08010152 CITY OF CUPERTWO
BUILDING DIVISION PERMIT C�i\911[!1V'i.11l�li«O� v
BVILQItt�CQ�,pqR ESS: PERMRNO.
LU3CU STEVENS CREEK BLVD APT SANT JOSE AIR CONDITIONING, 08010152
N AME: PERMSTiSSUEDATE
PROMETHEUS REAL ESTATE GROUP 1045 C N 10TH ST 01/28/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECffENGINEER: BUILDING PERMIT INFO
WSHR & DRYR RTROFITS, KTCHN & -eLGG ELECT PLUMB MECH
0 0 0 0
30o ucENseomNlxnc-rogsDEcuanno" .� IobDescription
vd d I hereby affirm dal 1 am licensed under provisions or Chapter 9(ammancing "^^^^ ^"^^' ^^^ ^^—
z1 with Section 70fif,of Division 3 of the Business and Professions Code.ad my license is
^owl in full fame and effem.
Z_ License Class Lk.0
Dau: Contractor
3
ARCHITECTS DECLARATION
I vedeesnd my putts shall be used at public reco is
5 c uaated Purwiow
OWNER-BUILDER DECLARATION
rZ O O I botchy..a .(Tire that I I.S.exempt from the ft ntramOra LiAny c law far tre , ...
i p O following..an.(Seddon N]LBw(ner. and ve(easinat Cade:Any cm or county ,
$li
which requires•permit m anuruct eller.Improve.dt,mnllxh,or mpOir my structure
Z� pdm to its issumcc,also requites the applicant for such pencil to Olt,a signed ataemcm
g a unuheislicensedpundmitotheprovide.oftheC.radmuraLicenseLaw(Chapter9 Sq.F[.Floor Area Valuation
S9i (commencing with Section 7f)(10)of Division 3 orthe Business and Professions Cook)or
Q than hek asempt therefrom and the baths for the alleged exemption.Any violadm of
section 7031.5 by any applicant far a permit subjects the applWnu0 a civil Penalty of APN Number Occupancy•f��
trot more than fin hundred dallan(&MP y `l Pe
1,at ewnen of Ce pdoPmtY.a mY wploym with mgat a te'v sok compewtm,
ness
ad PmethrcdaN c�The Gagen Lk...Lcndual aw�nal.(p'�e7 sm ow.of Required Inspections
Property who Wit&animproves macon,and wlwd such worst bieaelrmlluough his
awn employes,provided that such improvements are notimmoded maRemd for We If,
however.the building or Imp unment(a aid within ace year of ampl.fm,the ownm-
builder will have the burden of proving NM W did not Wild Or Improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contrwme to
construct the project(Sec,70w,Business ad Profasiets Cade:)The Cmaaamre U.
creme IAw dors at apply man owner of property who Wills or improves thereon,and
who contracts for such projects with a wro adorn)licensed punuam to we Contractors
Lkuse Law.
❑1 are exempt under See r B 6:P C nor thin mown
vee Dae
WORKER'S COMPENSATION DECLARATION
I WRby same under Penalty of Perjury one of the following dedmadom:
❑1 save and wnl eaim sw.Cw6neamof C...t m self-loam far Worker.Compen-
whom,as Provided for by Section 3700 of the Labor Code,for the pedarmmen of the
work for which Cuts permit is inu 1.
❑1 lave and will maintain Workers Compenudon Insurance.at rtquired by Section
3700 of the LaWr Code,for the pcolwan roe ofthe work formich Nu permit is Issued.
My Workers Compensation Ina.Can.and Policy number ate:
Carter, Policy No.:
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thhs=,am reed not becomplemd line permit is Intent,hundred dollam($100)
or ins)
1 artifv that in We pufmmma of the wart for which this Permit is issued.l shat not
employ any pwam in my maorcrsu as to mcoee subject in led Workers'Compensation
Laws of California.Due
Applicant
NOTICE TO APPLICANT:If.after making this CeaiOae of Exemption,you should
become sublem to the Workers Compensator,Provisims Of IW LaIWr Code,you mus
.,Q fwwwnh comply with such proviaam Or this permit shall he deemed mated.
