08040192 CITY OF CUPERTINO .r 4t`1 7� _ .r .lr
RMIT COr
BUIh.PING DIVISION PEi 'lRACTQR INFRMA�IO
! - O
QIIL`5?Y�o�,
BUIL I A ESS: PERMIT NO.
�l�re3�� STEVENS CREEK BLVD APT ORION FINANCIAL SERVICES 08040192
OWN AME: PERMIT ISSUE DATE
ml, PROMETHEUS REAL ESTATE GROUP PO BOX 693 04/28/2008
NE. SANITARY NO. CONTROL NO.
ARCHIIEC(ENGINEER: BUILDING PERMIT INFO
WSHR&DRYR RTROFTS,KTCH&BTH BLDG EIFcr PLUMB MECH
0 0 0 0
300 LICENSED CONTI ACT00.'S DECLARATION
Ito 1 hereby affirm that,I an B¢rued undo,poevlilhn of Chapter 9(nmmmekg ----�—_ _.. ..__.-. ...... ._-Job Description
with Section 700U)of Divition Jaffa Business and Pnefeaoom Code,aM my license,is
in run forme and effect
F, Llamsc Clete Lk.If
Deer Contractor
ARCHITECTS DECLARATION
I mtlemand my plans Ann he used As public remands
s�
5 cad Licensed Pmfeaianal
^ OWNER-BUILDER DECLARATION
i 0 9 1 Mse er.(Sect that 11. exempt from the Contractor's License Law o for we
D O following maann.(Seaton 1 mals,Business and ere,dem ll Coat:Any city or county
9 whleh mquhu a permit m cnnmrdo aper,Improve,acmolWt,our repairsig any omemum
grin to its issuance.p. roq wt
the led applicantof the Contractors;
permit to rile mm Law(Cha mem
< WUMhce ithSesum,tomepmvialon0(ththeSta tor'Wmemelsw(Chapm9 Sq.F[. Floor Area Valuation
$
(commencingaIsexempt
wpp Satin 1000)of Division r of the aueinnu And prion.pretensionsviCode)of
that W V exrmp,therefrom W tie Weis for the alleged csemptian.My Notation of
Sewn 70315 byany,pplicanl fora permit subjata the applicant to,civil penlly of APN Number Occupancy e
Am mart WTI Eve haired dollars,ISSUE).
P Y •J MITI P
0 1,u owner of fie property,or my employee with wage As thek a oleeompenaafon,
win do thematic,m4 the awmum tswtkteedea ser anered rortam(Sec.7044.Business
And profession Cede-The Carmine,Llcmlme Lata doe not apply an At ow.of Required Inspections
property who builds a improves thereon,and who d oes,uch wmk hivuelf m though his
owe,mploym,provided mat such improvemants see not intended moQend fnale-If,
however.the building or Improvement a said Whin arc yev of omnplerin,the owanr-
Wilder win have ft Wrden a(pmving tar M did not build or improv for purµvse of
oak.).
0 1.As owner of the property,am eadualvely contracting with licensed conuactoa to
construct the project(Sec.7044.Boutnea and Profession Code:)Tia Co motor'U.
chow,Law does not apply to an owner of proPe ty who builds or impmws sewn.and
who contracts,for such pruj au with a commov r(U licensed Famous,he the Conuacter's
Lkanse LAW.
0 l am exempt under See .B h PC for this retort
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of perjury arc of the fallowing declarWorre
1 have and will maintain a Certificate of Consent to self-Inum for Wohtrs Campus-
wion.As Provided for by Salon 3700 of the IAbur Code.far W performane of the
work far which Nis pmM,is banned.
0 1 have mrd will maintain Washes Compensation Imuran,an required by Stolon
3100 ofthe LAW,Case.for the perfomana offs wart for which this pares,is blued. '
My Workee,CompenNon]man=carrier and Policy number ate:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lhksecdou naw not M completed If Ile permit a forme hundred donna(3100)
or less)
1 certify that in the perforow.of Ila work for which this pmmh is woad,I shall nm
employ any person In my manner eo An he becomo subject to the Worsen'Compensation -
Laws of Califorow.Date
Apia can,
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
bSerne abfCm to NC Worke't Compereddon prevision of the Law Cafe,you muff
.,zz forthwith comply with such provision or this permit shill M deemed mwkcd.
z� CONSTRUCTION LENDING AGENCY
[—� I MmbY aEiml that more is cmatmcfnn lending agency for the performance;of
Ri
ft work for which this pewit Is issued(Sec 3097,Civ,C.)
