08110009 CITY OF CUPERTINO n�,pvi w�> :a4x ks�.-r es��ayTigzp "= ♦ 'T l�Ts
BUILDING DIVISION PERMIT C01rITRACTOR IIY.CQt1.�Ad1♦ '^
BUILDING ADDRESS: PERMITNO.
2
OWNSIPERMIT ISSUE DATE
yht�QMETHFUS REAT:, ESTATE 8R8UP PG BOX 693 O A 6 8 CONTROL NO.
916) 789-8484
ARCHTIECf/ErgGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATIONJpb DescriptionU 1 hereby strum Nat 1 am Imposed d
seer provisions chapter apter 9(commencing
with Section 7IXM))of Divisor 3 o the Busnev and Professions Code.and my license is
; N in full ram am affect. WSHR&DRYR RETROFTS, KTCHN&BTH CBNT & CNTR TOP
z f.i¢vc Clan Lle.{
gra Dam Contracor UPGRD; DCTLESS SPLT SYS; HVAC RETROFIT
e uuuy��� ARCHITECTS DECLARATION
< I uMuvaml my plans be used v public records
?
Been d Professional
'' OWair,. NER-B UILDERDECLARATION
j<E 1 hereby arm Nr 1 am aempt from than ConumWs License law for the
D O following onsum,m,(Sation 70713,Business and Professions Code:Any city ar county
C
$ff which require a Permit th cmuuwt.also.impmse,demolish,an repair my structure
Lzi prior to its issuance.aRo require the APPlicam rat such permit In file a signed seremem
<
theas W is Hectored porshoutt to the provisions of the Commatter's Uoaraec Law chapac,9 Sq.FL Floor Area Valuation
y�$ (commencing with Section 700(3)of Division 7 of Ute Business and Phafcssiov Cods)at
s
that Ise u amnpt rberefroanthe,m d basis for Ne alleged ammpdam My vlolauan of $3900
Section 7071.5 by my appllant far a permit subjects the applicant In a civil penalty of APN Number Occupancy Type
nm come Nm BK hundred dollar.(Sams
36901021 . 518
❑L at manna'of ma property,many employees with wages aio desole ccumpevadw,
will do thework.and themmoum is Out intended aroffecad fersale(Sce.71344.Business
and Protrusions code:That conmemrs Liam a nem law thet apply an owner of Required Inspections
property aha builds or emphases Nermn,and wM does such work Aimsell.r Nrou{h hu
awnem,theailding ri improvement
one
im ofcm.Rcrd for vial
Wildar r,the ana ith i m improvement Y cold within one yea or completion.the owe of
bauaa tum n,se Ne burticn or proving sew it ata rot balm or improve for purpose of
❑I.a awns of its,property am a.han ely con ommi,with licensed conuvtms to
construes Um project(Sec.7044.Business and Prefessov Cade:)The Conuaemr's Li.
ecnue Law does not apply m an owner of property who builds or improves Nemw,and,
who conmcu for such projects with a conhacthr(s)Im msed pumumt M rhe Conuactots
License Law.
❑lumaemptundm See ,B&PCror Nismasan
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby allirm under pensty of periury one of the following declaration,:
I have and will maintain.Coulials of Covent to self-inure far WmkehCommon-
"on,as provided for by Section 7700 of Ne labor Cade,for the performance of the
work for which this permit is issued.
❑1 hale and will msnWn Woft(.Composed..Wur .as mluired by Section
77(0 of the Labor Code.far the performance.(the wok for which Nis Permit is ivwd.
My Worker's Compensation Tnsurmae artier mal Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fThu account reed wtbecmnplamd Iflhe permit is[mane hundred dollars nIOU)
or less)
1 anify that in Ne terformawe of Ne work rot which Nis permit is issued.I shall am
employ anypermn in my meaner an at to become subject ut the Workers'Compcmdon
Taws of Caliromia Dam
Applicant
NOTICE TO APPLICANT:IL after missing this Certificate of Ecamption,you Owl;
become subject to the Worker's Compensation provisions of the tabun Code,You muse
.J O forthwith comply with each provisums or Nu permit shall be occurred ated.
Z` CONSTAUCIONLENDINOAI3ENCY
[--t Ihereby air=NU Vert u a construction waling ageray for thepMarmanco of
Cthe wok for which than Permit is isued(See 7097.Civ.C.7
cnd
W�0 Lels Name
a Z Icedees Address
U O 1 roti!,Nn T have rad his application tum sum than the show information is
D.F Wilding
ildin I spa ct comely with all airy mal county amadws of and stats Ian relating e
-� WildingconmwtproeM herobmcucumimmoesca. tivesof Nu city mcnmupun Ne
r W aMse-mentioned to saw.Tim ivpecuad purposes
G (We)spam svva,indemnify and keep harmlw use City of ..amino sgsvt
U to incaida.jd{mwts,c.auand ape�a which mey In any nyamue aisvl via City
U z A APPLICANT
of the RSTAN of this pu WI
^' APPLICANT ULATIONANOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
signmareornppban
erData
S MATERIALS Occup DISCLOSURE Type of Roof
ally LiteCupertino
no forum Wilding acouPant r.re orrand the
NUNomd Seel l
c darned by a Cupertino Municipal Cade.�tapmr 9.17.roti the Hevlth and Safety
oda.Sedan zs572(.)7 Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will me apprncmt or future building Occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hmamnus air contaminants as,dcfrnd by the Bay Area Air Quality Management all new materials for inspection.
erste@
❑Yes ON.
I hoverod thehvardnwm 6alamquimmenuunder Chvpmr6.95ofN Colifor-
.sH.IM&Safely Codc.Scdw25505.27533.d2 574. Wilding
does not currently hoc a mnam Nat it is my respovihiliry to notify the Occupant or Ne
requirements which most WMet prim Wissuance ofaCertificate ofOccupancy. Signature of Applicant Date
Owner or authmncd agent Dom All roof coverings to be Class's*'or better
CITY OF CUPERTINO
� 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . .. 36901021 . 518
DATE ISSUED. . . . . . . : 11/03/2008
RECEIPT #. . . . . . . . . : BS000006533
REFERENCE ID # . . . : 08110009
SITE ADDRESS . . . . . : 20350 STEVENS CREEK BLVD APT 5
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
IELECINSP 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
IMPERMITFE 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 AMEX
---------------
TOTAL RECEIPT 530. 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------ -------------------- -------- ----------------------------
100 FOOTINGS 102 PIERS
104 REBAR 301 ROUGH PLUMBING
302 TUB & OR SHOWER 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 305 FRAME
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
off// 0�� 9
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORION(U)SUREWEST NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 11/3/08
APT 518
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-0251, 5)g Project Valuation: $3900.00
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
Workers Comp.#: 238-0002445-07 Carrier:STATE FUND Exp, Date: 4-1-2009
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card#: 3717 363174 51029
Name on Card: Orion Financial Services Inc
Expiration Date: 01/12
Visa ❑ MasterCard 0 Discover ❑ American Express ■