'Z 51 CONSTRUCTION LENDING AGENCY
[r I hereby aRre that there is a construction lending agency for the performance of
the work fm which cis permit is issued(Sec.3097,Civ.C.)
aQ Landers Name
Z Lenders Address
V O 1 certify that 1 hon dead this application ad mum sal the°bun kmmmauan k
a ^ eednI"we
m"'C"y with"I city ane co rah ordimancesand see nmmisting m
�j Wilding rnmbromionr and herby suNodm representatives;of this city teener upon we
Dd 0ove-mendaned properly for inspection purposes
C (Wt,)agree to save,indemnify and keep hmmless Ce City of Cupertino against
anti ,4 Ilabilides,judgmenW costs and expenses which may In my my seem against said City
in
of the gratinit of
C)^•m
APPLICANT OUN UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
H
Sigwum ofApplicmZeMATERIALS Dae
UOUS MATALS DISCLOSURE Type of Roof
Will the mpliant Or future Wilding odcepmr Wore Or handle havNous material
41 deRucd by the Cuporthe Municipal Code.CTapmr 9.12.ale the Health and Safety
S ctm 25532(°)+❑Ya ONa All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,,l agree to remove
emit hazdwus air conuminants a de0xd by the Bay Area Air Qualify Management all new materials for inspection.
District?
❑Ya ON.
1 have read roe brand.maedats requirements underCbaper6.95of the Catter-
nuHealth BSafbty Crack,Sectors 25505.25533 and 25534.1 admw al IhnifCe building
dna not cmrcnnly have a want.that it it my responsibility in notify to occupant of to
regmemcmtwhahamtoman prior toissauset,eraCertificate aradupsay. Signature of Applicant Date
Owner or mdhoved ogee Dam'
All roof coverings to be Class"B"or better
® CITY OF CUPERTINO
8 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . 1 . : 36901026 .412
DATE ISSUED. . . . . . . : 01/28/2008
RECEIPT # . . . . . . . . . : BS000003784
REFERENCE ID # . . . : 08010152
SITE ADDRESS . . . . . : 20380 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 . . . . . . . : WILLIAM GENTILE LIC # 24783
COMPANY . . . . . . . . . . : SAN JOSE AIR CONDITIONING, INC
ADDRESS . . . . . . . . . . : 1045 C N 10TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
® TELEPHONE . . . . . . . . : (408) 286-2047
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
lELECINSP 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
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
PERMIT INVOICE OPERATOR: patg
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901026 .412
INVOICE DATE. . . . . . : 01/28/2008
REFERENCE ID # . . . : 08010152
SITE ADDRESS . . . . . : 20380 STEVENS CREEK BLVD APT 412 _
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS REAL ESTATE GROUP
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE 150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
CONTRACTOR . . . . . . . : WILLIAM GENTILE LIC # 24783
COMPANY . . . . . . . . . . : SAN JOSE AIR CONDITIONING, INC.
ADDRESS . . . . . . . . . . : 1045 C N 10TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 286-2047
• FEE DESCRIPTION _ DUEFORAMOUNT DUE ------PAID BALANCE
------------------ . ---------- ----------
SEISMIC RESIDENTIAL PRINTING PERMIT 0. 50 0. 00 0 .50
OTHER ELECTRICAL INSPECTION PRINTING PERMIT. 122 . 38 0. 00 122 .38
ELEC PERMIT ISSUANCE PRINTING PERMIT 40.79 0. 00 40 .79
OTHER MECHANICAL INSPECTION PRINTING PERMIT 122 . 38 0. 00 122 .38
MECH PERMIT ISSUANCE PRINTING PERMIT 40.79 0. 00 40 .79
OTHER PLUMBING INSPECTIONS PRINTING PERMIT 122 .38 0. 00 122 .38
PLUMBNG PERMIT ISSUE PRINTING PERMIT 40.79 0. 00 40.79
TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 40 .79 0. 00 40.79
---------- ---------- ----------
530.80 0. 00 530 .80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--- ------------------------- -------- ----------------------------
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL -
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
• 305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORIONASUREWEST.NET
Jobsite Address: 20380 STEVENS CREEK BLVD Date:12/07/07
APT 412
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-026 Project Valuation: 39S 00.00
Big. Permit Information: Bldg. ■ Elec.e . Plumb.■ Mech.■
JOB DESCRIPTION
Washer and Dryer Retrofits; Kitchen and Bath cabinet and counter-
top upgrade. Ductless split system;HVAC Retrofit.
