08040190 CITY
OF CUPERTINO
BUILDII IC DIVISION PERNUT CU1�ITfRACTtQR INFUItMATIQN'"
oat ° 'Re,?v.!.. •+ `�.ez�"S ver. '"�.. >;#a I A
Bm.lzilin.,apt5g51TEVENS CREEK BLVD APT ORION FINANCIAL SERVICES P�08040190
OW=LU.5AMUE: FERMIT ISSUE DATE
PROMETHEUS REAL ESTATE GROUP PO BOX 693 04/28/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECf/WGINEER: BUILDING PERMRINFO
lam
WSHR&DRYR RTROFTS, KTCH&BTH - O O O
30� LICENSED CONTRACTOR'S DECLARATIONJob Description
1 hereby affirm Nu 1 un Iimneed under Provisions of Chapter 9(commencing ^••^ •^'� ^ -----
i� with Section 70)10 of Division 7 offt BusircasW Prafcadom Code,aW my lccnm is
^ in fall forte sed effda
DOE uceac am Lic.0
S Dam Contractor
e ARCHTIECI'S DECLARATION
y 1 understand my plans Mall net used As Public nems
T
S ud�
Licensed Professional
OWNER-BUILDER DECLARATION
<9 I hcmby.allimSec Nat 11. exempt from the r"shms7ars umnse taw for the
yOO following reason.(Sutton 701.5. 4Alan and RofaWons Code:Any oily tcaunty
IRE! which nqulma•Permit to ennumet.alcor.improve,do permit
t ererepairsig any auueatro
S^ Primtoits Issuance,
ensed'alsongnave theapplicantfor each Permitm.Manedaatter9
< thehtamemivWpurmmtmNepmvivisio ofNeC^nuacmrendProfLaw
onCMpw9 Sq.F[. Floor Area Valuation
(can$ and W Is meant SeWou7nnal of Division 3 of theaFed essandon.Any s Code)
of
^ Nat he u exempt IMn(rom W de basis for the alle{m exception.Any NW Won of
Stu fian 7031.5 by airy appliant for a Permit subjects the applicant to a civil penalty a APN Number Occupancy Type
WA man Nan five hundred dollars(1500).
OLu.wnuof Nn Property,amyemployeeswithwageu Ne(S=. W.BusiUon,
and Pr senwh,and the W Cont U rtor,Li ded Of Law
dos.1 Apply 0 an Budws
and my who lu code One CmuectoM1 nd who law doh art apply m nt Owner of Required Inspections
own err who b�na mimpotsu cMmn,md who are not
himselled Waugh his
own employees,provided than vela improvements in not ounded m.Rued(male r.
however.the building or impmprovinissold whin am Wild
of mpoWaq doe owner.
Askldu will have the harden of proving that he did mm halal a improv for pugem of
O L As owner of the property,am helmivell,contracting with Vetoed ammucmn to
Aanstrut Use Project(Sec 70M,Buurlm and Profhslmu Cadu)Tho Contractors u-
«ere Taw does not apply on an owner of property who builds or Improves Nunn.and
who contacts far such projects with A contrutou(s)licensed porous.,m the Communicates
Lmnnse Law.
O l um exempt under Set .B Aa PC far this noon
Ower Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the folsont decluuimu:
1 ham and will malnuin•CeWOesmof autumn in elf-Insure far Workers Campcn-
udon,
As provided for by Section 3700 of the tabor Code,far W performance:of the
wort fm which this permit is round.
O 1 have and will munuin Worker's Compmwdon Insurance,As required by Section
3700 of W tabor Code,fou de pcRarmuue of the were,for which Jus permit is leant.
My Workers Compensation Insunnca carrier and Policy number ere:
Cartier, Policy No.:
CERTIFICATE OF MEMFI70N FROM WORKERS'
COMPENSATION INSURANCE
(rds sect rrecE rot bacomPlcetl Uthe permit is return hundred donan(SIM)
or leu)
1 certify that In the performance of Ne wort for which this permit is luucd.l Mall not
employ any Pecan in my mmmtm As m became subject to the Warkeui Compenhdon
Laws of Califomia.Data
Applieam
NOTICE TO APPLICANT.If. net making this Ceminoe of Exemption,you Mould
become subject to the Workeh Compensation provisions of On Tabor Cade.you mus
0z
foMwith comply with such provisions or this permit Mtll he deemed rnokcd.
.zr y CONSTRUCTION LENDING AGENCY
('+ Ihanhy aflmJut Nem la a consuacumr lending agency for the perfmman¢or
Cthe work for which this permit Is bound(Seo 3097.Civ.C.)
W Landers Nana
.s.7. z Leaders Addrtas
U0 1 coWTy that i have mad this Application and sum that Je Above Information is
L.! cornu.I agree m comply with all city and county oNlmuu and June laws missing m
0 SV' trAidin{conwucuan,and hereby mthoum repnrnutiv of this city to enter upon the
D.1 shove-mmtiomd property for Inspection purposes.
