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07110069 CITY OF CUPERTINO ' BUILDINC DIVISION pERMIT ��R,t�.�C?R��' _ ,. >: , : , :...: : _ .. , BUIL G D ESS: PERMIT NO. �� STEVENS CREEK BLVD #106 ORION ,INANCIAL SERVICES 07110069 . JER'S NAME: �� DA � PROMETHEUS REAL ESTATE GROUP PO BOX 693 � 11/13/2007 PHONE: SAMTARY NO. COMROL NO. ARCHI'iECC/ENGiNEER: BUiLDING PERMIT INFO WSHR&D;ZYR RTRFTS, KTCH&BTH s�DC E�.ecr PLUMB MecH C� 0 � O u o p LiCENSED CON7RACfOR'S DECLARATION � � � T - _ _ _,.... _ ,. ,..-. _ ... ,.. ..Job Descuption � I hcrcby �cm thst I am licenscd undcr provisions oC Chaptcr 9(commencing �� z� wi�h Section 700U) of Division 3 of ihc Busincce and ProCcssions Cade, and my liccnsc is �� y in fuil Corce and effect � Z Licenac Clus ��• � n E ;, p Datc ContncWr � � ARCHI7ECI'S DECLARATION � I undcrsund my plans shall be used u public �ccords �yU ; � y Licensed Pn�fcssional y � OWNER-BUILDER DECLARATION 1 hcrc6y al7irm that I am excmpt frum We Conuactar's Liccnsc Law far the � p O following reason. (Scctian 7031.5, Busincss and Profcssions Ca1c: Any city or county K,°, � which icquims a permit w conswc4 ��r, improvc, dcmolish, or repair any swcw�c y Z} prior lo ils issuancc. also rcquircs Ihc applicant for such permit �o Glc a signcd sta�men� �= o that hc is ticcnscd pucsuanl to thc pmvisions of thc Conuactor's Liccnsc Law (Chaptcr 9 Sq. Ft. Floor Area Valuation y F- �(canmencing wilh Scction 7000) of Division 3 of �hc Busincss and Profeuions Codc) or y �.. that he is exempt'thercfrom and the basis Cor t6e allcgcd exempuon. Any vioiauon o[ Section 7031.5 by airy appiicant (or a pertnit su6jecu �ha applicant to a civil penaity of ppN Number Oecupaney Type not morc �han fiw hundred dollars (5500). ❑ I. u owner of tt�e pmperty. or my employcea with wages az their solc compensaUon, will do the work and ihe s�cuctuee is not intended or oRaed for salc (Sa. 7044, Business Re uired Ins ections and Professions Code: The Conuactar's License Law does nut apply W an owner of q p property who builds or improves [hercon, and who does such wort himself or Uuoug6 his awn employces, provided Uwt such improvemen�s are not in�ended ar oRered Cor sale. If. however, the building or improvemen� is sold wi�hin ane year o� completion. �he owner- builder will have tiu burden o[ proving Wat he did not buiid or imprave [w puryose of sak.). ❑ I. u owner of �he property. am aecluaively convacting with Iiansed rnnvacWrs w construct the project (See. 7044. Business and ProCessions Code:) The Contractor's Li. cense Law does not apply to an owner of property who builds or improves Wmeon, and , who rnnuacls Cor such pmjects with a conuuwr(s) licensed pursuant to the Convaccor's Licenn Law. � �` I am uempt under Sec. . B k P C for �his rcason �� Date WORKER'S COMPENSATION DECLARATION I 6eceby affirm under penalty o( petjury one of the following declaralions: � 1 hsve and will mainuin a Cenificate of Consenl to self-insure for Worker's Compen- � sation, as providcd for by Seccion 3700 of �he Iabor Cade, for �he performance o[ U�e woric for which Uiis pertni[ is issued. ❑ I have and will maintain Workcr's Compensauon Insurma, as �cquired by Scction 3700 oC the Labor Code, for the performance of the work for wAich �his permit is issued. My Worke�s CompensaUon lnsucancc carticr snd Poliry number are: Cartier. Poticy No.: CERTIFICA7'E OF EXEMP'ITON FROM WORKERS' COMPENSATION INSURANCE ' (ihis sectia� necd irot be completed i( �he pertnit is far onc hundred dallus (5100) or Icss.) � I cenily th¢i in thc perfwmancc of ihc work fa which this permit is iseucd. l shall not cmploy any pecson in any manncr so u to bccomc wbject io the Workcrs' CompensaUon Laws of Califomia Datc Applicant NOTICE TO APPLICANT: If, aftcr making U�is Cenilicate of Exemption, you shauld bccome subjcct to lhc Warker's Compensation provisions of �he Cabo� Codc, you must , O fonhwi�h comply with such provisions or Nis permi� shall be dcemcd revoked. z '—' CONSTRUCI70N LENDING AGENCY (.~.