08030014 CCCY OF CUPERTINO a a�3m,°J�awaaa +
BUILDING DIVISION PERMIT CON,TRA�C. RT1F}01'IATION
Ow
PERMIT N0.
B UILDJNO440RESSSTEVENS CREEK BLVD #213 ORION FINANCIAL SERVICES 08030014
NELR'SUN3A 2M5E:: PERMIT ISSUE DATE
PROMETHEUS REAL ESTATE GROUP 'PO BOX 693 03/04/2008
'MMNE: SANITARY NO. CONTROL N0.
(916) 78978484
ARCHTIECTMNGTNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 (�
00 LICENSED CON RACIDRS DECLARATION Job Description'u FF I hereby affirm that 1 am IiccmN under provisions of Chapter 9(mmmercing
'i,y wilt Seen..? I0)ofDivisirm3rftheBusineaaMProfcario.Qommdmylicenseit WSHR&DRYR RETRFTS;KTCHN&BTH CBNT&CNTROP
' s
to rail forte and effect
License Citrus Lm. UPGRD;DCTLESS SPLT SYS;HVAC RETRFIT
Dan Contractor
ARCHITECTS DECLARATION
i j, I understand my plans shall be used as public records
)nu
a o G Liamed Professional
OWNER-BUILDER DECLARATION
iI 1 hereby from Nm 1 am esempt from the Conuactofs Litt..Law for c e
.CC following meson.(Section 7031.5,Bminestaha Protestant.Coca:Anyeby or rnunty
m which.quires a Permit to cnnswuL site,,improve,demolish,or.pair ar,s'mctum
3iy prior to its issuance,also requires the applicant(.such permit to fleasigrcdsuocment
€<f Nm he is licensed pursuant to the provisions of the Contractor's Liame,Law(Chapter 9 Sq.Ft.Floor Area Valuation$ (commencing with Section70W)ofDivision3ofNeBusinessandProfeuionsCode)Or $3900
that he is exempt therefrom and the basis for the alleged exemption.Any vlolafLn of
Section 7071.5 by any applicant for a permit subjects the applicant 10 a civil penalty of A� umber Occupancy Type
not mom than five hundred dollar('.SWI 36901026
. 3rd
1,nowrcroftheya ny.ormyemploymwithwag.uUm4mlccamp m,
wi➢aa Ne work..cad um nnrnamit nm intenaw arartew f°rt.la(sa.7aa,aaorae,a ns Required Inspections
and Pro(rasimts C°de:The Contractors Lumen Law don Out not apply m an storm,of q P
property who builds or improves thereon,and who does such work himandf or through his
Own employees,provided that such improvements are not intended ma/lerN(m sale If,
bowmen,Ne building or improvement LL anId within one year of impletion,tha comer,
builder will have the burden of proving Nor he did not build or improve for propose of role.).❑1,a owner of the property,am exclusively contracting with licensed contractors orcocoon La the project(Sec.i014,Busineaz end Professions Code:)The Conuacam.Li. TARY
ccaze Law don oat apply to an owner of propenY who haiida or Improves three,andSAN
� �
who comment for such projects wiNeeonvacmr(s)0anxdpurawnito Ne ConuanaYs \LitmanLaw.
❑I am esempt under Sec .B A P C far this ream°
w Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under perulry a(perjury ane of the fallowing decuume n e
I ham and will maintain a Certificate°f Ca.antra xl(-i.um for WorkefsCompen-
mrion,as provided far by Section 37W of the Labor Code,far the performarce of th
work for which this permit is issued.
0 1 have and will maintain W.Aces Compensation Insurvea,az tcquirod by Section
3700of the Labor Code.for the imformanee of the weak,for which this permit is ko,
My Workers Compensation Mmrance carrier and Policy number ace:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisteema aced not bcc°mplowd lithe permit is(°rant humbeddoBa.(S1011)
or less.)
1 certify th a in the perfmmanca of the.,it far which this perenil it issued,l shall not
employ any person in any mannerm az to become subject to ti.Wa kem'Compensation
Laws of Cattle.!..Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you shauW
become subject to the Wohers Compensation provisional of use Labor Coda you must
,J O forthwith comply with such provisions Or this permit shall h damcd Invoked.
