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08020076 CITY qF CUPERTINO -.. BUILDING DIVISION PERMIT C�,1„ Q } y ��nx 1+ BUILDINGTUESS;TEVENS CREEK BLVD APT ORION FINANCIAL SERVICES PU80M0076 L U.S ACMEE- J PERMIT LSSUB DATE PROMETHEUS REAL ESTATE GROUP PO BOX 693 02/13/2008 PHONE: (916) 789-8484 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 306 LICENSED CONfRACTOR'SDECLARATION IbDnon r6 t"i 1 hereby affirm lost I am licensed under provisions of Chapter 9(cco m u clog ODescription wiNSwlion7t )afDirition3ofNcOusin NdNofcuwmCo&,wdmylicenxis WSHR&DRY RETRFITS,KTCHN&BTH CBN&CNTR UPGRD.DUCTLS a ^ in full forte and effem. LicenseCma Lte.N SPLT SYS;HVAC RETROFIT Dam Conuxmr ;q ARCHITECTS DECLARA71ON @@ 1 undimmed my plans shall W used as public reamds aid Licerved Professional h OWNER-RUIIDER DECLARATION grf 1 herchy einem that 1 am exempt from Tho Conlracmr's License Law for the E o o following reason.(Section 7031.3,Business and ProfaNnns Cade:Any city or county j$� which xquirms a peri[to construct.nine,opmw,demolish,or repair my income -- Z y prior te its issuance,aim requires Me applicant for well permit m file&signed su uncru €< thatheis0ansedpusm.mtotheprovisionsofdteConsumesLicerclsw(Chapter9 Sq:Ft.Floor Area $3900 Valuation Section with Seon 7000)of Division 3 of the Business and Profeuimut Code)or $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.3 by arty applicant for a permit subjects the applicant to a civil penalty of roft" A.DN��Number Occupancy t mom man w hundred dollen `J (55001 3 6 9 010 2 6 . P y ZYPe ❑1,as owner of the property,or my employer with wages u thebmle cantpenuton, Wllldamawork.and the structure laoaimanded oraBered far NL:(Sec.70M,Bwsi. Required Inspections and Professions Cade:The Conuames Lias Law don ml apply to an owner of q P property who builds or improves thereon,and who dues ouch work himself or through his own employees,provided that such WiMmomme,are not intended aro@red formic.If, however,Ne Wilding or improvement is mid within ane you of completes,the owuar- Wiltler will have the When of proving that he did Out build or improve for purpose of tile.), ❑L as owner of Ne Property am exclusively connecting with licensed contractors m comuuct the project(Sec.7044,Bosiness awl Rof saioes Code:)The Commemr'a Li- cause Law dors not apply was...,of property who Wilds or improv thereon.and, who cannacts far such projects with a conuactar(s)limited pursuant in the Conuaemes License Law. ❑I am ammpt under See ,B h PC for this meson 40-1 Dau WORKERS COMPENSATION DECLARATION I hereby aOIIm under penalty of perjury ane of the following declarator: ❑I harm and will maintain a Cartfiauaf Consent to self-insure for WorloesCumpen- .mian,upro (or Sectors 3]00 of the Isbor Cade.fee the pmferenana a(the wort far whichh this permit is lasered. 1 have and will maintain Workark Compensation Irunna.as required by Section 3700 of the Leber Code,for the performance of the wart for which this .it ie iunet My Worker's Compensation Insmanm carrier and Policy number am: Carrier Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Dtmxmir mod nut be completed if the permit is format hundred Oil=($10(p) or legal - 1 certify,mot in the Performance of The work for which this permit is Wood.l shall oat employ any permit!.my mann.as in become subject o tin Wcake.&Cempenssdan Laws of California.Dem Applicant NOTICE TO APPLICANT.It,after making this Certificate of Exemption,you should become subject to the Worter's Compensation previsions of the Inbar Code,you most a�0 foMwithcomlt pbe ply with men or this permit Mail doomed revokW. z CONSTRUCTION LENDING AGENCY [-a I hereby storm this then is a consuectinn lending Mercy for the performance of C > the work for which Iw permit is knew(Sec.3097,Civ.C.) Ca Undoes Name 7 z Leaders Add. . V Q 1 certify that I have read this application and sum this Ne move information is Lgs E correct.1 agree to comply with all city and county ardmaneea and sun laws relating In _O building construction.and hereby mthorim xpreanutvrs of this city to enter upon the W ahove-mentioned property for Inspection purposes. P. (We)agree to ave.indemnify and keep harmless the City of Cupertino against l'n liabilities,judgments,costs and expenses,which may in my way same against aid City C.)Z in APPLICANTAND this WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of AWlirnVContracmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the appilcanwr future building mupanmmm or handle hazardous material deRned by Ne Cupertino Municipal Code.Chapter 9.17,and the Health and Safety u<, o ❑No zss3z(a)7 0osYAll roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding Occupant OR equipment or dcvim which If a roof is installed without first obtaining an inspection,.I agree to remove emit hanrdnr air contaminants as defend by the Bay Area Air Quality Management all new materials for inspection. Diwict7 ❑Yes r-lNo 1 have mad the harafdous materials requirements under Chapter 6.95 of the Califor- -I.Real"Safety Code Stcoes 25505,25533 and 25534.I undcumndthalifthc Wilding dm not currently have a kneel.Wallis my m N.Mility to notify the occupant of the mquimmenmwhkhemstbe mel prior to iuummc oft Ccnifkuc Of Ocapanry. Signature Of Applicant Date Owner or aumurfred agent Dam All roof coverings to be Class"B"or better 6VADD's • CITY OF CUPERTINO BUILDING PERMIT APPLICATION E-Mail ORI ON(cDSU REW EST.N ET Jobsite Address: 20380 STEVENS CREEK BLVD Date:12/07/07 APT 318 Owner's Name:PROMETHEUS REAL ESTATE GROUP Phone No.:(4081253-7100 APN#: 369-01-026 Project Valuation: 39S 00.00 Blg. 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 Name on Card: Orion Financial Services Inc. Expiration Date:08/2010 • Visa[] MasterCard ■ Discover 13 American Express 0 CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36901026 .318 DATE ISSUED. . . . . . . : 02/13/2008 RECEIPT #. . . . . . . . . : BS000003925 REFERENCE ID # . . . : 08020076 SITE ADDRESS . . . . . : 20380 STEVENS CREEK BLVD APT 3 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 1PPERMITFE 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 . MC , --------------- TOTAL RECEIPT 530. 80' , ' • 10300 Torre Avenue Cupertino CA 95014 MY Of Telephone(408)777-3228 CUPEkTINO Fax(408)777-3333 Build* Department JOB ADDRESS: 20380 STEVENS CREEK BLVD PERMIT# CUPERTINO, CA 95074 76 OWNER'SNAME:PROMETHEUS REAL ESTATE GROUP PHONE #(916 )789-8484 GENERAL CONTRACTOQ--- WHITES IDES FAX # 916)789-1051 I am not using any subcontractors: Signature Date Pleasecheck a licable subcontractors and co m Tete 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 )286-2097 Insulation Landscaping Lathing Masonry j Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing i Roofing Septic Tank Sheet Metal Sheet Rock T' n • Owner/Contra or Signature Date