0.Q IAedofs None
z Lcndels Address
U O I modify that I have rad this,pplkmion and cum that the:be.information U
IT, coeaL I agree 0 comply with ill City and cowry aNinaauand!atote law Made,to
O building conanuNon,and hereby authorine representatives;ofthts city to enter upon the
I� ,Mere-mentioned property fee inspection purposes.
y (We)agree to ave,indemnify and kap harmless the City of Cupertino agalnt
„w n If,bllife,jadgmna.cna and mason which may to Any way accme,3almltald city
I,z in consequence of the granting of thin permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1 NON-POINT Issued by: DBI,
SOURCE REGULATIONS.
Re-roofs
Sigmtun of Appliem/Coanmtor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me,ppliant or fu,un building acupantffom or handle harandoou material
as deEmd by the Cupertino Municipal Code.Chapter 9.11.and On Health and Safety
code, 25532(,)1
Oy. ❑Na All roofs shall be inspected prior to any roofing material being Installed.
PmWill the applicant or future building Occupant use,equipment or rkvias which If a roof is installed without first obtaining an inspection,I agree to remove
t IwAtdous air contaminants a defied by the Bay Am,Air Quality Management all new materials for inspection.
in4
Dyes ONO
I Were mal the haaaws reauriab mquimmenu under Chapter 6.95 of the Califor.
nu Health @SafetyCoM,S.A.25M5,25333 ana 25534.1 understand met lfthc building
Jona w,cnommly lave a mmL that It u my responsibility An iffy,tie amwmo of ft
roquiremmsswhkh most be mel pviar to issuance off Cablice of occupaey. Signature of Applicant Date
Owner or authorindagent Dam All roof coverings to be Class'W'or better
CITY OF CUPERTINO
8 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36901026.312
DATE ISSUED. . . . . . . : 04/28/2008
RECEIPT #. . . . . . . . . : BS000004599
REFERENCE ID # . . . : 08040192
SITE ADDRESS . . . . . : 20380 STEVENS CREEK BLVD APT 3
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 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 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
lEPERMITFE 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
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 1, 592 . 40 AMEX
---------------
TOTAL RECEIPT 1, 592 . 40
• CITY OF CUPERTINO BUILDING PERMIT APPLICATION
E-Mail ORION IWSUREW EST.NET
Jobsite Address: 20380 STEVENS CREEK BLVD Date:314108
APT 312
Owner's Name:PROMETHEUS REAL ESTATE GROUP
Phone No.:(408)253-7100
APN# : 369-01-026.. 3 12— Project Valuation: $3900.00
Blg. 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:4-1-2009
Cupertino Business License#:
CREDIT CARD INFORMATION
Credit Card#: 311-1 363 \-IQC�*C'2q
Name on Card: Orion Financial Services Inc.
Expiration Date: fj t (I U
Visa ❑ MasterCard 0 Discover 0 American Express, 1-
BUILDING ADDRESS - PEnMR ND
OWNER'S NAME:
08010 9a
POtMR�l1EDATE
NE:
tAtBrnRM ME CONTRA,NO.
• MCNIiFLTIFN4INEER:
BUILDWG PEgMR MFO
8IJ3G ELECT PLUMB MEM
op LICENSED CONidbod R'SDECLARA77ON l� (-]
InmT ,ffrRlGab.3d,ditBo k NmtimsofCLPv+9(mnmorins Job Description
Zu mlN Sxum 70(YII of Diviuon3d0e BupnCM aM PmfMcwu(bRt,WmYlk«IRu
'= In full fm¢anp effuC
LkmcGm, B Lk.. 7.97992
'J D+R_ Convana«
ARCNbo S DECLARATION
e m
� 1 uneuanu Alba N
my allll k M uRnd u pNbc l«MW
1 L
` icoo,e PnafuiNMl
OW NER-BUILDER DECLARATION
<e IcrcoY a1Trw Ince I am mbio o tomb bC CmvanClt IJ¢f¢LAr f«Iln,
]O IdRmnt m..abc.711.5.B.W ProfboeM coni My rn1mmnuY
-nolo rtymm a lvmn.cmnr«',,IIRL inns Ilamlimb.or moor My smcove
to pnm n-iauLC.,Ib bodd.lh,NMkbm r«ArB RIGIm
ppmi,bfklYLR'431
_� IMlmulmcmwpunuammincrynriii«uallcCOMncI«YIJco,RLaw(Glyllp9 Sq.FL Floor Arca Valuation
7. Icmm
mbmt rile S-6.700M d N%t4ion7 d,k Bo thimb,W Aof®w onto,h,
3 n Nal M u cacmp NMefrom a,M N,pail f«9alkLc
i e evmpum Ary ufdarnp d
S,nlm 7031.5 by any applkam(dr.p,bn,Whjau Ine.Wliov,b l dW pcmRY d
nm mm.man D,e how,.eNMrn am APN Number Occupancy Type
Ibol uwrcyeI"Mnpmlylo-1 whom«.]witi vaRsib Nevble ml.Buid
II mme wb,ana In[s vu„mintl1 MImhA Witbofade(LG W U Bvm,a
Ind Ndemnb,cbett TTi cnnu.n"r.,lm lar e«,l«apply if u o.n«d Required Inspections
mmcnr r.nb ;.M m Impm.s bcrmn,alb w,boc„um wrkbimsr3r«Uuootp nil
employes,ldi.,m IMIamnon,wwmonuart m,i oh.a «aRMend ra de a.
