR VALUATION 3 , 900 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1.ELECINSP 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
7.PLMBINSP HOURS 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1.PPE12MITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1'NRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- - ---------- ---------- ----------
TOTAL, PERMIT 530. 80 0 . 00 530 . 80 0 . 00
•
D
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORION Ca SUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 8/27/08
APT 118
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN# : 369-01-02 a 11 0 a
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
Worker's Comp.#: 238-0002445-07 Carrier: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 ❑ MasterCard ❑ Discover ❑ American Express ■
•