08010148 CITY OFCUPERTINO ��r{�> .�r..e�>: ir/��r �
BUILDING D'IS"ON PERMIT .CCS, RACTORILV IJ IV l\
BUILDING ADDRESS: PERMIT NO.
20380 STEVENS CREEK BLVD APT SAN JOSE AIR CONDITIONING, 08010148
IRAME: PERMIT ISSUE DATE
PROMETHEUS REAL ESTATE GROUP 1045 C N 10TH ST 01/28/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHTIEC(ENGINEER: BUILDING PERMIT INFO
WSHR & DRYR BLDG EO mum MECH
O
30Zp LICENSED CONTRACTOR'S DECLARATION
1 hereby alarm Mut 1 am licensed under provision of Chapter 9(commencing ^--^^ ^^^ o es&ption
x WiNSccdon7")a(DMMon3oflhc BusinmmdPro(nasion Codo,andmyliccnacis
<Eq3 in full face and erect
C 2 Licen¢Clan Lk.0
Dab Contractor
ARCHITECTS DECLARATION
I undcnund my plana shall he used ar public mcorn
k ted Licensed Pndcssianal
5 OWNER-exempt
ER DECLARATION
ZOO h rehy strum that 11. eausin from the Gommerors License Law o co the
ZOO which ng does a(Sermon 70 I.S,Business and improve.
dater Code:Any city or county
S$� which rcyuirn a Pamir a construct alar.imprve,dcmulloh,or repair any awnor '
Zy prigb hacc,aisu acquires the applicantfor tach Fennelafifu aligned wtemem
�e Watt he es liceansenstud porwaot to Ne of Diaion of Me Conuancess Liccmisw(Chapta9 Sq. Ft. Floor Area Valuation
y tha(commencing ourrin Section7000)and
Division of Muauelnrsumpt Professions Code)or
3 the ha 4 exempt,"^—from and the hula for the ailged assumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Mute few hundmd dollars($5007.
wiUL rbc wr of Sha gapmy, mmy.ti.M.cn with angn u th (S..tmmpemmcm
and da to Work.and th The Coe 4 uses Lianstse
or..do omab(Sec.in sm Buainrm
and era wholm Cade:The COouxteYs and
am don ant apply if rt owner,is Required Inspections
property whobuiltlsorimprow thereon.and whodoese�chwork himsel(er Waugh Ma
awnrar,0.Wiprovided Wthuhimpm idwalartnotlmcndcdnpme .fa Mons.
h elder Ne building u denheror pmann Is hold within one year of comoe for theMons.
or
builder will have the burden of paring that he did ant build a improv far purpose of
auJ.
❑1.or owner of Me property,am exclusively contracting with Ilamu d comments in
construct W project(Sec.7044.Buaineu and Peofessinn Cade:)The Conuxeeh U. _
core Law don not apply us an owner of property who leilds ar impravn Wmon,and,
who contacts for such pmjcm with a cantaeor(0 licensed pursuant to W.Cmunetor.
Lim.law.
❑Iareaemptunder See .Bk PCforthlomssan
40 net Dau
WORKER'S COMPENSATION DECLARATION
I hereby arin umber Family of perjury one of the(allowing Mnelantionm
❑Ihaveand willmainuin aCeNOnb of Commoself-insure fa Workers Compen- -
saMen,as provided for by Seedon 3700 of de Labor Code,for Mu performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compemilon Insurance,as required by Section
3700 of the lsba Code.for Mm performance oldie work forwhlch this panni,4 issued. '
My Worker,Compensation Income,Ones and Policy number art:
Cartier: policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thin section and tet ed compared if the permit Is return hundrtddollan rHN)
or less)
1 ceNfy tom in the performance of Me wart for which this Permit is issued.I Nail not
employ any person in any ran.,.v u become subject 0 the Workers'CompemMan
Laws of California.Dau
Applicant
NOTICE TO APPLICANT.If,after m ung this Certificate of Exemption,you should
become subject in to Waters Compensation provisions of Ne Mbar Cock,you mum
.,O forthwith comply with such prevision a Nis permit shall be domed revoked.
