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08010154 BUILDING DIVISION PERMIT . CO ,NTz RACT��ORZ�N.EE�LMATI . BUILDING ADDRESS: PERMIT NO. 20380 STEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08010154 'N AME: PERMIT ISSUE DATE PROMETHEUS REAL ESTATE GROUP PO BOX 693 01/28/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO ,SHR&DRYR RETROFTS,KTCHN & aO EO PLO 0 u o o LICENSED CONTRACTORS DECLARATION �d F I hereby afnrm that I an,Iimosed under provisions of Chapter 9(commencing --^^^-^ •-•••- •••• --•-^ IQb.Description with Section 70(10)ofDiv]Mon 3 ofdm Buvocu and Professions Cade,and my licemc is h in full force and effect. :R2 License Clan Lim.• w. Donk Conlreclor iQ ARCHITECTS DECLARATION ooZZ 1 understand my plane sholl be used u public reenrd ed y tad Licensed Pndcsstonal RATION tar Oat I mo ...I from m the C.."eve COO O f 1 berthy+(Rene Net 11. uusin from de Convenors :Any c Law far Ne C p 0 following sures.Permit t tfO LS,Business and -.de-li Code:Any city momism 3$� which requires a permit m construct.diner.improve,demulish,or repair any strunum Z�, prior 0 its issuance.also,requires the applicant forsuch Permit m Ole,signed statement< Nat he ix licensed pursuant m thepmvidons of the Contrmmrs Vceem Law(Chapkr9 Sq.Ft.Floor Area Valuation By�s (commencing with Section 7000)of Division 3 of the Bud.and Pmfesims C,e)tar Q that he is aumpt therafrorn and the basis for the alleged enempdon.Any violNon of Section 70313 by M applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e wt mar Nen 0w hu,mA dollen(55007. P Y ZYP ❑L u ewes of the pmpeny,or my employees with wage as their sok compensedon, will do the work,and the$umcmm Isnot untended oroQemd for sat(Sec.7014.Business and Pmfenlans Code:The Canmerors License law dem Our apply m an awner of Required Inspections property who builds or improves mhneon,and who doessuch work lumself or through his owncmployee,pmHded that such impeavomenu art not intend,oraRertd foreale.I(. hOeewe Ne building or Improvement is sold within one year of completion.the Owner. builder will haw the When of proving that he did trot build or improw for purpose of ask.). ❑1,as Owner of the property,am uclusively contracting with licensed contractors in consumer the project(Sec.7044,Business and Profusions Cade:)The Conuecmes I.I. ' cents law does not apply to an owner of property who builds or improve themon,and, who contracts for such projects with a contranor(s)licensed pursuant in site Contractors License Law. ❑lemesempsunder Sec .BkPCfor Nismason seer Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury ane of the following decluWom: 1 haw and will maintain a CeNfimu of Coasem to self-insum forWorkers Compen. Other,as provid,for by Section 3700 of de labor Cade,for the performance of can were for which Nis permit is issued. ❑I haw tad will maintain Workers Compenudon Iuueanne,as required by Section 37( Nc labor Code,for the performance ofthe wart for which this permit is inued. ' My Worker's Compeormlon Wuonm carrier and!Policy number are: Carder. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This lection need not be emmplcted if tie Permit is forme hundred dollars($1001 or leo) I certify that in Ne performance of the work for which this permit is issued,I shall trot employ any person In any mannerm as N become subject to the Workers'Compensation Laws of California.Disc Applicant NOTICE TO APPLICAN'1:IL after making this CenlRem of Exemption,you should become subjttt to the Workers Compensation provisions of Ne Labor Code you meat vJ O forthwith Comply with such prevision or this permit shat]be deemed rewked. „Z,t0CONSTRUCTION LENDING AGENCY [-+14 1bereby.M.that Nem Ise contiud.lending ageney for the perfamaanemuf ai > the work for which this permit is issued(Sec.3097,Civ.C.) fy Q lenders Num MZ Lenders"does ' U O 1 sonify than I haw read his application and some Nu the show information is