� r�-� 1 he�eby alfirm �hat thcre is a consuucdon knding agcncy Cor thc perfarmance uf . pG � ihe wark fur which ihis permit is iuued (Sec. 3097. Civ. CJ W� Q Lendcr's Namc ' C.cnde�s Addmss V � ( certifY Ihu 1 haw read this application and siate that the sbove informatiun is w� cortcct 1 asme to comply with �II rity �nd counry oniinsnces and sute laws mlaang to � U building consuuction, and 6c�eby suthori�t represcntativcs of ihis ciry to cntcr upon the � W alwve-mendom:d propcny tor inspec�ion purposes a (Wc) agree to save, indemnify and keep harmless ihe City of Cupcnino against �„H,� � liabilitiu, judgmcnla, cos�s and expensea which may in any way acccuc against said City V z in consequenc¢ of thc granting ot �his permit. Date �"� APPLICANT UNDERSTANDS AND W1LL COMPLY WITH ALL NON-PO1NT Issued by SOURCE RECULATIONS. Re-roofs Signuure of Applicant/Conlractor �a� Type of R oof HAZARDOUS MA7'ERIALS DISCLOSURE Will Ihe applicant or future building acupant storc or handlc ha•rardous mamriil - kfined by �he Cupenino Municipal Code. Chap�cr 9.12, snd �he Hcalth and Safety ;�, Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. oY� ❑No �11 the a�licant or futuce building occupant usc cyuipment or dcvices which If a roof i s installed without first obtaining an inspection, I agree to remove emi� harardous air contaminants u dcfincd by the Bay Arca Air Quality Managcmem all new m aterials for inspection. District? ❑ Ycs ❑ Nu 1 havc rcad U�e hvardous ma�crials requiremcn�s undcr Chap�cr 6.95 of thc Califor- nia Flcal�h & Safcty Code, Scc�ions 25505. 25533 a�u125534.1 undcrsiand ihat i! ihc building dacs not curtcnUy havc a tenan4 � it is my responsibility w noufy �hc occupant nf the requirements which must be me( peior to issuance of a Cenificaie of Occupancy. S 1gIIStllI'C Of APpI1Callt Date Owncr or authori�ed agcn� o„� All roof coverings to be Class ��8�� or better CITY OF CUPERTINO 7 ITEMS OF 35 PERMIT RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36901026.30 DATE ISSUED.......: 11/13/2007 RECEIPT #.......... BS000003225 REFERENCE ID # ...: 07110069 SITE ADDRESS .....: 20380 STEVENS CREEK BLVD #106 SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............: PRCMETHEUS REAL ESTATE GROUP ADDRESS ......... 19C0 S NORFOLK ST #150 CITY/STATE/ZIP ...: SAI� 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 ...: RO�EVILLE, CA 95678 TELEPHONE ........: (916) 789 FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 104.76 50.28 0.00 50.28 0.00 BPERMFEE VALUATION 3,900.00 104.76 0.00 104.76 0.00 BREMACOVER NO UNITS 1.00 17.82 0.00 17.82 0.00 BSEISMICRE VALUATION 3,900.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 295.73 0.00 295.73 0.00 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMI'I INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN ....... 36901026.30 INVOICE DATE......: 11/13/2007 REFERENCE ID # ...: 07110069 SITE ADDRESS .....: 20380 STEVENS CREEK BLVD #106 SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............: PRCMETHEUS REAL ESTATE GROUP ADDRESS ..........: 19C0 S NORFOLK ST #150 CITY/STATE/ZIP ...: SAT MATEO, CA 94403 CONTRACTOR .......: STEVE WHITESIDES LIC # 29564 COMPANY ..........: ORION FINANCIAL SERVICES ADDRESS ........... PO BOX 693 CITY/STATE/ZIP ...: RO:.EVILLE, CA 95678 TELEPHONE ........: (916) 789 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- ENERGY APPLICATIC�N 50.28 0.00 50.28 BLDG PERMIT FEES PRINTING F'ERMIT 104.76 0.00 104.76 AC UNIT >10000CFM PRINTING F'ERMIT 17.82 0.00 17.82 SEISMIC RESIDENTIAL PRINTING F'ERMIT 0.50 0.00 0.50 ELEC PERMIT ISSUANCE PRINTING F'ERMIT 40.79 0.00 40.79 MECH PERMTT ISSUANCE PRINTING F'ERMIT 40.79 0.00 40.79 PLUMBNG PERMIT ISSUE PRINTING F'ERMIT 40.79 0.00 40.79 295.73 0.00 295.73 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCR.ATCH COAT 3"13 ROOF NAIL . ,�� .3 � �� /v.�.�� 0 7 r/ v � � `� CITY OF CUPERTINO BUILDING I�ERMIT APPLICATION E-Maii ORlON(c�SUREWEST.NET Jobsite Address: 20380 STEVENS CREEk BLVD Date: 10/29/07 APT 106 Owner's Name: PROMETHEUS REAL ESTATE GROUP Phone No.:i408)253-7100 APN #: 369-01-026 Project Valuation: 3900.Q0 Blg. Permit Information: Bldg. ■ Elec.■ Plumb.■ Mech.■ JOB DESCRIPTION Washer and Dryer Retrofits; Kit�:hen and Bath cabinet and counter- top upgrade. Ductless split sysfi:m;HVAC Retrofit. CONTRACTOR INFOI�MATION Company:ORION DEVELOPMENT Phone:(916) 789-8484 Contact Name: STEVE WHITESIDES Fax: (916) 789-1051 Address: P.O. BOX 693 City, State, and Zip:Rosevilie. CA 95678 State Contractors License: 747992 Exp. Date:9-30-2009 Worker's Comp.# : 238-0002445-07 Carrie �:STATE FUND Exp. Date: 4-1-2008 Cupertino Business License #: CREDIT CARD INF�ORMATION Credit Card Name on Card: Orion Financial Services In= Expiration Date:08/2010 Visa❑ MasterCard • Discover O American Express ❑