08040189 CITY OF CUPERTINO 4.f4sh'17�a*.wysar-+��a
:.U'LDING DIVISION PERNIIT C�11\el
BUILq1ry1aq,,Appgq0.FSS: PERMIT NO.
l V.S 25U STEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08040189
OW AME: PERMITISSU11DATE .
PROMETHEUS REAL ESTATE GROUP PO BOX 693 04/28/2008
NE: SANITARY NO. CONTROL NO.
ARCHITEC ni NMNEER: BUILDING PERMIT INFO
WSHR&DRYR RTROFTS,KTCH&BTH BLDG ELECT PLUMB MECH
O O O O
300 LICENSED CONTRACIOR'SDECLARATION 7obDescription
rd eRrm cby& that I we Ikencd under pmNsioes of Chapter 9(commcming ^--^ •^-- ^ ^—^^^
with Section 70M)ofDiviuon Sof dte Business and Profewmas Code,and my wens,is
In full fame ane elm.
S ueenm Class Lia.0
Dam Contractor
0 ARCHITECT'S DECLARATION
1 understand my plan shall he used as public mcorde
J
5c Licensed Professional
,,, OWNER-BUILDER DECLARATION
1 bemby affirm that I em exempt from the Contractor's License TAW fat the
O o following moon.(Section 7031.5.Badness and Profcaainns Cade:Any city or county
9�+ which requires a Permit to construct,aitet.wprow,demolish,or mput,my mtructu.
ZS^ Prior in its issuance,sou mquims the applicant(orsuch permit to file a signed stammem
FF< that he isllnneedpawmtto the pmrimesofflue ca WsWelLiecom Law(Chapter 9 Sq.Ft.Floor Area Valuation
S9 (mmmemdni with Section 7000)Of Division S or the Due.and Professions Code)m
that he Is compo dtertfrom and de basis far dw alleged eumption.My violation of
Sevum 70513 by any applicant for a permit subjects the applicant to•dvil penalty of APN Number Occupancy e
not mom than Rw hundred dollars($500). P Type
0 T,uownerof0epmpety,amy=ploYeuwlthwaguu Nebm4com don.
wiUdo dewoh,and the swctum t rot imended oroBeed forsale(Sa.70N,BuJrcu
and Pmressioes code:The eanmtaes es ml WPIY M an LAW domane of Required Inspections
property aha buildamimprowa themn.and who dowsuch wank h ctualfor Waugh his
own employees,pmvlded that such improvemanu art not intended oroRertd formic.If,
however,the building Or improvement Is sold within oto year o(campla mm,the owner
Indictor will haw the battles of proving that w did not Ntild or impnm for purpose of
tile.).
0 1.u owner of the property.am ucludwlY conuming with 11"wed ammuatmn to
canna the pmjee(See.7064.Businm and Pm(esaiaes Code:)The Commences U.
mese Law does not apply in an owner of Property who builds or Improves desmon,and,
who moment far such projccu With a commmm(s)licensed pursuant m the Contractor-,
I.keme Law.
0 1 am tempt underSe. .B k P C fm thismo mn
owner Data
WORKER'S COMPENSATION DECLARATION
I hereby alnrm under penalty of Perjury one of the following dalamdoes:
I ham ave Will anaiown a Card law,or Cancern to alf-hare for Workers Cornier.
ewes.a provided for by an 5700 or the Labor code.fm the performance of the
works for wines Ws permit is Want.
0 1 haw and will maintain Workers Compensation Insurance,as required by Sewan
3700 of the Labor Code,for the performance crow work forwhich this permit is lured. '
My Worker's Compeesadon Wro acme artier and Polity number n:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
mrs smitm need out w completed Ifthe Pewit Is Isom huwredoodan($1010
or[am)
1 certify dant In the perfmmence of the wart for which this permit is mored.I shall not .'
mploy any person in my reactor an as in berme subject Inde Workers'Compensation
Laws of Calirmaw.Data
Millan.
NOTICE TO APPLICANT:If,star making this Cmificate of EmmPtion,you should
become subject to the Wodeh Campeesktion previsions of the LAW Code,you most
O raMwith comply with such provisions or this permit shall w named rewked.
Z� CONSIAUCfION LENDING AGENCY
F I hereby affirm that Nem is s construction lending agency for dte performan¢of
gk the wart for which this permit tissued(Sm.3197,Civ.C.)
