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09010020 7777 CITY OF CUPERTINO BUILDING DIVISION PERMIT NFOR 4 TINY PERMIT NO. BUILDING ADDRESS: 2 350 STEVENS CREEK RIAM APT QRIQN..Eil��!,�,i��!,,,i''��'C-I,i�'�!,�.-L PERMIT ISSUE DATE OWNrIT1 AME: A 8 9 CONTROL NO. to (916) 789-8484 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 Ll p C LICENSED CONTRACTOR'S DECLARATION Job Description iw C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code.and my license is '<y in full force and effect. WSHRY&DRYR RETROFTS,KTCHN&BTH CBNT & CNTRTOP ;�z License Class Contractor UPGRD, DCTLESS SPLTSYS,HVAC RETROFIT ±F Date Contractor ARCHITECTS DECLARATION -a I understand my plans shall be used at public records DyU n.y Licensed Professional n y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the p o following reason.(Section 703 1.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation G that he is licensed pursuant to the provisions o(thc Contractor's License Law(Chapter 9 Sq t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3900 > that he is exempt therefrom and the basis for the alleged exemption.Any violation of - Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars(6500)• 36901021 . 113 [11,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Cade:The Contractors License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workers Compen- ..ion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as inquired by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i(the permit is for one hundred dollars($100) or Icss.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must ,J 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z 0-4 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a.7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lendces Name Z Lenders Address V C) I certify that I have read this application and state that the above information is LL E" corecL I agree to comply with all city and county ordinances and state laws relating to oU building construction.and hereby authorize representatives of this city to enter upon the >4 LTa above-mentioned property for inspection purposes. 04 (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. fi ❑Yes ❑No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. ,trict? ❑Yes ❑No 1 have read the hazardous materials requirements undcrChaptcr6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class'V'or better Owner or authorized agent Date Lrq 0 � CITY OF CUPERTINO BUILDING PERMIT APPLICATION E-Mail ORION(dSUREWEST.NET Jobsite Address: 20350 STEVENS CREEK BLVD Date: 1/7/09 APT 113 Owner's Name:PROMETHEUS REAL ESTATE GROUP Phone No.:(408)253-7100 APN# : 369-01-02 , 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 Worker's Comp.#: 238-0002445-07 Carrier: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 0 MasterCard 0 Discover 13 American Express M CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36901021.113 DATE ISSUED. . . . . . . : 01/07/2009 RECEIPT # . . . . . . . . . . BS000006913 REFERENCE ID # . . . : 09010020 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 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 ---------- ------------- ---------- ---------- - --------- -- 1BCBSC VALUATION 3, 900 . 00 1 . 00 0 . 00 1 . 00 0 . 00 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 ---- - ------0_00 ---------- ---------- - TOTAL PERMIT 531 . 80 0 . 00 531 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 531. 80 VISA --------------- TOTAL RECEIPT 531. 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