,zv CONSTRUCTION LENDING AGENCY
1 hereby aTirt Mut Nem Is.c..M m funding agency,for W performance of
a > Ne work for which this permit is issued(Sec.3097,Civ,C.)
0 Le"MusName
=I z Lsnders Address
V Q 1 certify that 1 have most this application and sick that W above information 4
Ir.!' coma 1 apo in comply with ail city and county ordinances and sum lows miming to
building construction,and hereby authorin representatives afthu city to enterupon the
W shove-mcrafmcd property for inspection papaes.
6. (We)agree 0 saw,indemnify and kap harmless the City of Cupertino against
Iti y liabllitin,judgmcnu,coed and npenm which may in any wayname against said City
(„)'z in comme ana of the Starting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicanJConuacur Dau
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant Orfuture building acevpant sort or handle bacadon material u "'
dcOnd by the Cupertino Municipal Cade.Chapter 9.13,and Ne Health and Safety
.Section 25532(a)? All roofs shall be inspected prior to any roofing material-being installed.
❑Yrs ONO
WIII the applim,or future building occupant use equip=[or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmaNnus air comeminanu at deOneM by she Bay Area Air Quality Management all new materials for inspection.
District?
0Yea 0 N
1 haw read W hvsNau mabMah mg meronts under Chapter 6.95 of du Cilifor-
niaRestth&Safaty Coda Secd=nM5,g5533mWM34.lunWc dNmifMn building
does not currently have a tenant that it 4 my responsibility to modify Me occupant of Ne
requirements which mum the met prior he Warman,of a CaNlkaa of Compaocy. Signature of Applicant Date
Ower a anthadred.,ent Date
All roof coverings to be Class"B"or better
• CITY OF CUPERTINO
8 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . : 36901026.108
DATE ISSUED. . . . . . . : 01/28/2008
RECEIPT # . . . . . . . . . : BS000003784
REFERENCE ID # 08010148
SITE ADDRESS . . . . . : 20380 STEVENS CREEK BLVD APT 1
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 . . . . . . . : WILLIAM GENTILE LIC # 24783
COMPANY . . . . . . . . . . : SAN JOSE AIR CONDITIONING, INC
ADDRESS . . . . . . . . . . : 1045 C N 10TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
® TELEPHONE . . . . . . . . : (408)286-2047
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR 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
1MPERMITFE. FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
IPLMBINSP 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 1, 592 . 40 MC
---------------
TOTAL RECEIPT 1, 592 .40
•
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
• CITY OF CUPERTINO
PERMIT INVOICE OPERATOR: patg
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901026 . 108
INVOICE DATE. . . . . . : 01/28/2008
REFERENCE ID # . . . : 08010148
SITE ADDRESS . . . . . : 20380 STEVENS CREEK BLVD APT 108
SUBDIVISION . . . . . . .
CITY • CUPERTINO
. . . . . . . . . . . . . .
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS REAL ESTATE GROUP
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE 150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
CONTRACTOR . . . . . . . : WILLIAM GENTILE LIC # 24783
COMPANY . . . . . . . . . . : SAN JOSE AIR CONDITIONING, INC.
ADDRESS . . . . . . . . . . : 1045 C N 10TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408)286-2047
eFEE DESCRIPTION------ - -_ DUEFORAMOUNT DUE _-----PAID BALANCE
--- ----------- ------ --- ----------
SEISMIC RESIDENTIAL PRINTING PERMIT 0.50 0. 00 0. 50
OTHER ELECTRICAL INSPECTION PRINTING PERMIT 122 . 38 0 . 00 122 .38
ELEC PERMIT ISSUANCE PRINTING PERMIT 40.79 0. 00 40.79
OTHER MECHANICAL INSPECTION PRINTING PERMIT 122 .38 0. 00 122 .38
MECH PERMIT ISSUANCE PRINTING PERMIT 40.79 0. 00 40.79
OTHER PLUMBING INSPECTIONS PRINTING PERMIT 122 .38 0. 00 122 .38
PLUMBNG PERMIT ISSUE PRINTING PERMIT 40 .79 0. 00 40 .79
TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 40 .79 0. 00 40 .79
---------- --------- ---------
530 . 80 0. 00 530 .80
CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORIONASUREWEST.NET
Jobsite Address: 20380 STEVENS CREEK BLVD Date:12/07/07
APT 108
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN#: 369-01-026 Project Valuation: 39$ 00.00
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
Cu ertino Business License#:
CREDIT CARD INFORMATION
Credit C
Name on Card: Orion Financial Services Inc.
