07110055 CITY OF CUPERTINO ' �,,�+ ` `
BUILDII�G DIVISION pERMIT ��3�'� �«��������������«
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PERMIT NO.
8 ���������TEVENS CREEK BLVD #111 ORION :?INANCIAL SERVICES 07110055 .
PERMIT L56UE DATE
NER'S NAME:
PROMETHEUS REAL ESTATE GROUP PO BOX 693 � 11/13/2007
SAMTARY NO. CONTROL NO.
PHONE:
BUi[,DING PERMTI'INFO
nRCH��cr�avcrr�Ex: WSHR&D:ZYR RTRFTS , KTCH&BTH aL�c e�cr PLUMB MgcH
0 � � O
a p � LICENSED CON7'RACTOR'S DECLARATION __ ,.,� �„_ ," ,,,.. J,p}� �SCT.I�t1011
i� V C I hcreby af[icm �hat I am licenscd unJer provisions oC Chaptcr 9(commcncing '_" """' ,
Z� ari W Sccdon 7000) of Division 3 of ihc Busincv and Profcuians Codc, and my liccnsc is
�� y in full foree and effect
� � Z Licensc Class ConuacWr
± F , p Dam
� ARCHITECI'S DECLARATION
-� I undcrstanJ my plans shell be wcd u puAlic recorda
W
�
U
4 Q y Liccnsed Prufcssional
y 3 OWNER-BUII.DER DECLARA'CION
1 hereby uCfirm �hat 1 am exempt Gum 1he Con�ractors License Law far the
� t � ra
i p o following rcason. (Scction 703I.5, Business and Profcssiom Codc: Any ciiy or caunty
y^ Pi which rcquims a pcm�it w cons�nx� altcr, improvc, dcmolish, or �eEwir any swcwrc
prior io its issuancc. alw rcquires ihc applicant for such pertnit to filc a signcd s�alcmcn�
� Z< that hc is IiccnscJ pursuant to thc provisians of thc Conuactor's Liccnsc Law (Chapicr 9 Sq. Ft. Floor Area Valuation
z i = -� �(commcncing wi�h Scction 7000) of Division 3 of Ihc Busincss and Profcssions Codc) or
y�� ihal he is exempt the+etrom md ihe basis for �Irc alleged ezempuon. Any violaUon of
Section 7031.5 by siry applicant [or a pem�it subjecu �e appiicmt w a civil penalty of ppN Number Oeeupancy Type
not more �hsn fiw dundred dollars (5500).
0 I, u owner o[ tl�e propercy. or my cmploycw with wages az their sole compensation,
will do the work, and ihe sttuctuee is not intended or o[Cued tor sale (Sa. 7044, Busi�ss Re uired Ins ections
and Professiona Cade: The Conuxar's License Ltw da� not apply w an owner of Q p
ProP�nY �"'� �ilds or improves �her�on. and who does such work himulf or thtough his
own employces, providcd thst such improvemen�s ue not imm�ded or olleced for sala I[.
however, the building or improvemenl is sotd wi�hin one year of comple6on, tlte owner-
builda will haw itx b�uden of proving �hat he did not build or improve [or puryoae of
sak.).
0 1, u owner of �he property. am enclusively conuacGng with liansed contrutors to
construct the peojea (Sec. 7044. Businas and Professions Code:) The Conuactor's Li-
ccnse Law docs not apply m an owner of propcny who builds or improves �henron, �nd ,
who contrac�s Cor such projeas wiW a contractor(s) licensed pursuant to �he Convactor's
L.icense L.aw.
'� I am exempt undu Sec. , B& P C tw this rcawn
� Date
WORKER'S COMPENSATION DECLARATION
16ereby aftirm under peaalty of perjury one of the following declarations:
❑ I lu+e and will mainuin a CeniGcam oC Consem to self-insurc (or Workcrs Compen-
sarion, as provided for by Secdon 3700 of �he Labor Code. [ar ihe performance of the
woric tor which Ihis permit is issued.
❑ I havc and will maintain Workcrs Compensauon Insurana, u �equired by Scnion .
3700 oC the Labor Code. Cor the pedormance of �he wrork for which �his permit is iasued.
My Worke�s Compensadon insucance carticr and Poliry number are:
Camer. Poliry No.:
CER77FICA'I'E OF EXEMPI'ION FROM WORKERS'
COMPENSATION INSURANCE '
(77�is section need wt he comple�ed it the permit is for onc hundn:d dollazs (5100)
or Icss.)
I cenify �hnt in the performancc of ihc work for which this permit is isaced. ! st�all not
cmploy any pccson in my manncr so as w bccomc wbject w ihe Workers' Compcnsauan
Lawa of Califomia Date
Applicmt
NOTICE 7'O APPLICANT: If, aftcr making �his CcrtiCcatc of E�ccmpGon, yau shoulJ
bccome subjcct to thc Worker's Compcnsatian provisions of thc lal+or Codc, you must
� O forthwit6 comply wi�h such provisions or this permil shalf be dccmcd �cvokcd.
� '"'' CONSfRUC170N LEND[NG AGENCY
[.~.� � 1 heeeby aRrtn Uiat �here is a consuuctinn Iending agency for ihe perfurmance of ,
p.! � ihe work for which this permit is issucd (Scc. 3097. Civ. C.)
