08090076 CITY OF CUPERTINO '??.�'• +va'r ' ''' c � � '" '""'`^ -'rel?
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUU_fOSNyy,,ASDyESS: PERMIT NO.
STEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08090076
OW AME: PERMIT ISSUE DATE
PROMETHEUS REAL ESTATE GROUP PO BOX 693 09/15/2008
40
ONE: SANITARY NO. CONTROL NO.
(916) 789-8484
ARCHITECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
4 mF 1 hereby aRran Nal l am licovd under pmvisioo of Ckaper 9(mm=ming Job Description
wiNSccuon7000)ofDivulou3oftheBummer,Ord ProfcssiosCoca,and mylicense is WSHR&DRYR RETROFTS, KTCHN&BTH CBNT & CNTR TOP
d in full forte and.fiat
�qi Lieemeetau Lm,g UPGRD; DCTLESS SPLT SYS; HVAC RETROFIT
nF-q Dain Canuaclor
e 7W ARCHITECTS DECLARATION
5 0 U I understand my plansshall be used!as public records
a to Licensed Professional
''0OWNER-BUILDER DECLARATION
j�F 1 berth'a1Erm Nal 1 am exempt from de Canoactoes License Law for the
COC fallowing mason.(Section 70313.Business and Rofessium Cade:MY city or county
$ which reeuw a permit as cnnswel.alter.improve,dcmalim,or spur my strunsure
prior to its issuance.also rectums the applicant forsuch permit to file a signed statement
<
that he is liconsed pursuant to to provisions of the Conuacors Lfcone Law(Chapter 9 Sq.Ft. Floor Area Valuation
x(`$ (cammeucing with Section 7000)af Division7ofthe Budnessaod Pmfcaiov Code)v $3900
e S g that leu exempt therefrom and the hast far the alleged exemption.My violation of
Schon 7031.5 by any applicant fm a permit sunacs the applicant to a civil penalty of bOccupancy monroamNanfive hundred dawn(SM 36901021 .M� 6Numer OCCIl P yTyPe
0 1.v owner of the poputy.or my maploym with wages as their=is compcnsstion,
will do the work.and can structure is not intended mofered for sale(Sec,7044,Business
and Pmfessims Cade,The Contractors License Law does WE apply In ower an nof Required Inspections
property who builds a impows Merron,and wha data such wok himself or dhmugh his
oweemplaym.provided Nal such improvements art am intuWed maRttd fvaate.U.
however,Ne building or improvement Is mid within one year of completion,the matter-
holism will Mw,de burden of pm ing ds,M did rot Mid or improve for puTom of
sale.),
0 1,w owner of the property am exclusively contracting with licensed contrmmrs o
comtmct the project(See.7014,Business ad Professions Code:)The ConmeNrs Li-
cove Law dm not apply to an owns of property who builds or improv thereon,and,
who contracts far such projects with aconuxror(s)licensed pursuant un the Contractors
License law.
D lameaemp,underSee .B&PCfar Nisreamn
Owner Dae
WORKER'S COMPENSATION DECLARATION
1 hereby of ires under pevlty of Perjury oro of the fallowing declarations:
I have and will muasin•Cmnifiomof Consent to mIf-1.frc WorkersCompen-
tion,u provided for by Section 3700 of the Labor Code.far the perfmma.of the
wok for which this permit is issued.
0 I have end will maintain Workers Compensation Insursve,u nquird by Sc vow
3700 ofte Labor Code,for the performance of Ne work for which this permit is issued. '
My Worker.Compevdao Inmram.artier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ThhmNm aced mtbecomplmed Bthe permit is fosse hundred dollars(6100)
or leas)
1 unify that in the performance of the work for which Nis Permit u issued.I shell not
employ any Person in my summer an an m become subject to the Workers'Computation
Laws of cartoon.Dee
Applicant
NOTICE TO APPLICANT:If,are,making Nu Cenificas of Exemption,you should
become subject to also Workv's Compcmetim provisimu of the Labor Cade you mut
0 z forthwith comply with such provisions or dos Permit shell W do and m.okcd. _-
.�a OCONSTRUCTION LENDING AGENCY
[-+ � 1herebyaRot than there ala connotation lending agency far the performance of
!Yi thm work far which this Permit is wand(Sec.3097,Civ.C,)
QLenders Name
z Lenders Addma
U O 1 cadfy own I have read this application and suet that the now bdonamma is
ly ;-'! cortat 1 agree Or comply with ell city and county ordinances es and state laws relating to
'0 rV' building construction,and hereby mNaum mpmsenmivcs of One city to enter upon Ne,
ILl shove-mcnuonemas.ca YfminsPenses purposes
I� (We)agmn N saw,indemnify and keep harmless the City of Gupertlao+gains,
UZ Iiaecaseae.c.or ts,eoru ad expevnsmit. may in anyway accruc+gdns,mid City
U z APPL CANTeUNDERSTANDS Adon of IND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOU
SSignatureof ApplicaDas
x&znxnocs rdATERIupr olsao had, . Type of Roof
8911 the apCuperty future buildingoecupmt sono.luck Health and
C dented by the Cupertino Municipal Cade.Chapter 9.@,and the Health roti Safety
Cotle,Section 23332(+)?
❑Yv ON. All roofs shall be inspected prior to any roofing material being installed,
Will the, licmt or future building ecct nt use equipment If a roof is installed without first obtainingan inspection,I agree to remove
OP B W c pmcn,or Mara which P
In vardnv tar cantaminans ss defined by tine Bay Area Air Quilty Management all new materials for inspection.
ct7
Dy. ON.
I have read the havrdousmaeriab m t.hanew under Chap crd.95 of the Califor-
maW.Ith&StlklyCadc,Scce.255D5.25533 thus 25534.1 understand!Neifthe building
dm not currently have a mount,has i,is my wspandbility to notify Ne saeupent N Ne
requirements which must be me,prior to issuance or a antficate of Occupancy. Signature Of Applicant Date
Owner orstNatircul goal DamAll roof coverings to be Class'%T'or better
CITY OF CUPERTINO
• 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901021 . 410
DATE ISSUED. . . . . . . : 09/15/2008
RECEIPT # . . . . . . . . . : BS000006076
REFERENCE ID # 08090076
SITE ADDRESS . . . . . : 20350 STEVENS CREEK BLVD APT 4
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
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
IPPERMITFE 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 530 . 80 AMEX
---------------
TOTAL RECEIPT 530 . 80
009 oo� (�
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORIONaSUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 8/27/08
APT 410
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
^1
APN # : 369-01-02U 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 0 MasterCard 0 Discover 0 American Express ■