10100190 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20350 STEVENS CREEK BLVD APT 316 SERVICESON RATOR:ORION FINANCIAL PERMIT NO: 10100190
"'NER'S NAME: PROMETHEUS
PO B(N 693 DATE ISSUED: 10/26/2010
OWNER'S PHONE: 6509313457
ROSE VILLE,CA 95678 PHONE NO:(916)789-8484
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB
License Class /3 Lic.# 7 y 7 l MECH F RESIDENTIAL r COMMERCIAL
Contractor
�F �^C;)l? Date 10 X2, !�
JOB DESCRIPTION:ADD A/C SPLIT UNIT&REMODEL KITCHEN
I hereby affirm that I am licensed under the provisions of Chapter 9 BATH mWOM
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,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 Worker's Compensation Insurance,as provided for by Sq,FFloor Area: Valuation:$3900
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:36901021.316 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses w . h e against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permi' diti ly,the applicant understands and will comply
with all non-point s rce re i s per the Cupertino Municipal Code,Section
9.18. Issu:d by: Date:�G�2.
c- -nature Date o a 0 C 7
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
All r)ofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of insta[led without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: insp,xtion.
I,as owner of the property,or my employees with wages as their sole compensation, Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant:
Business&Professions Code) —
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Cal fornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. con pliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Saf:ty Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use eq ipm t or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by e y Area Air Quality Management District I will
permit is issued. maintain complia upertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall He:Lith&Safe � o c' ns 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I ON ner or a ed g t: Date: Q
become subject to the Worker's Compensation provisions of the Labor Code,I must —
-20
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hcreby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Le'der's Name
to building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save Le rder's Address
mify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I u nderstand my plans shall be used as public records.
9.18.
Li sensed Professional
Signature Date
CITY OF CUP:ERTINO
9 ITEMS OF 9 PERMIT RE'-EIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: LDt:
APN . . . . . . . . : 36901021 .316
DATE ISSUED. . . . . . . : 10/26/2010
RECEIPT #. . . . . . • • • : BS000011849
REFERENCE ID # . . . : 10100190
SITE ADDRESS 20350 STEVENS CREEK BLVD APT 3
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER PROME-HEUS
ADDRESS 1900 NORFOLK ST STE 150
CITY/STATE/ZIP . . . : SAN MJ=O, CA 94403
RECEIVED FROM ORIOE FINANCIAL
I A CIDESSERLIC # 29564
CONTRACTOR . . . . . .
COMPANY . . . . . . . . . . : ORION FINANCIAL SERVICES
ADDRESS : PO BO:� 6.93
CITY/STATE/ZIP . . . : ROSEVILLE, CA 95678
TELEPHONE . . . . . . . . : (916) 789-8484
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL-
---------- -------------
---------- ----------
----------
----
00
1BCBSC VALUATION 3, 900 . 00 1 . 00 0 .00 1. 00 0 •
1BSEISMICR VALUATION 3, 900 . 00 0 .50 0 .00 0 . 50 0 .00
1ELECINSP HOUR 1. 00 126 . 00 0 . 00 126 . 00 0 .00
lEPERMITFE FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 .00
1MECHINSP HOUR 1. 00 126 .00 0 .00 126 . 00 0 .00
1MPERMITFE FLAT RATE 1. 00 42 .00 0.00 42 .00 0 . 00
1PLMBINSP HOURS 1. 00 126 . 00 0 .00 126 . 00 0 . 00
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 ------0_00
---- ------ ---------- ----------
TOTAL PERMIT 547 .50 0 . 00 547.50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-----------------
--------------- ---------------
CREDIT CARD 547 .50 `TISA
---------------
TOTAL RECEIPT 547 . 50
VOICE ID DESCRIPTION VOICE ID -------DESCRIPTION
------
_ ------ - -----------
--
--
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304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
512 FINAL HANDI-CAP
CITY OF CUF'ERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN:
BP#: "VALUATION: $1 0
5
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition `
PRIMARY
7_0 7.111, ___JPENTAMATION 1 REAP 10
USE: SFD or Duplex /"1'001\1 41,x,1, PERMIT TYPE:
WORK
SCOPE
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00
Mech.Permit Fee: 1 MPERMIT
Plumb.P,rmit Fee: 1PPERMIT Elec.Permit Fee: 1EPERMIT
Other Mech.Insp. 1.0 hrsL$42.00 Other Plumb Insp. 1.0 2hrs $42.00 Other Elec.Insp. 1.0 hrs $42.00
Mech.Insp.Fee: IMECHINSP $126.00 Plumb.Insp.Fee: 1PLMB126.00 Elec.Insp.Fee: IELECINSP $126.00
NOTE: These fees are based on the prelinddnatry in ormation avaibrble and are only an estimate. Contact the De t or addh7 info.