® CONTRACTOR)N FORMATION
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: 4-1-2008
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card#
Name on Card: Orion Financial Services Inc.
Expiration Date:08/2010
® Visa❑ MasterCard ■ Discover 0 American Express 0
( E7. Cup 0ertino CAA95014
CITY OF Telephone(408)777-3228
• CUPEkTINO Fax(408)777-3333
Building De artment
JOB ADDRESS:20380 STEVENS CREEK BLVD PERMIT#
CUPERTINO, CA 95014
OWNERS NAME:PROMETHEUS REAL ESTATE GROUP PHONE #(916 )789-8484
GENERAL CONTRACTOR STEVE WHITESIDES FAX# 916 )789-1051
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com Tete the followin information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
I Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring- Carpeting
Linoleum/ Wood
Glass / Glazing
x Heating SAN JOSE AIR ( 1408 )286-2047 a 3
Insulation
i Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
i Plumbing
I Roofing
Septic Tank
Sheet Metal
Sheet Rock — ..
T
Owner/Contras or Signature Date
n SUIDINGADDRFSS:
PBRNT NO,
OWNERSNAME:
— PFRIRtMSUEDA]E
4L
SANITARY NO. CONTROL N.
�A0.CHITER/Fllr'INEER:
BUBDING P[0.MTINfp
BLDG EIF,Cr PLUMB MECN.
pG LICENSED CONfIACTORS DEC!AIATION O
G1 bdeeY affim uv I m Ii,cnad umRr pW1.i.d Ca.,.,a(minrmting Job Description
z4 rim5m1m]00)oroiviman3dda,B..and Prdvadpm Cade,mad my Jim=I.
inf.nfmnaamdfmB
7.47992
�x Lke�CTua li.a
^ DI. Cminmr
C� ARCHITECTSDECLAII nnON
I Imuvam ny plats NuR h u+ed ar'ady,le«m
Lrrnled Pndmsinmi -
OWNER-BUILDER DECLARATION
n x I krc4r affirm man I am curial frim me Cmmmo.l Liulle law f«in,
no folNwnt ma.on.($ Wn 71131 S.Buai.am Refvdyna Code:Any oty W MM
`J L rbi.p Irym,n a Fmn I.mn3lruy I.,impm na.dLT11011N.«Igmi,a,mWJum
xi mmmin issuable.a4u lmuves lir applinnl f«mcf pvmilmfikatii«Euumml
_Q unkialkcnru Fruamin lk pmdiainudl4cCml.acm'a liullm V.([Tapav9 Sq.FL Floor Area Valuation
3$ Itmelvmring.u45¢amn]BBO)dDiv4imldlk BWneMam Pmkalov fade)«
mu k n c.mp dnrifrem and me M.la fe,dr allnon uanpdoe Any Mp4dpl d
Sn ift 7M IS h am apd�nl Im a prmil Rm)m.Ibe applionl m a dao peva,,,d
an, m.n I—eumrm WWI,(1,(0a APN Nu mbW Occupancy Type
QI,Nm.11y ddr popr s.«mrefnalnYccl.'v,gjtflad.(mk eu4.Zand an,
-33 ft f.w and,I: a Can N n,,I, W, offeredfmWnfS«.IOAd.r
ane ftwhO Cmc Tna nota ... d nM Lar dina uc1%mi in appy b m d.nv of Requited Inspections
prgrnyimna.1.er,m W,h imeand.bo.W,ma..rtblmmlf«mmut4 k4
wm An ipmgcdlyi,mkim«oamcnin acini ,m ,,dm,f«We U.
ma,me01 Inn t- P-11,
lmpmamnel i. II ridid nn ared d mlamin,for
ya Wind,
idf
W i.) vriB wa lk Lureu al amNnp wl lr did m 4dla«impew ry pmyom or
Nk.l.
