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07110068 CITY OF CUPERTINO ' 'BU[LD[NG DIVISION PERMIT �� ,. _,:: ;,..__. ;� PERMIT NO. BU1LD N ADDRESS: ��380 STEVENS CREEK BLVD #217 ORION :?INANCIAL SERVICES 07110068 . PERMiT LSSUE DATE .VER'S NAME: PROMETHEUS REAL ESTATE GROUP PO BOX 693 11/13 2007 SANTfARY NO. CONTROL NO. PHONE: BUII.DING PERMIT [NFO ARCHI'['ECT/ENGINEER: WSHRScD.ZYR RTRFTS , KTCH&BTH B� � PLU�MB M�ECH u p p LICENSED CON'f12AC1'OR'S DECLARATION _ _ ^ � ^ ^ , _ � T � ry � r T , . . �pb ]�SG?l��l Oil m 1 hcrcby a(Ii�n �hat ( am liccnsed undcr provisions of Chapur 9(commcncing � z� aiih Sccdon 7000) of Division 3 of thc Busincss and Profcssians Code, and my licensc is �� y in fu0 force and etfec� � � Z Licensc Clazs Conlrxwr = i ,,, p Datc � ARCHI7'EC1'S DECLARA7'ION 1 undcrsunJ my pians shall bc wcd as public rccords m� s U L p y Liccnsed Prufcuional y � OWNER-BUILDER DECLARATION I t�crc6y a17rm �al 1 am excmpt Crom ihe Convactor's Liccnae Law for � � o O following rcasan. (Scction 7(13I.5, Busincss and Profcssions Ca1c: Any city or county �$�i which rcquiccs a pc�mit w consuuct, altcr. improve. dcmolich, or �epuir any swcw�c p�o� �o �ts is,cuancc, aiso rcquims thc applicant for such permit io fiic a signcd s�a�cmcnt Valuati on � x � that he is licenscd pursuant to i hc provisions o f t h c C o n u a c t o r' s L i c e n s c C a w ( C h a p t c r 9 S q. F t. F l o or Area x t- $ (commcncing wi�h Scction 7000) of Division 3 of ihc Busincss nnd Profcssians Codc) or y� that he is exempt therofmm md the basis far the allegcd exempuon. My violation of Secdon 7031.3 by a�ry applicant for a permit subjecu ihe applicant to a civil penalty of ppN Number Oeeupancy Type nat more than five hundred dollars (5500). ❑ I, u owner of the penpecty. a my emptoyces with wages u their solc compensaUon, will do ihe work and ihe structuce is not intended or afCered for salc (Sec. 7044. Busineu Required Inspections and Prokssiona Code: llu Convxtor's Lia.nse Law daes not apply w an owner of propeny who builds or improvea thercon, and who das such work himself or iheough hia own employces. pro�idcd that such improvemrnts are not in�ended or otfered fa sale. !f. hawever. the building or impmvemmt is sold within one yeu oC compledon. �he ownerv buildu will have the burden o[ proving Wat he did not buiid or improvc fa purpose of salc.). 0 I. as owner of the pcoperty. am acclusively conuuting with licenaed rnntraaors to conswct the project (Sec. 7044. Business and Pro[essions Cade:) The Comracwr's Li- cense Law docs no� apply �o an owner of propeny w6o builds or improves Ihemon, and , who conuac�s tor such projects with a convactor(s) licensed pursuant to the Convactor's License Law. � I am exempt unda Sec. , B Qc P C for Wis rcawn wner Date WORKFA'S COMPENSA'I70N DECLARATION I heroby aflirm under penalty of perjury one of the fo0owing declanGons: ❑ 1 hsve and will maintein a CcniGam of Consent to ulf-insure for Worker's Compen- satlon, as provided for by Secdon 3700 of che Labor Code. for �he performaMC of the work for which thi� permit is issued. ❑ I have and will msinuin Workcr's Compensation insunna, u icquired by Section 3700 oC the Labor Codc, for thc performancc oC Uu work for w6ich thit pccmit is issued. My Worker's Compensation Insurance nrrier end Poliry number a�e: Cartier. Poliry No.: CER77FICA'fE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE � (This scction necd wt 6c completed if the permit is for onc hundred dollara (5100) or Icss.) I ceni(y ihul in �hc performancc oC thc work for which ihis pertnit is issucd, ! shall not omploy any person in any manncr so u to bccomc subject to ihe Workers' CompensaGon Laws of Califomia. Dstc Applicanl NOTICE TO APPLICAM: If, aftcr making �Mis Ccrti[ica�c of Excmption, you should bccome subjcct �o thc Workcr's Compcnsetian provisions of thc labor Coda you muu , O forlhwith comply with such provisions or this pecmit shall be decmed awoked. Z N CONSTRUCCION LENDING AGENCY [-� .-. 