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07110067 CITY OF CUPERTINO ' . BUILDInt. DIVISION PERMIT �Ll��.��'CT�.�� , :>... ,.. ,;>.:.;: BUILD D ESS: ; , , PERMIT NO. �� STEVENS CREEK BLVD #408 ORION FINANCIAL SERVICES 07110067 . .JER'S NAME: PERMTf LS6UE DATE PROMETHEUS REAL ESTATE GROUP PO BOX 693 � 11/13/2007 PHONE: SAMTARY NO. CONTROL NO. ARCHITECT/ENGiNEER: BUILDING PERMff iNFO WSHR&DRYR RTRFTS,KTCH&BTH B� E� p�� O p LICENSED CONTRACTOR'S DECLARATION � � I hcrcby aftirm that I am lixnscd undcr provisions of Cluptcr 9(commcncing --^ ^^ ^ ^--^-^- ^ -. --- .� ... -J.ob Description z� wilh Sccdon 7000) of Division 3 of �hc Busincss and Profcssions Code, and my liccnsc is °� y in fuil force and effat ,� ? Licenac Clus Lic. N �'-� E, � Dalc Conlractor ARCHITECI'S DECLARATION �� U I undcrsund my plans shall be wcd u public rccords d y w o y Liccnscd Pn�fcssional y 3 OWNER-BUILDER DECLARATION +� `� I Nereby alTirm that I am excmp� Gum ihc Cantractors Liccnsc Law for ttic L C O following rcuon. (Scction 703I.5, Busincss and Profcssions Cadc: Any city or county K,°, � which rcquiccs a pertnit to conswct, alter, impmvc, dcmolich, or repair any suucturc y Z� prior w ils issuancc, also rcquims �hc applican� for such permit io filc a signcd s�amment £ x 0 lhal Ne is licenseJ putsuanl to thc pmvisions o( �hc Conuactor's Liccnsc Caw (Chaptcr 9 ;;q. Ft. Floor Area Valuation � t- $ (commcncing wi�h Section 7000) of Division 3 of ihc Busincss and Profcssions Cadc) or y � that Ne is exempt theecfrom and the besis for �6e sllegcd eumption. Any violatlon of Section 7031.5 by arry applicant tor a pertnit subjects �he applicant w a civil penalty of APN Number �CCll aI1C T e not more �han fiw hundred dollars (5500). P }� yp Q I. u owner oC the pmperty. a my employces with wages az the'v solc compensadon, wiA do �he work, and ihe strucw�e is not intended or of[emd for sale (Sec. 7044, Business end Professions Codc: The Conuacwr's License Law does not spply w an owner of Required Inspections property who builda or improvea �hercon, and who das such work himselt or through his own employces, provided ihat such improvements arc no[ imended or oReced for sate, lf, however, �he building or improvement ia sold within one yeu o[ completion, ihe owner- builder wiU have tMe �rden of proving Idat he did not build or improve for purpose of sak.). ❑ I, as owner of the property, am aeclusively conuacting with Gcenaed rnnuactors W constnxt �he projett (Sec. 7044. Busincss and Professions Code:) 7]x ConVactor's Li- cctue Law dacs oot spply W an owner of propeny who builds or improvat Ihenron, and , who rnnuac�s Cor such pmjecu with a comractor(a) licensed pursuant w �he Convactor's Licenae Law. '` I am exempt unda Sec. . B& P C fw Ihia rcawn .wner Date WORKER'S COMPENSATTON DECLARATION I hereby �rm under penalty o[ perjury one o[ the fallawin` dalaralions: ❑ I hsve and will mainuin a CertiGcate of Conaent to ulf-inswe for Workcrs Compen- sation, u provided for 6y Section 3700 of �he Iabot Code, for �he performance af the woric Cor which this pertnit is issued. ❑ I have and will mvintain Workers CompensaUon Inswana, as required by SccGon 3700 oC thc Labor Codc, fw thc performance oC �he work for which Utis permit is issued ' My Workefs Compensation Insurancc nrticr and Policy number uc: Cartier. Policy No.: CER7'[FICA7'E OF EXEMPIiON FROM WORKERS' COMPENSATION 1NSURANCE , ('fhis section need not bc completcd if �he permit is far onc hundred dotlua (S 100) or Icss.) 1 ttnify �hnt in thc performancc af thc work fw which ihis permit is issucd, [ shall not employ any person in any manncr so as w bccomc wbject w the Workcrs' Compenution Laws of Cslifomia. Dam Applicant NOTICE 7'0 APPLICAM: If, afYcr making Ihis Cenilicatc of F�ccmption, you shoulJ bccome subjcct w thc Worker's Compensatian provisions o( �hc Labor Code, you must . O fonhwi�h comply with such provisions or this pecmit shall bc dccmcd n.wolccd. � � CONSIRUCI70N