Cl I.a m.lr.d me pmpmY-am uclu.iay Warman ,villi Brcum mnuaa«r m
.1.W,Maim(Sce'1(W.B.I.am Profeadmu Cnde)Ttn Cmrnota LL
aau.lan,mm ml appy...d.«a d pmpuy nue bdlpa«4npo.m mmmn,rid,
vne mnVKu f«sirh mi.. IiG(ed Dagain,m ma C04g0/f
Irenr u..
Q lm,.elnp.mm see .B a P C IUIWI ILIiIp
D-M+ Dar
d"ORKPR3 COMPENSATION DECLARATION
® 'alk.Dy.ffim ulvNrKmIV dP.Oml mr due fdb.mg d«INNkne
a
will mmnwn a Cudfimm ofCmm.m mil-Inde.any WMelf Compml,
n.v pevged f«,Y sc,Ilm Jrt)0 d dr la,«CW,f«14e pmfamalla d rip
for Mr4 Nli rnm,l i.lssdm.
D I Na and rill malum WmM/f Cam«Iwuod IVNvana,u Bgd.d by secdm
JABWeMf am�e Laeor Cue f«lk pertwmameof me tori I«will m4 ymi 4 imv6
MY ScC FUND�,ri«wrolgr nllmx,m:
Icm Poti X238-0002445-07
CERTIFICATE OFE EMPDON FROM WORK91ir ..
j C Ulilld SATION INSURANCE
OTu vn,nlcd mloctumprrd lfur pom44fFmclunMYdeBm Rlrol ,. -
mkYl
1..,dy and,In me pmfnnI mule.M fan Mi,A min pmail'u im«A.1 shell np
trim,,,any«run in my momrm as in bemm mbj«I in drwoeive fads avUod
Lanny d Califmnla oar
Applin.
NOTICE TO APPLICANn If,afm making 1,4 Qrormr of fiamnplidn,rm a,oub
hour aubjcN m lk W e.Cimmma,im pmitlw of ue LaIIM Code you and,
�z fmli-ah dd,vim iu[k rym4im.M m4 Frail,Null h dtemm mmh6
Zy CONMUCfION LENDTNG AGENCY
1 mlenY alarm mal dr.4 a,mnnrlgk Icndinj.gmrY fm me INlfarmfnx d
ur.nrc la rIni din m—n 4 room(scc M.Cir-C.)
Q Ixmkh Nam,_
Z Isms'.Admen
O- I,mdr m+l I w.e a.d uu applialm and....me.dow inland 4
. F mule lags In p,mm NI NYy,uM cmmD winann am.4.a miningm
mnt,mwlellm.am kmbY amk«l..pc a amcnidmss.I.Inmupm dr
r alcor-mnllmM P.FnY
for a.pmamp,vpmsd .
_ (W,1 acne m u e immdaY amy tl n old' d Cumnim agai ,limilidµlm .linen abeapmM i I,is aevm agNmpq Cla
)Z in,daW« Frablingd '
`•' APPLICA ND N WITH ALL NON-POtNY Issued by: Date
SWRGF. TONS.
silmmedAppo VCmnawRe-roofs
F 04
HAZARDOUS MAT IALS DMC1 IRE Type of Roof
krimuAd lml,1.CuapmtlmakMmu.inMmilriCnngma,RChaapnim Nu9.e11 W dWaye CHWO nman1N
and 4fnr .
Col`r""°'ss'J"')'
❑rxN° All roofs shall be inspected prior to any roofing material being installed.
Will lk a lAm,W find.Wilding If a roof is installed without first obtainingan inspection,l agree to remove
Pa tby ft l um eRm it Qn m devim Mica I
durum ai,mlllNmlwMa M mfimq 4Y ur B.r Am A4 pw4y Mmagan,m all new mate iIs for inspecti n.
w.elAn
waarmvsmarria4 mpvemmuundrr Chydv695ddm Glifm /
n4HMW ksaf Cvdc.Samm s]] SXIugNnaM diamond
Pr
'•`a//Y/'/—
Ueu m, Ir a�,"7' y
dualFnl pf drSighatumofAppliean[l. .,d a - - All roof coverings to be Class"BI'or better