CONSTRUCTION LENDING AGENCY
I hamhyaffrm that on.Its contorted..lending agency far the Mr..
(Yi> ft work far which Nu permit is Wood(Scc 3W7,Civ.C)
W O Le meet Name
P z lander'.Address
U Q 1 certify that 1 have read this application arm soon that the above information is
(y P correct.l agree to comply with all city and county ominarcn and state laws relating in
0U building construction.and hereby authodm representatives of this city to enter upon the
W ahova-mentioncd property for impccmlon purposes.
D.
(Wo)agree to save,indemnify and keep harmless the City of Cupertino against
liebilidus,judgments,costs end expenses which may in any way accrue against said City
U z in consegirce of the granting of this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT -Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicanJConData.
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the applicant C. rt m forum building e.Chapter
hapt r9.or handle heaths.material
'I az dented by Ne Cupertino Municipal Code.Chapter 9.11,and the H.IN and Safety
Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.❑Yrs 0N
Will thc applicant or Tum.building w.cupant uta equipment Or dcvkv whicd If a roof is installed without first obtaining an inspection,I agree to remove
emit havudnus air can.mirmno a Jcfacd by the Bay Ansa Air Quality Management all new materials for inspection.
Disrict?
QYn ON.
1 hove mad Ne hmamis mamrialsmyuimmenu underChapmr6.95 o(the Calif.,
235115,23573 x.123334.1 undcmm�d NmifNc Wilding
don our currently haw a.nam,that It u my responsibility in unity Ne icupanr of the
requimments which must W met prior to issuance of a Carfificase of Occapanoy. Signature of Applicant Date
Owncr or auth rind agent Data All roof coverings to be Class"B"or better
• CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:,
APN . . . . . . . . : 36901026 .213
DATE ISSUED. . . . . . . : 03/04/2008
RECEIPT # . . . . . . . . . : BS000004076
REFERENCE ID # . . . : 08030014
SITE ADDRESS . . . . . : 20380 STEVENS CREEK BLVD #213
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS REAL ESTATE GROUP
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE 150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
RECEIVED FROM . . . . : ORION FINANCIAL SVC-
' CONTRACTOR . . . . . . . : STEVE WHITESIDES LIC # 29564
COMPANY . . . . . . . . . . : ORION FINANCIAL SERVICES
ADDRESS . . . . . . . . . . : PO BOX 693
CITY/STATE/ZIP : ROSEVILL&, .CA 95678
TELEPHONE . . . . . . . . : (916) 789-8484
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT' THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 3, 900. 00 0. 50 0. 00 0. 50 0. 00
1ELECINSP HOUR 1 . 00 122 . 38 0. 00 122 .38 0. 00
1EPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40.79 0. 00
1MECHINSP HOUR 1. 00 122 .38 0. 00 122 .38 0. 00
IMPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
1PLMBINSP HOURS 1. 00 122 .38 0. 00 122 .38 0. 00
1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0 . 00
1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40_ ------
79 0_00
----
TOTAL PERMIT 530 . 80 0. 00 530.80 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 530. 80 VISA
---------------
TOTAL RECEIPT 530. 80
•
op-k
0
• CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORION cDSUREWEST.NET
Jobsite Address: 20380 STEVENS CREEK BLVD Date:3/4/08
APT 213
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN# : 369-01-026, DL I Project Valuation: $3900.00
Big. Permit Information: Bldg. ■ Elec.■ Plumb.■ Mech.■
JOB DESCRIPTION
Washer and Dryer Retrofits; Kitchen and Bath cabinet and counter-
top upgrade. Ductless split system;HVAC Retrofit.
CONTRACTOR INFORMATION
• Company:ORION DEVELOPMENT Phone:(916) 789-8484
Contact Name: STEVE WHITESIDES Fax:(916)789-1051
Address: P.O. BOX 693
City, State, and Zip:Roseville. CA 95678
State Contractors License: 747992 Exp. Date:9-30-2009
Worker's Comp.# : 238-0002445-07 Carrier:STATE FUND Exp. Date: 4-1-2008
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card It :qzUlo 31ST �10t, L 77y�/
Name on Card: Orion Financial Services Inc.