W� 0 Lendees Name ,
z Lande's Address
U O 1 mdfy Nn I low read this appliwim and sum dw the above Information It
Iy^ cmrtcl I Gime m cvmplY with
JI dty and county and omen and mule Ian rthdng u
0 tS-J: Wilding mnwunion,aw hembY auNorim mPreaceutiwa of this city m enter upon the
W ahwe-mentimne0 Property far.. Pam en purpmea
(We)ago to saw,indemnify and keep hssmiess the City of Cupertino against
rap liabilities,judgment,emu and espeeses which may In my Way acme against said City
U 7 in consequence of the g main$of this permit.
t'7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppliesnmCantramr Dete
xAznRDoug MATERIALS DISCLOSUREomMai Type of Roof
WIII y t applicant m future building occupant atom m candle huardeud Sariai
u deBnetl by de Cupertino Municipal Cade.CMpter 9.13,W de Heslth and Sorely
code,senior 25532(a)1
Oyu ON. All roofs shall be inspected prior to any roofing material being installed.
WIII the applicant or future building occupant use equipment Or device which If a roof is installed without first obtaining an inspection,I agree to remove
I hu mind,air c roumiesnu as defined by the Bay Area Air Gustily Management all new materials for inspection.
win?
0Yes ONO
1 haw read the healloesm arias mquirementunder Chapter 6.95 of W Caiifor.
me Health&Safety Cade,Sadao 25705.25533 and 25534.1 understand the ifdu Wilding
does at currently how a mnant,that It is my respoeslNlity in notify W mupent of the
requirements which mum Wrat poor missuance oraceaEcaeorOccupancy. Signature of Applicant Date
Owner or suthamcd a put Dam: 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 . . . . . . . . : 36901026.116
DATE ISSUED. . . . . . . : 04/28/2008
RECEIPT # . . . . . . . . . : BS000004599
REFERENCE ID # . . . : 08040189
SITE ADDRESS . . . . . : 20380 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 FINCL SVCS IN
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
d�n� o l 89
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORION(aSUREWEST NET
Jobsite Address: 20380 STEVENS CREEK BLVD Date:3/4108
APT 116
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-026.11 �v Project Valuation: 39S 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: 4-1-2009
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card# : 3-11 .�(G•- 3i'7 y5)L''L�7
Name on Card: Orion Financial Services Inc.
Expiration Date: O I l j O
Visa 11 MasterCard 0 Discover 0 American Express 01—
BUILDING ADDRESS. PERMIT1 (�D q o 18 1
f/ IJIt
�OWNE0.S NAME:
P001rrISlIHDATE
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• AacNITBCraFNCInEER:
BURDulG PFRaIIT INFO
BLDG El ct-r PWMB MFL71
�p LICErISED CUNIRACTORS DFLI.IRATION Description
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O u Y, I Mmq af0m Jn l ran 6anNE paler wanicam aOapa 9(alsamdng Job Descri tion
< rairmbn lryDlnr Di.i;mrOru.Bmlmmw ROf6GIn6ILE0.WYr FifplbY p
in rm rola ana am" 7.47992
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a. C OEc
� wRAnON
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L` I uwuvaml my polo abal W,._.u ppbE.imlu
uD JU LicrncO Maraa�al
OWNER-BUILDER DELLA.ATIOM
.
Z O I InmCl,ITrm InN I am u[npl(bp yi[YIvaC10'!IkLO¢IJw Rf IN,Ia4xnn!rtaum,fS¢litsn lmis.Rui.r w P,ermw cmr.w.y coy s mm.y
waJ rNuxa+Pmmn m amaxt+Iv.vnPaw,c OOxaliN.a,Mmb ry m®m
ii lawmuiaumn.abts-uJU IN applicuu rnmN pmmilb BkadgaG mkaaml
_D uwaJlirt�.Ipn,:u,nlbJnPw�Im,nrJlcrm.PYnu�L,.«a�lm9 Sq.Ft Floor Area Valuation
o Immcamt•Jn NNuu,OpO)a Otutimp(a ft a alm wamm-twaor®mComaa
ScaiN I.a —h. il.dWlam(ml Mpuatsu abjcY Je apprioubacva pmuh>a APN Number m mam Jar a.w,m tsaw rsRm. Occupancy Type
I[]1.amw at.Pmm,l,a my MPWYcu wJB map,a Jav aae laypmumm,
Y En Je�raY.+M JCiWrlurt N W Y,pldt(proROfl fOdC ISIG)DM.B®m{
w 14x1—.a.Coat Tim raaraoY..mum La..m ww"b..mea Required Inspections
pr.prnY wW Wilda a mplaa Il.+.mt au.W EparN na5:binmfa Woyb by
mpY>m.PwYcts Jm m.a imprawau m m imbts.oamvaJ fade a,
Aaw,.r.Jn ewYiy w impesmal i.WE MJill ea nV NmaPYYpp.Oe exm-
WiYer.iB Ww J.WrOex a P• g WI W yY m bWIII a Impar fa puppb a
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a.m.ct u.pbjm(Sol.TING.B a .m Pla mala Cmc)TLe rirl[aat ud
au.s V.aaapply u an prnpany.W ba0b Imep Oemy W
I ,
.bmNl+it+aI aw.a ud Pp/ayWilli.caVamf.)Iii pVm pmplb00 CO®CM
as ..
p I un aaamp mYv s.. .B a r c ra lm.nm.