EFEEITEMS(Fee Resolution 09-051 Eff i/1/10) FEE QTY/FEEMISC ITEMSFee: $0.00 0 # Electricalee: Reg. OT 0.0 hrs $0.00 $0.00 Electrical
Recep/Switch/Outlets
PME Plan Check:
$0.00 = # Plumbing
Permit Fee: $0.00 $0.00 1PRSEWER Sewer, Sanitary
Suppl. Insp. Fee.• Reg. 0 OT 0.0 hrs $0.00 # Mechanical
PME Unit Fee: $0.0C $0.00 IMFR=<100 Furnace,Forced-Air
PME Permit Fee: $504.00
C o;i.SIrllc'tion 7-ax
Acoustical Fee: 0 Yes (F) No $0.00
Work Without Permit? 0 Yes E) No $0.00
Plannin Fee- $0.00 Select a Non-Residential
Building or Structure 0
Travel Documentation Fee: 1 TRA VDOC $42.00
Strom Motion I'ee:
1 BSEISMICR $1.39 Select an Administrative Item
Bldu Stds Commission Fee: IBCBSC $1.0)
SUBTOTALS: $548.39 $0.00 TOTAL FEE: $548.39
Revised: 10/17/2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: aG35-D _C4-e�ec' g Cry PERMIT#
OWNER'S NAME: — PHONE#
GENERAL CONTRACTOR: O ' p✓\ BUSINESS LICENSE #
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in th ity to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCC CV ' CTORS ZfECTION(S)
OBTAINED A CITY OF CUPERTINO
UNTIL THE
GENERAL CONTRACTOR AND ALL
BUSINESS LICENSE. f� c6 d
1 am not using any subcontractors: Date
Signatu re
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
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CLPERTINO
ADDITION[REMODEL
CUPERTINO FEE SCHEDULE
APN# Date:
Is a 2nd unit being added? Yes ❑ No ❑ If yes, please fill out the permit application for 2'dunit.
Building Address: / Jf�
3/6
Mailing Address (if different from building address): C�
Owner's Name: Phone#
Contractor: - Phone#:
Fax#:
Cupertino Business License: State Contractor License#: ,/ 7q
Contact: Phone#:
Fax#:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Proje,:t Submittal is required.
Compliance Method: ❑ Plant Type ❑ )'Vater Budget
Building Permit Info:
BIdLy. 9 Elect. [� Plumb. Tr Mech. (� Hillside ❑
Job Description:
Addition-What is;being added?(Be Specific):
41C 5,12 l � Gtl/7 1 f
What is//being remodeled (not including addition)?
Remodel Includes Re-Roof Yes ❑ No ❑ IEyes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre-application planning approval? Yes [0" No ❑
If yes, please provide a copy of your planning app i-oval letter. Planners name:
Square Footage:
Addition: Porch: Deck: _ Garage: Detached Attached
Remodel: Kitchen Bath Othe:-
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ HUN-A ❑ =B, IV-HT, V-B [�-- Valuatio '?>q C
Please check this box if the project is a
Project Size: Express Standard ❑ Large ❑ Major ❑ second-story addition ❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in plan set & the sheet index.
Revised 05/18/10