W� A Lendcr's Namc
Lender's Address
V 0 1 cenifY that I havc read this application and sta�c �Aat the above infortnation is
w ►� cortect 1 agrce to comply with all rity and counry ordinances and sute laws relating a
� U buildin6 consuuction, and hercby authori�t rcprcsentaGvcs of Uiis city w emcr upon �hc
� W ahove-menuoned pmperty (or inspection purposes
a (Wc) agice to save, indcmnify and kecp h�rmless the Ci�y of Cupertino agsinst
�� liabiliuu, judgmcn�s, costs and expenses which may in any way accnic agtinsl said City
V Z in consequencc oC thc granUng oC �his pertni�. Date
�"� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by;
SOURCE REGULATIONS.
Re-roofs
Signuure o[ Applicam/Conuxtor Datc
HAZARDOUS MA7'ERIALS D[SCLOSURE Type of B.00f
�I► Ihe spplicant w future building occupant storc or hanNc harardous ma�crial
:fincd by Ihe Cupertina Municipal Code. Chaptcr 9•�2. md the Hcalth and Safcty
�. Scction 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu ❑No
Will ihc applicant or futurc building accupant usc cquipmcnt or dcvices which If a roof i s installed without first obtaining an inspection, I agree to remove
cmit ha•rardnus air contaminan�t as dcfincd by the Bay Area Air Quali�y Managcmcnt all new rr aterials for inspection.
a����
Q Yes ❑ Nu
1 havc rcad �he hs�ardous matcrisls requiremcn�s undcr Chap�cr 6.95 of thc Califor-
nia Ficalth & Safcty Codc, Sectiong 25505.25533 aiu125534.1 undcrsund �hu iCU�c building
dacs no� currenAy havc a �enan4 � it is my responsibiliry w notify ihe accupant nf the
requiremcnLS which must bc mel prior w issuancc of a Cenificatc of Occupanry. S lgflStllre Of ApP11C211L Date
o �� . All roof coverings to be Class "B" or better
Owncr or authori�Ld agcnt
CITY OF �UPERTINO
7 ITEMS OF 35 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 36901026.33
DATE ISSUED.......: 11/13/2007
RECEIPT #.........: BS000003225
REFERENCE ID # ...: 07110055
SITE ADDRESS .....: 20380 STEVENS CREEK BLVD #111
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OWNER ............: PRCMETHEUS REAL ESTATE GROUP
ADDRESS ..........: 1900 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 FMOUNT 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 RATE 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 ITNOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
PERMI�' INVOICE OPERATOR: patg
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 36'�01026.33
INVOICE DATE......: 11,'13/2007
REFERENCE ID # ...: 07_L10055
SITE ADDRESS .....: 20.380 STEVENS CREEK BLVD #111
SUBDIVISION .......
CITY .............. CU:?ERTINO
IMPACT AREA .......
OWNER ............: PR�)METHEUS REAL ESTATE GROUP
ADDRESS ..........: 19�)0 S NORFOLK ST #150
CITY/STATE/ZIP ...: SA]J MATEO, CA 94403
CONTRACTOR .......: ST:�VE WHITESIDES LIC # 29564
COMPANY ..........: ORION FINANCIAL SERVICES
ADDRESS ........... PO BOX 693
CITY/STATE/ZIP ...: R03EVILLE, CA 95678
TELEPHONE ........: (9L6) 789
FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE
--------------------------- ---------------- ---------- ---------- ----------
ENERGY APPLICATI��N 50.28 0.00 50.28
BLDG PERMIT FEES PRINTING ?ERMIT 104.76 0.00 104.76
AC UNIT >10000CFM PRINTING ?ERMIT 17.82 0.00 17.82
SEISMIC RESIDENTIAL PRINTING ?ERMIT 0.50 0.00 0.50
ELEC PERMIT ISSUANCE PRINTING PERMIT 40.79 0.00 40.79
MECH PERMIT ISSUANCE PRINTING PERMIT 40.79 0.00 40.79
PLUMBNG PERMIT ISSUE PRINTING PERMIT 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 10._6 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 FR.AME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
�P�- ��9� �02��, .�� rv� �� � a:��
CITY OF CUPERTINO BUILDING f�ERMIT APPLICATION
E-Maii ORION(c�SUREWEST.NET
Jobsite Address: 20380 STEVENS CREEK BLVD Date: 10/29/07
APT 111
Owner's Name: PROMETHEUS REAL ESTATE GROUP
Phone No.:L408)253-7100
APN #: 369-01-026 Project Valuation: 3900.00
Blg. Permit Information: Bidg. ■ Elec.■ Plumb.■ Mech.■
JOB DESCRIPTION
Washer and Dryer Retrofits; Kit�;hen and Bath cabinet and counter-
top upgrade. Ductless split syst�;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: Roseville, CA 95678
State Contractors License: 747992 Exp. Date:9-30-2009
Worker's Comp.# : 238-0002445-07 Carrier:STATE FUND Exp. Date: 4-1-2008
Cupertino Business License #:
CREDIT CARD IN1 =0RMATION
Credit Card # :
Name on Card: Orion Financial Services Ir c.
Expiration Date:08/2010
Visa❑ MasterCard ■ Discover � American Express �