IL F correct.I agree to comply with all city and county ondru mss and sum laws misting to ' OU building conumcuon,a,hereby authodec mpmaenuuws of this rimy he enter upon the W above-mentioned property for Inspection purpose, (We)agree k taw.indemnify and lust harmless the City of Cupertino sialism N Iiabilide,j,gmems.,mts and expcascs which may in any way scene aEalmt said Limy UZ in conumence of Ne swung of Nu Permit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. IS Re-roofs Signature of ApplkaHAZAR cmm r Da HAZARDOUS MATERIALS DURE Type of Roof Will Ne applapplicantapplicantor fuwre building eccopantmOre atom or or handle ha'rasdam material F efined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety c,Scetion 25572(x)? All roofs shall be inspected prior to any roofing material being installed.. ❑Yes [j No Will the applicant or future building occupant uso equipment or devlma which If a roof is installed without first obtaining an inspection,.1 agree to remove emit hanrdmu air consminanu u dcftn,by the Bay Area Air Quality Managcmcnt all new materials for inspection. Dimlict7 ❑ye No 1 haw mad the hvadou muedsls mqumements under Chapter 6.95 of the Califor. nia Heal"Safety Cade.Saxon 25505,25533 a,25534.I u,emand that ifde Wilding does not curtendy Mw•amen,Out Itis my eaponmitilimy m houfy de occupant of the requlremenu which most comet poor to inuvce of a Cedlcem of Occupancy. Signature of Applicant Date Owner anuNamadagent Dam' All roof coverings to be Class"B" or better oCITY OF CUPERTINO 8 ITEMS OF 24 PERMIT RECEIPT' OPERATOR: patg COPY # 1 Sec: Twp: Rog: Sub: Blk: Lot: APN . . . . . . . . : 36901026 .211 DATE ISSUED. . . . . . . : 01/28/2008 RECEIPT #. . . . . . . . . : BS000003784 REFERENCE ID # 08010154 SITE ADDRESS . . . . . : 20380 STEVENS CREEK BLVD APT 2 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 IMECHINSP HOUR 1. 00 122 .38 0. 00 122 .38 0. 00 IMPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 IPLMBINSP HOURS 1 . 00 122 . 38 0. 00 122 .38 0 . 00 1PPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 ITRAVDOC 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 .211 INVOICE DATE. . . . . . : 01/28/2008 REFERENCE ID # . . . : 08010154 SITE ADDRESS . . . . . : 20380 STEVENS CREEK BLVD APT 211 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 . . . . . . . : STEVE WHITESIDES LIC # 29564 COMPANY . . . . . . . . . . : ORION FINANCIAL SERVICES ADDRESS . . . . . . . . . . : PO BOX 693 CITY/STATE/ZIP . . . : ROSEVILLE, CA 95678 TELEPHONE . . . . . . . . : (916) 789-8484 • FEE DESCRIPTION DUE FOR ------ AMOUNT 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 CITY OF CUPERTINO BUILDING PERMIT APPLICATION E-Mail ORION(rDSUREWEST.NET Jobsite Address: 20380 STEVENS CREEK BLVD Date:12107/07 APT 211 Owner's Name:PROMETHEUS REAL ESTATE GROUP Phone No.:(408)253-7100 APN#: 369-01-026 Project Valuation: 39$ 00.00 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 Carrier:STATE FUND Exp. Date: 4-1-2008 Cupertino Business License* CREDIT CARD INFORMATION Credit Card OJAENNNNmdwokl Name on Card: Orion Financial Services Inc. Expiration Date:08/2010 ® Visa[] MasterCard ■ Discover 11 American Express 11 eullalNc nDDa FSs: Pmurt NO. OWNER'S NAME: • PAfgQl�llEDnni NE: . SANRARY NO. CONTabI,NO. nM:HffEf.TrPf+GINEER: BUILDING PEI PLUMS L)NFO O O MFa ^� IJCENSbl 461.lam I licti..libb(g.of ION -0 zC Inn7MI) rDivimmlisamonumpmtymioorCogo, wmyliMcwt lob Description i� ri.aflfmom o'fl fDiriuon 3of0a BannrcM,4 Pmfe92fSd.li,e mYlkmau ;n full l l ,m ef4a .: upennclgm B �,p 7.47992 j Dtu Cumfaa ARCHnECrs DEcuawnDN `6 I unerinanJ by pluu mall be me4 u fanik mobou C� -•• al Pm4 . OWNER.BUII UOPLIwaAnON ,mm,na I a,n aaoq rnw me cm.w.Ibuc i,a,b raf 0a OO fa4mnd,uum.