0. (We)carte m ave,indemnify and keep hamkss the City of Cetera..against
(VI Ilmi1PJes,judgmonlacosts and upensem which may in my way accrue against said City
617a incomequence of the granting of this Permit.
r� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Si{noun of AppliesDam
HAZARDOUS
S MATERIALS DISCLOSURE Type of Roof
WIII yt e Cupertino
der fMun adding Co attupantaon mhaddk hahNens material
As de0ned by the Cupe.ina Municipal Code.Chapter 9.13,roti Jon Health mtl Safety
Cade.Suction 35533(.)7 All roofs shall be inspected prior to any roofing material being.installed.
❑Yes ON.
WIII the Applicant or future building occupant use equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
tt hv.Wam air conumiunts u defined by the Bay Ana Air Quality Management all new materials for inspection.
istrict7
0Ims 0 N
L hove mW dom nua,tlous materials requirements undcrClupmr 6.95 afde Califor.
nla Hhlth k Safety code.Smiw35505P 35533 And 25534.1 urtivswd and if Ne Wilding
doh Out currently have A moan,Jut it is my mpoeslNlitY m rmdfy de occupant of Je
requirements which mus W mem pilar to iuuaae of A Ccnificam ofOccupancy. Signature Of Applicant Date
Game,.,anthmanal.10 t Data All roof coverings to be Class'/Q"or better
CITY OF CUPERTINO
• 8 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901026.216
DATE ISSUED. . . . . . . : 04/28/2008
RECEIPT # . . . . . . . . . : BS000004599
REFERENCE ID # . . . : . 08040190
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 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
1TRAVD0C FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 530.80 0. 00 530 . 80 0 . 00
oeoq olgo
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORION(o)SUREWEST.NET
Jobsite Address: 20380 STEVENS CREEK BLVD Date:3/4/08
APT 216
Owners Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-026 P Z( (p Project Valuation: 3900.0
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 Carder:STATE FUND Exp. Date: 4-1-2009
Cupertino Business License*
CREDIT CARD INFORMATION
Credit Card# : 31h 3 X75 t'� C� �j ip29'
Name on Card: Orion Financial Services Inc.
Expiration Date: b 1 1 1 b
Visa 13 MasterCard 0 Discover 0 American Express f�.
{UIIDINO ADDRESSo
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�I
JOWNERTNAME:
PHOOrMMOATE
NE
OLOG
�'�Y� CONfRp,No
• MCHITECfIENGINEER:
BUIIDtNG PFSMR INFD
^Ip LICENSED CVNIRARORS DECLARATION RUMB MFI]I
"�- I tnctry aff mm I am Iiantd nmfm'bywe.It Ncbe 9(tmmNCR Job Desc
mBsalm TDmldoi.ie®)N'K Bmma aid Pmfetium CoEe,¢tl myGmwu riP
tion
3. mrmdame"" B 7,47992
ua.�aaa Ijt.{
ARcxrrrrrs DEcuRAnoN
' y� I umuaaee my plats dull K utN u Nnst aaaam
�u
o< a__e PnYaawal
OWNER-BUII-0E0.DECIw..
<'e I,mal alTam Ina I un.acdM fdd IK Carvact°/t IJAb, b fm U y
p a raknnt maa"A rsmwl Ml l.s.anon.[n RNv b.by Pa .m awy
vnun¢yvm.Pmnn m a.IW nl'm.imPaac emwu,by Paw m)mrcnw
zi Pnammiauarce.amu renuiea lM apPlieuA fa and pvmilm(ka GircAAaleil
�0 nalK Wgi ,pu 'o TODD)a fa 3meC 3m bgbkrnmlar(Clmp'm9 S Ft Floor Arra
e (cmlrcrcmt^'t Scion)OOD7NOir'umn]dIKO®nm.atlMN®K.Gec7m q' Valuation
3 mu K n I.S b maeW YN IY mO fd ei alet¢I Ca®;iat W.6,11p .n p(
Swan lB1I}h vy appliaK I..pmnil NOjea Ik:appfioa b t u°R Imtn er APN Number
Iml mPe m.n a.e Nmdaemw(sIDBs Occupancy Type
It]l.uo-rca°I'K pmpen).d my anM-Y vimvaYpuamutnlemnVtmlim. .
