08120001 CITY OF CUPERTINO + -
UILDINGDIVISION PERMIT CON"CRACTURIN 'OTtMATION
BUILDING ADDRESS: PERMIT NO.
20350 STEVENS CREEK BLVD APT ORION FINANCIAL SERVICES o8i9nnni
OW N€UIIAME: PERMIT ISSUE DATE
NE: - A WG98 CONTROL NO.
(916) 789-8484
ARCHRECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MBCH
30, LICENSED CONTRACTOR'S DECLARATION IOb Description
1 hoully"on that 1 am Occulted under ptdm
ons of Chapter 9(comencing
wNSection7").fDivislon3afdteRostrum,andFrofusiwaCuts.andmylicenceis
±oH nfull ro=and drm. WSHR & DRYR RETROFITS,KTCHN&BTH CABNT &, CNTR TOP
P Z License Clasp Lk.
g— Dam Cmtrascar UPGRD; DUCTLSS SPLT SYS; HVAC RETROFIT
ARCHITECTS DECLARATION
o V 1 understand my plus shall be use!as public meeNs
a
g G Limnttd Professiond
3
OWNER-BUILDER DECLARATION
.�<S 1 humblymason.
.(Tire on I e1.exempt from Um ConoCo Resew ty O for nw
00 following moon.(Scion 703 L4 Bush...and Professionsde Co dc:Any city alroomy
$ which its ensuocs•pc.it to reqalsecMuires
aiter.impmw,deermit nr alio el comment
pd.bitaisswnm.also
mall Wim dteapplkant for such pamitbIt accam Law
alhNmcnt
E G that(comae licensed pursuant b Nc of Division
3 dmceBuxmsand Professions
(Chapm9 Sq.Ft.Floor Area Valuation
$ due he is
with Section70X))and ofWll 3Of al c,cBusiness and.Any
l.6,Coa.of $3900
_ Nu he b emmpl n...from and the bash for IW ailc8ed emmptlam Any violafon of
Salim 7M"by any applicant for.Permit subjects the applicant to a gvil penalty of APN Number Occupancy Type
out mere doer Tow hundred dollar,(SIM 36901021 . 107
❑Lo ownerof fu:ryopmy,mmY emplendes withwageuateo ant m .Buss rte,
wail dathewort and the heC coboar'ktended Lawdofamk(Sid.us an Buser,of
plod ery wh ons Cullen The CmoubYs and
who Law dao Out apply lf rt ower, is Requited Inspections
Own cro who builds aimprowuch im n,prem a is dm ssOchwurk himuVor forage his
owncm.meea,ping or Nnsuch improwmmu tame year ltal fcaroRenud ror roles,
however.Ne building a i le owmenl b that
within ane acid!of hollow,
the owner-
Wilda will low fte When of pvvke fat W did ret Wad a improve[a purpose of
0 I.as caner of the property arm mclustwly contracting with licensed mntraclai to
cmuums the project(Sec.70th.Business and Prafeauans Code:)The Connamts U.
come Law does not apply to an owner of properly who Wilda or Improves Nemo..and
who contacts for such projects with a ronuactor(s)licensed pursuant to the,Convector's
License Law.
O lameaemptundersee .B$PCfmfluO.n
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ate of the following decimation -
I haw and will maintain•Cenifomm of Consent o elf-insum for WorMfsCompcn-
uon,u provided for by Section 3700 of the IAba Code.for the perfamance of thc
work for which this Permit is issued
0 1 haw and will maintain Workces Compensation Insurer,as wished by Section
3700 of the laWr Code,for do performance Often amt for which Nb permit is lou W, '
My Workers Comprswtim Inmraiax artier and Policy number am:
Carrier. Paltry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissecom need retbecompktud UNe permit bfaonchunmcd dollars(SIOM
or Ism.)
1 certify fat in use pcdf n m.c Of the work for which this Permit in issued.l chair'ma
employ any person In any maener an o b became subject as the Workers'Canpewdon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after mating this CcnlRote of Eacmption,you should
become subject to the Waters Canperts uon pmvivau of due IAhor Code,you mon
.J z forthwith comply with such provisions or this Permit shall W deemed ranted.
z CONMUC71ON LENDING AGENCY
[-oma Ihembya .then Nem is a comuuctim Leming agency,for tlm penfamuae of
tYi ti
One woe for which tuts permit in bound(Sec.3097,Civ.C.)
A 1<ndcfs Name
z Lender's Address
U O 1 cedify that 1 Mw mad Nis spplieano.and sant Nu the show iNamaOn.b
D, comeM 1 agree be comply with all qty and county ordinmces and sum laws minting to
-0 building construction,and herebyauNones mpmuanuiw of Nb city to now upon the
r[17 ahow-mentiaend property for inspection puryaex
y (We)agree to saw.indemnify and soup hamkm One,Cly of Cupcnom against
F h liabilities,judgments.costs and expenses which may In my way ammo against mid City
U z in conMgunncc of the granting of this permit.
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature o(ApplinHAZARDOUS
Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will y t applicant a ro building atnawk om hatoward.toward.toward.material
m deMm by dte Cupertino MunicipalCode.e.Chapter 9.11,and the Health and Safety -
cak. y.255324)?255324)? ❑Na
0All roofs shall be inspected prior to any roofing material being installed.
Yea
Will No applicant or future building Occupant use equipment a devices welch If a roof is installed without first obtaining an inspection,I agree to remove
'l hvudo.air conuminanta m defad by the Bay Area Air Quality Management all new materials for inspection.
he
pro ONO
I haw mad the hamNmus materials requiremcros under Chapter 6.95 of Ne Califa-
nb Health&SafoyCode,Sections 15X05.M533 stat 5534.1 mdersund fw V me handing
does not currently haw a mama dost it b my responsibility to remit,use acupani Of the
requirements which most W met prior to imuvwc ofa CenuGcate of Occupancy. Signature Of Applicant Date
Owimr a antharivcd agent Dam'
All roof coverings to be Class'W or better
CITY OF CUPERTINO
• 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901021. 107
DATE ISSUED. . . . . . . : 12/01/2008
RECEIPT # . . . . . . . . . : BS000006708
REFERENCE ID # . . . : 08120001
SITE ADDRESS . . . . . : 20350 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 FINANCIAL
. 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 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
�gi� 000l
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
• E-Mail ORION(cb.SUREWEST.NET
Jobsite Address: 20350 STEVENS CREEK BLVD Date: 11/3/08
APT 107
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN # : 369-01-026 Project Valuation: $3900.00
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 Carder:STATE FUND Exp. Date: 4-1-2009
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card#:
Name on Card: Orion Financial Services Inc.
Expiration Date: 01/12
Visa ❑ MasterCard ❑ Discover ❑ American Express ■
•