O.m Dam
WORKERS CDMPENSATION DFLI.a4AT10N
I M by alum um a anally of gamy am aJp following tsmvmlaac
wam Wlm.mm..+Cptir'..a Coln.NIN.fa Womwictsmpla
aapanm I.by fra.tsn]=aft l Cola:.fa Jnpaf.aIra
a• ra"mNa W.ywY R,--
�I Ww am will mNam waRal rarapcmaian Ya,vanlc M Wtim q Smipn
TlllBa J.Lam Cm.fa me pmawaa.atl.mule fa.airA Ibis pvmiu ims6
T
MyawgSr+t '�'E F NU Dc•�re Folia mmmuc an.., M,kyNo:238-00024 07
CERy1FICATEOF EXFJAPIIONFAON WORKFY4
j COMPENSATION INSVRA)J[E
("na.mxm.rrn maamNaW i1Nlumil urm`pNIma WW`NB-6100)
mall
I aniry wl In-pma—Q a u.wlxt ra.aira tWa Imit u ipnN.l Nall m
employanYRabembymba.rbaIYWma sabjmwJeW CNmINwmtb
w%
ANk +lifm�a am
KP l
NOr10E TO APPLICANT,If,Nm making Wa Cca a aarlpalom you.ballJ
Ovma mnjm, Inc WaRh imiws.0.4 pmwtlw a be 4 t Cub. mm
�z faJ.Ja.anpy wq1 soca pwwra a IAV Avail WR W Opeer raot6 .
�2 CONSiRUCr10N UND0K)AGENCY
N Lkm.,aRiw um m.rtuacmavmiw kaaBlagapncy fa Jmpmama¢a .. .-
7u..urtlw+niin Ju.emx Y�ml.J lyre]WI.CF.C.I
LIQIL e,Namn.
z I-H.Anmoa
Q IRnlry matIlowratsIb11,I1lum.&N.tatN,Jm+bRIaamliak
slam I apa m amply axn,11 aly W Lowy aanam am luN Ymi lybtiaR Y
�~ Wibiall.muu'Imnacl Wou,antis mPa'—Num a mu k,m Nur atupC
-.a ma pMr ,fa i [NONE Tawara
(Wc)at.b M,.immunity am 1aP WlmkM IN City 0(CIPMimy Wink
C. 14bilu Nt .cros+.eapapa yYymlc Wim.all"
a n
Z APPLICA pm wiltN WyTN Au.Ngm MW ]cued by: Date
SOU0.[E noNt.
Re-roofs
Baa..aApl.HAZARDD0tli MATFIIALS DE;G%Gs LRE Type of Roof
j will p.apliaa.la..."itug mawntmc alt.—I.bmlime-mato
u aB.J y IN CxPmr MtmNlMl Cm,Cam.m 9.11 am ba Hd0 a!Sa.p
C.,s l a WINA? All roofs shall be inspected prior to any roofing material being installed.
❑y.. )m,(W
Will la alannal.elm Wiwing mvp+a m aNitpum a minim melee If a roof is installed without first obtaining an inspection,I agree to remove
u..air aaam-nm a,hBa l nr J.my Art,Ail owln Maaprn0r all new, s for mspecti n.
r
IW.. Walamay.riaB vaNncs,.+N Im0a0upv 695aJ.oww
_ mNaWb C*N.SNm t25 Immanatl Daum Wl6ay
Jas ran. ry m mNdfyte®n.Ndf
t Immm catifo� Signature of Applicant Date
wv m.xmmuJ a n rSi
te All roof coverings to be Class"B"or better
• 10300 Tom Avenue
Cup
5014
honec(40 )7 93228
Telephone(408)777-3228
w Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS:20380 STEVENS CREEK BLVD PHRMrr# O�j (J o Q
I CUPERTINO, CA 95014 0 -I Q
QWNER'SNAMB:PRONETHEUS REAL ESTATE GROUP' PHONE#(916)789-8484
GENERAL CONTRACTORSTEVE WHITESIDES FAX#(41 789-1051
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following 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
Insulation
Landscaping I
Lang
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing .
Roofing
Septic Tank
Sheet Metal
Sheet Rock
T'
• Owner/Contra or.Signature Date