Ilouc.ak.mNe¢t¢ucmm la w aI aR. fmdn(saeWW.8®um
me fr Y-M c°m:Ty¢CRn¢aanr. U.ucm ."t WWI,insc n M Rrm N Required Inspections
P°Pn>vK bamaallnp°nu'b un Wvim euu auW vat ti,W bINmo(p Mt
aPmYau.Pmbce mm ama mlyun eln biI ip W inr+dea dnDval feaate k
ne..vf.'an trlein{minPlnaao'is wa alma aimfWa rqa N xa p D•aw
luilnV N4 M1am Ur Kaes N Pan^nt mal K ek nm laeb m imlays fFI^ppm N
akl_
❑1.a arcr N Y¢Pnpm),am u41mrelY eauaeain{vim UdAaaY m
mn'Na nc pmjrt IScc TOM,Buarca ttl ravf®mt CRac)Tet CM.M.1;I.I.
ews V.ed.am apply r an°.ales d Pm{m'Y vPn hoBea mimpn+sa Rmma W.
vbmnruu fd xla Pojaa vim a cvuamNlal rlmue0 painammmammCM
Liald 4v.
p Tan aacmP llndl$tt .Bt YCfd mbrOmC
Ovnu Dam
W 00.KEAT COMP4JSATION DECUItAT10N
I Pucny aPan mukr KMIU of pmyury elm N IK fdbWa{ealutllonc
w ane Wl wmulnaC ifcm dCRncmm sar.luma faw*i 'C�
nu pmnmY IM by ucnm 17011 d ae ub C.for me eeRPaoaa N ma
�..ulk(P.III[II In¢PrrnY 61 6
• O 1 M¢W vin ma'axr WbMy',Cmalm .InmaAc.u ,t G by SrLiN
]TBdurt lam fwd fu¢c pul¢mada d me w ld.11idbm&P kalm¢6
Gw"ff1 FNU D..Fah.,238-00024 07
CE1[nFICAT£OF EKEMMW FARM WQ1iU=
j COMIQ+SATION INSIIRA)1Q
fnu umrm Kn nmK campk¢e xm Ie'nU iafamemeleemmt RI WI
d Taal
I[enify mal m ue pvf°muan N me wort fm vNm Ilw Ivmil u iNm1 I LItO as '
unpby any peram In my mmrcrm um Kmne AIBJm IR'An WaImFGmpelmUo{
faam dCnlifmra w¢
App
NOnCE TO A�GNT:I1. a
k aAP matin[mit Cs N Er®pa°a yna tLmM
t anjm r IWatrla CmKmaaa Pw:tlNa N IK labf CnOe.P snla
�Z ferua4tculP)rut such Pmitimi a e:.pwil tm0 be mY moh6
�2 CONSTAU 0140 Owo AGENCY
�4 IAuenY affirm aw mc¢as mauuafm knWnttteKY fame fmfmmt a .. .
_7 uc.ura Iur.Fw1 rnu°erina u Iv"ee ISae YRT.CM C.1
Q lomeft Name.
j 7- IINN's berva
O I maty mal I Mm lawn wa apNimaw..e wm Nat Nc nbm lafdmuim a
^ cnnm I a{me u r ply vW JI mY aM mmlY ermllvam W Pm kw dtain{m
nuimatcKamnm..abK¢ty aubim nPma^'a^u Nmia citY'mav°Fml me
a•LI a1m..mcmwlee PmFP'Y for inai¢mlu Nry°ma
f Wcl atnz m a.e il�amnify uE k,,i M1umleu me CNy N Clmmiu a{a¢m
v y fuNli¢A Plot
M .c¢N a.euynlaa qu 1�ac a{MwtY{OO �
ALICA N N WIYaI ALL N {ptT pM•i0Issued by: IIale
SOURCE TIONS.
_ Re-roofs
SGrPc dAtp
HA Iff)0us MATEIUACS DISCCOMILE Type of Roof
Will'.M C.onl.bbW lc
x\pmllamem"ftEtLfemmmsdm
mfiNn n)IK Cummn NmiiNl G"ec Clyxm 9.11 ln{Bm Ndm aC Safep
care"'m'm.ssssAan ,.,r All roofs shall be inspected prior to any roofing material being installed.
pm bom
Will ea aaavam or m'um Wileint cc np al a m Qa WWII If a roof is installed without first obtaining an inspection,I agree w remove
awemm mr cmlam'mat N ueanrp
by me w)Am Aa owiry Mein M all new ials for inspeeti n.
Y!
❑Yu
Imm mzamvamrviNamN.ralenu'nlc CNmv6{sNme CaBNn
m Hum4 CmtSaor35 .I nneaaaAtm8Y kd6l{
— IWtaid[ n mKtirylRanm�aame —ZC _'L
A °" coram Signature of Applicant Date
W,nlnmaea P r m All roof coverings to be Class"B"or better
10300 Tom Avenue
Cupertino 95014
Telepbone Lone(4(4 08))777-3228
WOF Fix(408)777-3333
• CUPERTINO
Building De arbnent
JOB ADDRESS:20380 STEVENS CREEK BLVD PERbm#
CUPERTINO, CA 95014 0 I
OWNHR'SNAME:PROMETHEUS REAL ESTATE GROUP' PHONE#(916)789-8484
GETIERALCONTRACTOR:STEVE WHITESIDES FAX#(916)789-1051
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
j Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
x Heating SAN JOSE AIR (1408)286-2047
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
f Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
T'
ti
Owner/Contra or.Signature Date