LENDING AGENCY Er � I hemby allirtn �hat thcre is a conswction lending agenry for �hc performar�cc u( ai � ihc work for which ihis permii is iu�xd (Scc. 3097, Civ. C.) • �W A Lendcr's N�mc ] z Lcnders Address V 0 1 cectiCY iha� 1 have rcad this application and siatc ihat tlie above infortnatiun is w� cortec� 1 sgree to comply wiih all city and county ordinances and su�e laws relaung m 0 U building consuuction, and hereby authorin eeprescn�ativcs of �his city w cntcr upon �hc � W ahove-mentioned pmpcny for inspenion purposes �y (Wc) sgrce �o save, indcmnify and kecp harmless ihe City oC Cupcnino against �,,.� � Iiabilitiu.judgmcnLS, cosb and expenscs which may in any way sccn�c against said City V z in conxquence ot the gnnting of this permi�. �"' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA770NS. Re-roofs Signuurc o( Applicant/Convacwr Datc HAZARDOUS MATERIALS D[SCLOSURE Type of Ra �f �111hc applicant or futurc building aavpant storc or handlc harardous ma�crial c detned by !he Cupenina Municipal Codc. Chaptcr 9.12, and the Health and Safcry �«� Section 25532(a)? All roofs sh all be inspected prior to any roofing material being installed. ❑Ycs ONo Will Uu applicant or fuwre building accupant usc equipment or dcvices which If a roof is i nstalled without first obtaining an inspection, I agree to remove cmit hvardous air contaminanls az defincd by the Bay Arca Air Quality Managcmcnt all new mat �rials for inspection. Disuic�T ❑ Yes ❑ Nu 1 havc rcad the hv�rdous maicrials requircmcnts undcr Chapicr 6.95 of thc Califar- nia Hcalth & SafctyCodc. Scctions 25505, 25533 aiu125534.1 undcrstand thet if ihc building elaca not cumently havc a tenan4 �hat it is my responsibiliry w noGfy iIu occupant of �he � WnMh m�� x m�� ;o�w;u�� ars c�,;r�� ar o��. Signature oi' Applicant Date All roof coverin s to be Class "B" or better Owncr or amhori�cd asrn� Datc g CITY OF CUPERTINO 7 ITEMS OF 35 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36901026.32 DATE ISSUED.......: 11/13/2007 RECEIPT #.........: BS000003225 REFERENCE ID # ...: 07110067 SITE ADDRESS .....: 20380 STEVENS CREEK BLVD #408 SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............: PRCMETHEUS REAL ESTATE GROUP ADDRESS ..........: 1900 5 NORFOLK ST #150 CITY/STATE/ZIP ...: SAN 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 ...: ROSEVILLE, CA 95678 TELEPHONE ........: (916) 789-8484 FEE ID UNIT QUANTITY PMOUNT 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 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 IP�VOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMI7' INVOICE OPER.ATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36��01026.32 INVOICE DATE.. 11,'13/2007 REFERENCE ID # ...: 07:.10067 SITE ADDRESS .....: 20;�80 STEVENS CREEK BLVD #408 SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: PRC)METHEUS REAL ESTATE GROUP ADDRESS ..........: 19()0 S NORFOLK ST #150 CITY/STATE/ZIP ...: SAT1 MATEO, CA 94403 CONTRACTOR .......: ST]�VE WHITESIDES LIC # 29564 COMPANY ..........: OR:=ON FINANCIAL SERVICES ADDRESS ........... PO BOX 693 CITY/STATE/ZIP ...: R0:3EVILLE, CA 95678 TELEPHONE ........: (9:_6) 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 :?ERMIT 40.79 0.00 40.79 MECH PERMIT ISSUANCE PRINTING :?ERMIT 40.79 0.00 40.79 PLUMBNG PERMIT ISSUE PRINTING :?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 SCRATCH COAT 313 ROOF NAIL ��o��a �� 7�� 00��7 CITY OF CUPERTINO BUILDING iPERMIT APPLICATION E-Mail ORIONCc�SUREWEST.NET Jobsite Address: 20380 STEVENS CREEk: BLVD Date: 10/29/07 APT 408 Owner's Name:PROMETHEUS REAL ES7ATE GROUP Phone No.:(408)253-7100 APN #: 369-01-026 Project Valuation: 3900.00 Blg. Permit Information: Bfdg. ■ 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 INFOftMAT10N 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 INFORMATION Credit Card Name on Card: Orion Financial Services Inc Expiration Date:08/2010 Visa❑ MasterCard ■ Discover O American Express ❑