(SuLm TOI.3.Bmnea,m Refuuom com:Any niy a many Mnk.eyuim,,pumi,.n ooyw i Ami manote.Etmnlub.a fepwf My a,arme iO Maim mizu,at,alwm9m.a,pe,pq'vamfaw�mm,ilafk,c[I,cGa+4mem q Valuation t w,t41i¢uwp,um,n,n,InpmtimmnNueComrc,oh[i¢nalar(aurw9 S Ft Floor Area :s Icommnain[MiR Sa.im y000)MOiwgiM]Mma Buginm,m RofWRu fbec)a 113 by )nni'ffa•aM Ba nun fa Ne l lio am,glat Any i mgaRI of sman�oslser„y,pplia,urof,a,mil,Lelw,ll,eapp)kwu.firBpmwyof APN Number Occupancy Type ne.mom Rtn aM.nnmae mmm D30D1 ❑I.,i nMmr J Ua progny,a my cmpleym rid M,da u mwmk eanparm.lm. Mill anefic MprRC : g Comism,inammb U.do rm o any.An.Bueneu Ma Ro4a,m,cme:rla con,ameri a^-••U.eoa•n•gpNr R m orc w Required Inspections pfannr rla Wiw1 a wgorci Bemn.,m Wn m ong ib w,R 6imaRa Rwanda hif wt bi-bibldi-Im w,tapnanpmtad eft ib nR eaWeaainNe rm rack a. Will- 1 wiWi•fa;m offmen,;,mM WJin antsoaf•r mnnono 1.mmbmga wi1M.vu IOS,A[Mmmm of q•r{nd w,no U)a„d Yin a imgm0 fm'pa[na nr ❑1,a w,v ot,nc gepmY,n uelmi mnmoa,t ria 0onaa cvfnraws in mt,vmm ua pmleii IseL TIM.Buurcv tee F,p(p2oDk CRIm17ae(aafgNfi LL awcli.eau appy ntnwv NpfnW,y melWW,a MPn`u 0„mi uG. _•• rbeRencu fa am meym wRamuvtea(t)Iim,ee gvaun,b YvCm,noeh 0 M. Alan uemq u,ecf See ,B kPCfw lal,l®v ' O.R Dow WORKERS cf))A SAnON DEC)-.RAMON ® Ihimbytfnm•m4r manly a pcf)ury oa or lac following eMuulme r .ml11 manning Cobifwanfcomuu Io alFan imfor Wptm'i emm, ,p . A.ml pmviem for by S oon 37W of,ac Ianm Cme,for w mmfmmue of ae f.url,fa M4Y to pumil u uss6 Q 1 lug,M rill m,lnan Wohn',CLmpmighim laxogn ,M RifwM by SfmM ))OOwa.W Cmc.fa Re pertam.a ma ret for wak,h du pomkaimam My arSjcbbF F De,n:m w Pmiv.Rn.. Irma,: PNihNd238-0002445 07 CERfISCA7E OF EKEMPf10N FROM WORKERS COMPFA Mbr INSUR,bMi (iniawim Ilam emmeanple,ee ifft pumi,41renenum,mmBaal:11001 ,vii 1 rmifY w,n w prifmmat¢M N[rot fa rnke au pama V iarcG.I gMB oa empwy ny pcfmn m im,mm,arm M Io Nmm alijeeao Ba wR4ae comixo vtlpn U_of Canfomu.Co. Applin NOIICE TO w in bin Nr:If,,fee obbo ab Ceawnan d "nor gamw �Zenomc,unotp y w' We,h bro Comfani„lon gprl,lm,N w lana Conn.Ipo mw Rmrnn rnmp,y Mm siren gm;nnm R ay paml,mall ane eamm mroten LO CONSITUCnONIP.NDINGAGENCY I Mmnr tflm au uart w comuuctim kmwtg[[,AY fa ae IamoMa,¢ff - iM Mia Iw Mn;cn,nµpcmn u;a,ae(S ]o%.Cl.,C.) CQ luiah Namc. yz IaMelf AeuMi Jo l I awl'R„1 Mre,cu,ai,"Boum tm,aa oN Ua abode inram,lim u 1,[,a,n campy woh An m)aw loon'Rein &M Sago labo Mtw jUwmu[emuia,m•.tm MmnYteamafepm,mww Medi mYmnmupm ae „G ,mre.men,wia pmpm,y,ra iupefmm rWpnae (Wi,),S..o ai a imemwfy,m lb p hormNsa ft City of Gpm ino aping �y 14wli,q,Pw .emu,mnpniv ra y+gag,dgam away , JZ w pm,mLe qaa.[w .. _, APn.1cA NO N wr*N M1 NpN. fyr Issufd by:2�5 Date SWRCE SI[naan of npplkanmCm.ma . . ZS D. Re-roofs HAZARDOUS MA7 ALS LXS OSURE Type of Roof will Re mplinm m W.bwah.,ia•pm„nae or M,meaga,mwamgmiJ as Wirce by IM Cupm,no MuwciNl Cod.Chgpar 9.13.,m Oa Heath gm Sday cad.arm usuw' No All roofs shall be inspected prior to any roofing material being installed, Will,a,ppli,an,or I..Wiwi,am m wo ali ipmMl.d.:C rtkb If a roof is installed without first obtaining an inspection,I agree to remove ..o a"mwmwmp M dlnoe n'Ba Ba Ami All Quallry Mmateaem all new m ' is for inspceti n. • _ powi No IMM. N,uweambmg reaunri,en,iueeaf]up.n 695 ofw OEfm ilu Hralac5m Coe�Yawv 373 .l u,pmnane mn(Oe au,wat pci m Sadly Ba p?epm 4<tla 221 � Signa ore of Applicant Date R,mm�nan,[pn, w All roof coverings to be Class"B"or better FF�c✓: 10306 Toae Avrnue Cupertino CA 95014 CITY OF Telephone(408)777-3228 CUPEp 1 �NO Fax(408)777-3333 rC1l�`' 'V Building De F ent JOB ADDRESS:20380 STEVENS CREEK BLVD PCUPERTINO, CA 95014 OWNERS NA.ME:PROMETHEUS REAL ESTATE GROUP P91 6 )789-8484 GENERAL CONTRACTOR-STEVE WHITES IDES FAX # 916 )789-1051 I am not using any subcontractors: Signature Date Please check a2plicable subcontractors and com lete the followin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting ® Linoleum/ Wood Glass/ Glazing x Heating SAN JOSE AIR ( 1408 ) 286-2047 a423 Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock T" Owner/Contrac or Signature Date