1 hereby afGrm Uut there is a conswction Iending agency Cor ihe performance u[ . a� ihc work [ur which ihis permit is iuued (Sec. 3097. Civ. CJ W� Q Lendcr's Namc L.cndds Address V 0 � certi(Y tha� 1 have rcad this applica�ion and smte U�u � above informauun is w ►� cortcc� 1 agra w comply with all rity and counry ordinances and sute Iaws celadng w 0 U building consuuction, and haeby authoria mprescnutives of this ciry w cn�cr upon thc � W ahove-mcnuoncd propcny far inspenion purposes. a (We) agree to save, indcmnify and keep ham�lest the City o[ Cupertino against �� liabilities, judgmenls, cosu and expenscs w6ich may ia any way acrnu against said City V� in conuquence of Uic grandng of �his permi� Date �"� APPLICANT UNDERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by; SOURCE REGULATIONS. Re-roofs Signature of AppliantlCon�rutor Datc ru T of P.00f HAZARDOUS MA7ERIALS DISCLOSURE }�� Wil1 �he applicant m futurc building occupaot storc or handle ha•rardous matcrial s defincd by the Cupenino Municipal Codc. Chap�cr 9.12, and the Health and Safcty .:� ,Scction25532(a)? All roofs shall be inspected prior to any roofing material being installed. �y� ❑No Will lh� applicant or future building occupant usc cyuipmcnt or dcvices ahich If a roof is installed without first obtaining an inspection, I agree to remove cmit ha•r.ardous air coniaminants u dcGncd by ihe Bay Arca Air Qualily Managcmcnt all new rr.aterials for inspeczion. a��, ❑ Ycs ❑ Nu 1 havc rcad �he hasardous maicrials requiremcnu undcr Chap�cr 6.95 of �c Califor- nia Flcalih & Satcty Codc, Secuons 25505, 25533 and 25534. I undcrstand Unt iCthc huilding does not cu�ntly have a mnant, ihat it it my responsibiliry to noriCy �he occupant of ihe � Signature ofApplicant Date D �� . All roof coverings to be Class "B" or better Owncr or authori�.cd agcnl CITY OF �UPERTINO 7 ITEMS OF 35 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36901026.31 DATE ISSUED.......: 11/13/2007 RECEIPT #.........: BS000003225 REFERENCE ID # ...: 07110068 SITE ADDRESS .....: 20380 STEVENS CREEK BLVD #217 SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............: PRCMETHEUS REAL ESTATE GROUP ADDRESS ..........: 1900 S NORFOLK ST #150 CITY/STATE/ZIP ...: SA� 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 iJNITS 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 R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 295.73 0.00 295.73 0.00 INVOICE INVOICE INVOICE INVOICE ITVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMI'I' INVOICE OPER.ATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36�01026.31 INVOICE DATE......: 11/13/2007 REFERENCE ID # ...: 07110068 SITE ADDRESS .....: 20_80 STEVENS CREEK BLVD #217 SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER ............: PRC�METHEUS REAL ESTATE GROUP ADDRESS ..........: 19C�0 S NORFOLK ST #150 CITY/STATE/ZIP ...: SAl`f MATEO, CA 94403 CONTRACTOR .......: STE;VE WHITESIDES LIC # 29564 COMPANY ..........: OR]:ON FINANCIAL SERVICES ADDRESS ........... PO BOX 693 CITY/STATE/ZIP ...: RO:�EVILLE, CA 95678 TELEPHONE ...... (9].6) 789-8484 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ----------�------ ---------- ---------- ---------- FNERGY APPLICATIC)N 50.28 0.00 50.28 BLDG PERMIT FEES PRINTING I'ERMIT 104.76 0.00 104.76 AC UNIT >10000CFM PRINTING I'ERMIT 17.82 0.00 17.82 SEISMIC RESIDENTIAL PRINTING I'ERMIT 0.50 0.00 0.50 ELEC PERMIT ISSUANCE PRINTING I'ERMIT 40.79 0.00 40.79 MECH PERMIT ISSUANCE PRINTING I'ERMIT 40.79 0.00 40.79 PLUMBNG PERMIT ISSUE PRINTING I'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 FR.AME 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 313 ROOF NAIL .�/I ., � �-i � C-��7// �� o�' . ��" � � 9 l C' o� � ✓ CITY OF CUPERTINO BUILDING F'ERMIT APPLICATION E-Mail ORIONCc�SUREWEST.NET Jobsite Address: 20380 STEVENS CREEK BLVD Date: 10/29/07 APT 217 Owner's Name: PROMETHEUS REAL EST4TE GROUP Phone No.:(408)253-7100 APN #: 369-01-026 Project Valuation: 3900.00 Blg. Permit Information: Bldg. ■ Elec.■ Plumb.■ Mech.■ JOB DESCRIPTION Washer and Dryer Retrofits; Kitc:hen and Bath cabinet and counter- top upgrade. Ductless split syste�m;HVAC Retrofit. CONTRACTOR INFOfZMATION Company:ORION DEVELOPMENT Phone:(916) 789-8484 Contact Name: STEVE WHITESIDES Fax:i9161 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 INFORMATION Credit Card Name on Card: Orion Financial Services Inc_ Expiration Date:08/2010 VisaO MasterCard ■ Discover ❑ American Express ❑