07110054 CITY OF CUPERTINO ° � ' * (� �
BUILDINGUIVISION pERMIT ���.`E�.��.�����"�������' `
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PERMIT NO.
BUILD ��� 4p � ES STEVENS CREEK BLVD #415 ORION E'INANCIAL SERVICES 07110054 .
r�
dER'S NAME: �� �� �
PROMETHEUS REAL ESTATE GROUP PO BOX 693 � 11/13/2007
PHONE: SANTfARY NO. CONTROL NO.
ARCHTIECT/ENGiNEER: BUILDING P£RMIT INFO
WSHR&DRYR RTRFTS , KTCH&BTH BLDC e�.ecr PLUMB MECH
C� O O 0
�'+ o o LICENSED CONTRAGTOR'S DECLARATION _ _ ^ ry ^ T � _ _ � T ` � � � � T �. . �b DESCi}��lOn
� I hcrcby aflirm tAat I am liccnscd undcr provisions o( Chaptcr 9(commcncing
� z� wiih SecGon 700U) of Division 3 of the Businest and Professians Code, and my license is
'� y in fu0 force and eftett
' � ? Licenac Clua Lic. M
F p p Conuacmr
� � ARCHITEC]'S DECLARATION
� I undcrsunJ my plans shsll bc used as puAlic rccarda
w
d
U
L p y Licensed Prufessional
, � OWNER-HUILDER DECI.ARATION
I hcrcby alTirm thal I am excmp� Cn�m ihc Conuactors Liccnsc Law for thc
� p O following ica4on. (Sccuon 7031.5, Busincss and Profcssions Calc: Any city or county
� ^� which requi�cs a pcnnit w consinxt, altcr, improvc, dcmolish, or repair any swcmm
_ Z y prior w iLS issuancc, alw rt�quims �hc applicmt far such permit �o filc a signcd sutcmcnt
�_ � m� n� � i���a ���.�<<o u,� ����:�o� or m� co��a��s L«� �W ccna�� 9 Sq. Ft. Floor Area Valuation
y h $ (commcncing with Scction 7000) pf Division 3 of �hc Busincss and Profrssions Cndc) or
y �., that he ia exempt tMacfrom and t6e besis (or the sl►egcd eumption. My violauon of
Section 703t.3 by airy applicant for a pemiit su6jecu �he applicant to a civi] penalty o[ pprl Number Oeeupaney Type
not more fisn five hundmd dollars (5500).
❑[. �s owner o[ tlu propercy. or my employcw with wages az thcir sole compensadon,
will do W� work, end ihe suuctuee is not intended or of[eced far sale (Sec. 7044, Business Re uired Ins ections
and Professions Code: The Canuumr's Lia.nse Law dors not spp�y w a� owur of Q P
propeny who builds or impmves �hercon, and who does such woric himulf or Uuough hia
awn employca, provided �hat such improvements ue not imended or offued Cor sale. If.
hawever, the building or impcovement is sold within one yeu of completion. Um owner-
builder wiU have the burdee of proving lhat he did not build or improvc for puryose of
sak.).
❑ I. u owner of tAe property. am eacclusively convacting wiU� Gcenud conusctors a
constnict the projen (Sec. 7044. Businas and Profcssions Code:) The Contracwr's Li-
ccnx Caw docs not spply �o an owner of propeny who builds or improves the�eon, �nd ,
who conuacts tor such projects with a conuuwRs) licensed pursuant to the Convactor's
Litense Law.
'( am uempt under Sec. , B� P C for �his reaton
wner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby �mi under penalty o[ perjury rn+e af the following decluations:
Q I hs.�e and will mainuin a Cenifiple of Conaent to ulf-insure (or Workcrs Compen-
sation, u provided far by Secdon 3700 af �he Labor Code, far �he pedormance of �he
woric tor which this permit is is4ued.
❑ I havc and will maintain Workcr's Compensatian lnsurana. u required by Scction
3700 oC thc Labor Codc. Cw thc perfarmmce of �he work for which �hi� pecmit is issued
My Worket's Campenaation Insurancc nrtiu and Policy number are:
Cartier. Policy No.:
CER7'IFICATE OF EXEMPf70N FROM WORKERS'
COMPENSATION INSURANCE '
(This scction necd rrot bc completed if the pertnit is far onc hundrcA dollua (S I00)
ar Icss.) '
I ceni(y that in thc performancc af tdc work for which ihis pertnit is issced, t shsll not ,
employ any pecson in any manncr so as w become wbject to �he Workers' Compensadon
Laws of Califomia. Date
Applicant
NOTICE TO APPLICANT: If, aftcr making ihis CertiCcate of Eecmption, you shouW
become subject to thc Workcr's Compenssdon ptovisions af �he Labor Codc, you muu
, ;� fonhwi�h comply with such provisions or this pcxmit shall6c dcemcd awokcd.
Z O CONSfRUCiION LENDING AGENCY
(� � 1 hcmby aCCirm Nat thcre is s consuuctian Icnding agcnry (or ihc per[ortnancc uf .
LY. � ihc work fur which Utis permit is iuued (Sa. 3097, Civ. C.)