Expiration Date: o I/)o
Visa 0 MasterCard 13 Discover 0 American Express 0
BUILDING ADDRESS
J PFAM"NO. �� 3 00 1
��OWNI ER'S NAMNAME: ,
YWLn ISUE DATE
NE
• SANITARY NO. CONTROLNO.
ARCH"ER/FNrINEFA:
BUILDING PERM"INFO
RI.DGP, Q MECH
po LICENSED CONTRACTORS DECLARATION
u 1 heed,affiem mu I..lircnRd udde prwirim,OIOapRr 9(d,dd IG11 p
2 wiNSeuonTOYI)nlDivioonSofUeRuuU-..andPeWeaieruCode.addmYlkeaxis Job Description
w3 .ronmm add roes B Lae.. 7.97992
I..- Out
"� Dam G,meDCL
y4 ARCNIT a dee O NNIi,dTON
`z< Iunaevadd my pyo ilWlkuwlu Nhfic rcaMa
�U
O J Lcw¢O Pmluaitual
OWNER-BUILpfR DECLARATION
<F 1 aeRYY alum mw I am earmM W.tro[wtMeO(a 13eue IAT fp be
OO Idb.mp rea.nn.ILcuun AD IS.Bueu add Aefmioiu
M [sed Any MY w mmnY .
r� Man irymre a wmn b emurvrt. ur,tmprme.MmdiW,m rtpab MY,arlleauO
Yj, pnIXbW muanrc,alw myutm tro apNim,l lIXwapemilbrRasiradd mRmml
_0 uuwelveMw Putsswtuue prow,uonsNtbeCWrYbYt LkeaM la+(hyav9 Sq.FL Floor Area Valuation
Irwnmewma mim ScctmnTWJf M Divia,on]of tM Blw;nmadd Pmfeauwu CaM3 a
3 WI be It c+cmry.1.and Ys pau for Nn all if n.-..W,Any wb.,;ed OI
Sudan)0313 by In,applicuu far a,,mil wbjdU Ik aWed,0.6r0 pe R,W
rot mIXalMnr nurMRC WWaISYNt APN Number Occupancy Type
(]1,u nww,or tnc pmpcny,w my. wa wib wapct u ticv mE CYnIBplYllro,
,ill M Nc wwE add Inc imeluR LL nd injdRa WyA IX ollmW IeruN($eG)0M,BYYxe
add PIUIeMrml Cdde:Taw Cde.Rary Ir�ve Law,beat,ea WI,0 N Owe m Required Inspections
prweny dW Wild,a Impwtroman,add wln bduauN qb himtdfIXlhuvjb hit
Own mpl0y
ba-16-1-
Incltanimproaemenu lie roti......n IXOReard Tante R.
amvetee me iMinp w Imporcmmu is add widain aam yew d mmpWbm OnmA+rv-
WiMe wiB urn tnc norm W poNvp Wt W SM Trot bulb IX Impure(IX pwpom of
uR.l.