Expiration Date:0812010
® Visa❑ MasterCard ■ Discover 0 American Express 13
. 1 i
lo3oo Torre Avenue
Cupertino CA 95014
CITY OF Telephone(408)777-3228
CUPS TING) Fax(408)777-3333
Building De artment
JOB ADDRESS:20380 STEVENS CREEK BLVD PERMIT#
CUPERTINO, CA 95014
OWNER'S NAME:PROMETHEUS REAL ESTATE GROUP PHONE #(91 6 )789-8484
GENERAL CONTRACTOR STEVE WHITE
SIDES FAX#(916 )789-1051
I am not using any subcontractors:
Signature Date
Please check a2plicable subcontractors and com Tete the followin information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
I Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring:Carpeting
Linoleum/ Wood
Glass / Glazing
x Heating SAN JOSE AIR �y 2
( 1408 )286-2047
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock --
T'
Owner/Contra or Signature Date
. 1
BUILOfNG ADD0.FSS:
' PEILMfT NO.
� • OWNERS NAME'.
PImWTtSITE DATE
4E'
SANRARY NO. CONTROL NO.
ARCHITELTIENOINEER:
BUILDING PERMIT INFO
BLDG Elrr` T PLUMB MFLN
C0 LICFNSEDCONTRACTORSDECLARATION
JG IMrceY arhrm gnu l,m linawd undn Pnauiriom nrCMPtra9(c«n„wawing Job Description
-a Snum 1078 of Di.inon l aaa Bon«.•"W PmfeMlom Code.W mY Ilua,m V
�a in full forte am effas
a= udmwclma B �.. 7.47992
D.- Cumncto,
ARCHITECrS DECLARATION
Y� IummR,m mY PJ
am shall be urcd u mblic rmnt
Lici Pmfuutmal
3 OWNER-BUILDER DH ILATIDN
NNI mitt, Or.—,nu I m„.mmp,(mmafs
m ad Cmu , LiCC.Lave-1,ac
D ftl Wit.9 maann.fSeciiunInn IS.But.W Piamaiom code:Any,,«man,
u "icn,mums a Iemi,m c i.a1R,.,mm„ac dndubN.Or,erld,any Rmednre
t< Mol w in iuuyut ala,mquirm IM apNitlnl r«met,windt m rik a sismi WYJnrnI
_D did,w u hmnidd'mwn'line.(aiding ConlnnoYa L,,Wd,Lr(Chg.9 Sq.Fc Floor Area Valuation
. mc
(cmm � ,ngwia 001 Section 10aniuu;m 3 ardi B «udinWPmiging MCade)«
59
- d«Mia eadmN mme mi W di pais f«and,a1kGM erampdm My.ii,11 m a
Swim 7031.3 by any aP9linnl f«a Tsm,n mejew Ilse appl'vanl m a Idvn legally a(
nOccupancy Type
nm..a wit Rr mmmd awn naU). APN Number
r]1,u WrofIM IM mil ,m it ltitayeu Wo farad w VehmlacampemWm,
silldaPisfew«l Co IM hecumNw,Lim U.
fmpb(Sea.)BM,BuGn«a
and iwhima Cme:The fa dWmaa l.im«d Vr adm m1 amly b w arc big Required Inspections
Prmmr—lanea."Oul Obadw Ihmam am rro dncaaucnwo.1 roll d;Ort gen.
W—n O,at Wiping Miw,wri impoaenrnuamm,inaodrd«Hoed f old.U.
Wreaec,uNWi,dinl nita acmn.Issab tidbit ore)car a m,lir.dr dwnm.
Wibn rill mve ae W lawn a pmMag W I M did m,Adb«impm.e r«pvrpo¢o!