W� Q Lendcr's Namc '
� z Lcnder's Address
(� � I cenify ihat I have rcad �his application and siatc �u thc above informauun is
w � cortect 1 agrce to comply wiih all rity and counry ontinances and suie Iaws rclating to
� U building consuuction, and hereby authori�t rcpresenuGvcs of Uiis ciry to emcr upon tAe
� W ahove-mrndoncd propcnyforinspenion purposes
Gy (Wc) agree to ssve, indcmnify and kecp harmless We Ciry of Cupertino against
�„E"",� y liabilitia. JudgmcnLS, costs and expenses which may in any way accruc against said City
V z in conuque�c o[ Wc granting oC Ihis permiG Date
�"� APPLICANT UNDERSTANDS AND WILI. COMPLY WITH ALL NON-PO1NT Issued by
SOURCE REGULA770NS.
Re-roofs
Signaturc of ApplicanUControcwr Date
HAZARDOUS MATERIALS DISCLOSURE T}r� Of R OOf
�Il lhc applicant or future building accupant storc or handlc hanrdous matcrial
dcfincd by Ihe Cupertino Municipal Code. Ctiaplcr 9.12, snd the Hcal�h and Safety
,a�. Scction 25532(a)T All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs ❑ No
wll thc applicant or futucc building occupant usc cyuipment or dcvices ahich If a roof i� installed without first obtaining an inspection, I agree to remove
cmi� ha air coniaminants az dcfincd hy thc Bay Arca Air Quslity Managcmcn� all new m aterials for inspection.
a����
❑ Ycs ❑ No
1 havc rca�i Ihe hvardous maicrisls �cquiremcnLS undcr Chaptcr 6.95 of iMc Califor-
nia Hcalih & Satcty Codc, Sections 25505, 25533 and ]5534.1 undcrsund Uuti( ihc 6uilding
does no� cwrently have a tenan4 ihat it is my rcsponsibiliry w notify the occupant nf the
�q��rcm��� Wnxn m� n� �� P�o� w;��� ore c�r�a� or aN�r. Signature of Applicant Date
Owner or authori�ed agcm o„� All roof coverings to be Class "B" or better
CITY OF CUPERTINO
7 ITEMS OF 35 PERMI'I RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN ......... 36�01026.34
DATE ISSUED.......: 11/13/2007
RECEIPT #.........: BSC00003225
REFERENCE ID # ...: 07110054
SITE ADDRESS .....: 20�80 STEVENS CREEK BLVD #415
SUBDIVISION .......
CITY .............. CUF'ERTINO '
IMPACT AREA .......
OWNER ............: PRC�METHEUS REAL ESTATE GROUP
ADDRESS ..........: 19(�0 S NORFOLK ST #150
CITY/STATE/ZIP ...: SAP� MATEO, CA 94403
RECEIVED FROM ....: OR]:ON FINCL SVCS IN
CONTR.ACTOR .......: STf:VE WHITESIDES LIC # 29564
COMPANY ..........: OR�:ON FINANCIAL SERVICES
ADDRESS ........... PO BOX 693
CITY/STATE/ZIP ...: RO:>EVILLE, CA 95678
TELEPHONE ......... (9'.6) 789
FEE ID UNIT QUANTITY ��NIOUNT 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1,478.65 MC
---------------
TOTAL RECEIPT : 1,478.65
INVOICE INVOICE INVOICE INVOICE I WOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
PERMIP INVOICE OPERATOR: patg
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 36901026.34
INVOICE DATE......: 11/13/2007
REFERENCE ID # ...: 07110054
SITE ADDRESS .. ...: 20380 STEVENS CREEK BLVD #415
SUBDIVISION .......
CITY .............. CUPERTINO
IMPACT AREA .......
OWNER ............: PR�METHEUS REAL ESTATE GROUP
ADDRESS ..........: 1900 S NORFOLK ST #150
CITY/STATE/ZIP ...: SA[� MATEO, CA 94403
CONTRACTOR .......: GILROY, JOHN LIC # 15128
COMPANY ..........: JUST WATER HEATERS INC
ADDRESS ..........: 3400 INVESTMENT BLVD
CITY/STATE/ZIP ...: HAYWARD, CA 94545
TELEPHONE ........: (510)293
FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE
--------------------------- ---------------- ---------- ---------- ----------
ENERGY APPLICATI�N 50.28 0.00 50.28
BLDG PERMIT FEES PRINTING PERMIT 104.76 0.00 104.76
AC UNIT >10000CFM PRINTING PERMIT 17.82 0.00 17.82
SEISMIC RESIDENTIAL PRINTING PERMIT 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 ��OICE 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
� �/�/' - .�../ � �� V � �� i � � v �f ! V O��
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORION(a�SUREWEST.NET
Jobsite Address: 20380 STEVENS CREEr BLVD Date: 10/29/07
APT 415
Owner's Name: PROMETHEUS REAL ESI�ATE GROUP
Phone No.:(408)253-7100
APN #: 369-01-026 Project Valuation: 3900.00
Blg. Permit lnformation: Bldg. ■ Elec.■ Plumb.■ Mech.■
JOB DESCRIP7'ION
-
Washer and Dryer Retrofits; Kit�hen and Bath cabinet and counter-
top upgrade. Ductless split syst�m;HVAC Retrofit.
CONTRACTOR INFO'RMATION
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
Workers 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
VisaO MasterCard ■ Discover O American Express O