. ❑1.u ww d Nc prYDanY.am uclueYalY ronvaRfn[e'iN Emu i wnvaMa ID
conevun lire wnjm IS¢TO.a.Bmircu add PYaf®ms CI>0e)Tbe DnuagNa LI-
^•»Uw ewer nw apph m an vrry Npaepeaty.m nulm wMpwv 0e+m++dd, '
vno mnxu(w tan pejcna wiN a mnvrla(tI litvuN gtgnwla Ina[YapRlefa
Lir—Law
O tun comm lUmR Sac ,BlPCfIX Kit wop
Oww�-_ Dam
WORKERS COMPENSATION DECLARATION
I hee0Y arfm nMu 1.11,a pa(ury arc N the 1011awiep dWauBe,e
w add,il) Csnirom pr C....b.elf-ieum fw Wortcfa Compeer
as p addd le by Seuwt 3M a the L&W COM,for by pufomm of Illi
• lie(}white uu'—d IS uurd
Q 1 MK add vitt mNmam Wtrtps CotnpenMtapt Ia9VY1¢.4 t�YIR4 br SLCiob
Myere t-CNed,addd arriWunart Iwvbirh Uiu pwmAulaaur6
MY V.bl iaCm nsaRaa Naurar¢nmeab Pduy mmbe erre
Came.:HATE FUND PotterNe_.238-00 2 —07
CERTIFICATE OF EXEMMON FROM WORKERS
j COMPENSATION INSURANCE
(Taw vytM reed M Icranptd eIf We, Teak iafMMCnYnbrtdda0•e Q10p)
n!leR I
1 a^,t'ML.b dar Wt...N the wort IIX whirl that pemR IS lw.l tNR m
emple,any prawn rn.,manner ed u b pR.mc W bjm td tro WO,Yat[vnpunlbd
Iawnf CAW—.,Ma
Applicant
NOTICE TO APPLICANT:If.after meront this Ccadrnx df Famptipm yea,RIDYM
dwwrn wb/rt..be amen+Cwalem+aipn prv+N .bf lir Lab Coes yro mow
rZ fnmrwilb mmNy wird taco mmidros er did Iwmil M41 be decoded tevWU6
ZN COYTSfRUCTION LENDING AGENCY
r., h"'.a mu i'i w a<onumion cm
C.)crcy fIX tM pefmwtrm d
Y.>_ was Nur dein rota wrmit i.rower(B¢JDZI.Cir.C.T
7 z Icmn'a Ad.'.'
Jo t RnRY sur have Rae NN apNimron,m auu dW tne.boR iNwmatiro u
" emlex I apRc m cumDlY nth all roY and,ecanry pNinura+aw tae ewa Rimes b
jUaw., .I'dw.amaaddy a-- epebutio a data ay u.npn ere
+rove-ade."d et,Ivgvty lIX ids ..
CW. IYkI.C.to sane.iddcmnrfY and IRn,IurmRfa tro C y N Cl atitb WIm
N Iiabilitc,,1W .eow,add eapu,n •,in Yaemue apJw nM Oh
Z :MIC crane N. N'e wr ALL Nw-mivr Issued by: IIate d
SOURCE nONS.
sipnvme nrnpplirMl2omxaIX Re-roOfS
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will sae apd.L w Iw—twildinp u¢upint wort IX huddle baaedwa mueial
M Mrnce by the[upettrro Mdew,al CaM.O,apur 9.12 add Re Nulla lid SIN
Ely.y.
cwR.swrssr.D'' Nu All roofs shall be inspected prior to any roofing material being installed.
�'{
Will IW+ppecaw w Iwurt Wibint eRa,am u¢'.PmW w etv10 vWelt If a roof is installed without first obtaining an inspection,I agree to remove
urenua w,.,wmlw..w Mrrod n,tM Bar Asa,All Owby M.t bt all new m s for Inspection
"pyo �No
Tearer N>wdan mueriW rtyuvunmtu umfwCebabbdbaudae Caffin,
niaNeldai sd COdesmamss sn ItmevmMlMlaule m'IsttB
�... IlmwteY 1, my ..IrmnnRrr Re atb
R e " Ceorto 3 Signature of Applicant Date
dm.w aYr wan d„ am All roof coverings to be Class"B"or better
10300 Torre Avenue
Cupertino CA 95014
I CI OF Telephoce(408)777-3228
• CUPEkTINO Fax(408)777-3333
Building De artment
JOB ADDRESS:20380 STEVENS CREEK BLVD PERWr#
CUPERTINO, CA 95014 Qg O3 O d
OWNERS NAME:PROMETHEUS REAL ESTATE GROUP PHONE#(97 6 )7gg_g489
GENERALCONTRAClOR:STEVE WHITESIDES FAX #(916 )789-1051
I am not using any subcontractors:
Signature Date
Please check a licable subcontractors and complete the followin information:
n'
NAME BUSINESS LICENSE #
i Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
X Heating SAN JOSE AIR
( 1908 )286-2047
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
T
-- -
.— Owner/Contrac or Signature 7 Date