❑1,a arms tl ac"Opi,m ueluuuelY contracting riN Uganda d mnncl«a m
mnnruct W Pmjm,Isco.IOM.Bulms:am Pmfem«u Cade)TM Cama®h 11
maw Law dam n«apply m in arrcn a PcnPwY rha Wall«hnProaca de,ma bad,
rnamurww r«curl«oFaa'O'kh. nnan«(L)Iimmi lmmanl at Nn C«PrK1Ya
Limns taw. ..
❑lammun«undo St, .BdYPCrtaYremm
Or v
DOW
wOli COMPENSATION DECLARATION
• IW-by affum ume,«muy a pn)ury,mw a lM fobuing dmiawime
and whim naCnifinw arconmmmadlFhuumfmrWmbhCmnpm-
A as"ntd la,by Scmm 37m a au lapin cavi for w parranna„m a b,
5«d C.N„ch an,'—nu laond
I Plant W willmnmau Wdi Campnuauon O,Pvu,¢.M nsrylmd by swim
Blmaae Law ewe,f«w Pnr WWmmbrina ret f«Nich WO perm,k Toned.
G Y A E FUND e T dan
�,yN`d.238 0002445-07
CEIITIFICATE OF EXEGVnON FROM WORRF
COMPENSATION INSURANCE
(Th,a vnum,4aa w Mmy,ft.IDM pmminfrcmenumrm daaan 61001
,n Rlr.l
I cmily Via,In w W...al IM lamp Em whim Nis Pm iii u ienK I alull mi
employanypawnmanymanmrmua NxPmembj.IdtM%V tr Cmgp 00n
Agra tllSnramu.I>.,e
OTICE,
NOTICE TO",I-d. NT:IL ago mating Ina"WtOn,a A E.e.Cu yon ahmld
e®ow,unjw y"O wmtva cnmfwm,um«adman.a ae math r Cmc yon muR
�Z fmawia cnmDlY"Oh awn«Pritl(ba rc au pemll alai M d[ela,ea nwotrn
LN CONSTRUCTION LENDING AGENCY
I nvcnr alarm in.anc u a cautrucdm lamins Otani Ion IM Pcrbmmm a
`vim uR rwk t«.nice aia'.Ic W.ii ingr),CN.C.1
L Q Larders NO..
i1<mel]AOdrrla
Jo I tnify ma,I have rind RM ii miemun W auw Or.it.amw Ia«maYmn u
. F t(i1a[rtem CW1,AY rRh ul City and M ray dalnarcaam Nw aft rtaIN[m
jU Wmm�[Cm,u«nnbm"'r.Wait..
bmmnenwiaYa aaia n,rmeun trim ae
hoe-memnu,a pmP m f«Ingwmm ptrHmrea 4
D. (Wt)alae to was imcmnify and 1?cp harmtew Ne Cly a cl,pmWi asai,lR
y IiaNllua,ludG .emu amryin rya.non agumt mid MY
JZ
'AP
Pam,NO'
APPLICA w1TM Au NgIV- Corr Issued by: Date
SWRCE TONS. i 7 ^
r/ Re-roofs
sipa«ea AmlimnHAZAARWUSMATERIAISDlS SURE Type of Roof
Will Y,c Wham«Tamm Wildii,u¢vW,done mpandla Iwwdmamamaial
in Chad by,M Ciyoni Municipal Cot.❑wl,e 9.11 and the Hmla W Saep
cmm.scum 1351:dM'
pito" All roofs shall be inspected prior to any roofing material being installed.
.,If l y pl an,«famm Wild;n[aw pa«uw Qu p nm«t ions which If a roof is installed without first obtaining an inspection,I agree to remove
® a'amnm air cmwm,wna M delnca by ae Bay Aru Air Qua1Ny Mwusm,ca all new ma Is for inspecti n.
gp ns �Nu
I M.. M>Wdruamacrivartquvmawundo
,MFlralakW Cadetw:nd25 All
tbla?ns] 3311visRdiliftCsfm
dnam 1, inaum y IYa mdfy Lha arm, c•�
cm,Rv' Signature of Applicant Date
rw«anlmnssd+fdm a 2� All roof coverings to be Class"B"or better