W-WIhmm-,ua--Un, und-U pwalli,We WNinon5w d mnplCRon,p itwan
W iWcr rill lura Ne WNui d pomL IMl lr GN roI BWIe«bMOR(«pep.'aR of
❑1.u w.er tl IK Mopml,am eaduvr,lY imuvint viN Iimlid Cmml,1«.,p
C«u,nel uw pmiul(s«.]ON,BusincM.M Pb(®or,3 Cbpe)lDe Cm0.aafb L4
uw,i ur.ema..m apply r an O..nn dp,yeny arp"WRN m Mpmw ReapOn.aM,
im emlRem fm nen poaa,.riN a evnmauorO)li«nRE pMmlMbRmCmsab(b
Licn.¢Lav
❑1 un racmM unRr Su. .B d P C fm Ibh mbv
Orrc, fMe
woaRms mMPFi+snnDN DFcuwnoN
I bwby,(limn mbbp«Mlly Of q r,u,o«d Nc rdbW'vIL Olrla,almc
Ind boll mamum,Carlifiabof Cn oblow RlFinquc(«Wmnm,,Cpmpm,
It pbwme Im by kclRb 3700 of el,Labor Com,r«Ne peaf«mum d Na
}Nt
F.vnrtn Inn«,mil u IYme.
• ❑I MI[ane.,It mNnl,m WOR,,,C2Rp SHllm M9buK, ay it by$IOion
TT90dNc Lam C"«,fm me pmlmman¢d pe emrt f«ritcA Wupemk a"m 1
My".ort i Cmn Mabvre nnic ane Poluy ne«m 11e
§ A E FUND pn,kyll>238-00024 07
CCRnFICATn OF OJ EMP IGN FROM WORKEA.4
COMPENSATION INSURANCE
Th-—b-neae nal memnpkml it Norpermit is f«onclo WRI ebRN(S10D)
•IrJ{.1
1 nnny mm m u,p:NomNcc of ui wort I«inland,ditto fmm,i,iv«d 1 sMR nn
employ,nypermIn manmrbubb,mne abjenblM Wor3eK Cmnpum0m
Lar,MUlirmnn.M.
NO7C
HGONC
E TO AFPIJCANT:If.
matinthisPis C,nlfiva dch pilot
m «,conIiWbrlrconnpn,aYsm pwiPwme,UW each,ypi
Z wN.uF comply will smn inni,ims m Nis cmil WB ie ec,ma nl6
mbO
.
CONSTRUCnON Lp7DPIQ AnF1X.1'
vy
IWbmy
bo
um uirt u,cbluvunm kv01 C.) cyf«don p«formal¢d _-
Y^ ui "lu.vpi"b mu pnml u.vuee ISee 1pT.CN.C.1 '
5 0 db— Name.
Z Lmame Aeerm,
i I 1amt,mu 1Iuw nae IW,,p,i.mn W suR Nu the WOw IWv«ltimh
. " cenm I,Lrt,in cmnply iM.11 do,It Cm«Y pMlnanm am silk Ams RMO.L b
jV m9einp cnnwri,mn.I.burly amnbn-mMvenmiav d Nin eby in mum upon the
cnlxuutl anwc.mM« nY i, lom iupcam rylpb¢
rboomod ob vac Wmnily bond tep Mnnkss RR Gry d CWm,iw ataim
�y MY1bwA luet .cosu NEn�`�. qu Yaana lLliW vW city
Z in cbmrgm. Lra«mL d �1
" AFRICA ND N WI7N ALL N(M-POIILT l$sued by:%Off
IIate i//,fY 1u3
SWRCE TONS.
Sltnau,ed ApplianmCmvaCl« C Re-roofs
Hn RDOUS MATEIUA DISCLOSDRE Type of Roof
will ui apN.or luuuc ho t«ngml Bort«MMk Mswepm mll«ial
v mbRe by IN Cu«loom MumnNl COR.CMpam 9.11 Nb Inc 51dN bond SILIM
C.ettnm xssnnr
0Yu ,J(1' N" All roofs shall be inspected prior to any roofing material being installed.
will IM ,hum m lolm.Wibi.,.1.1 OR WuipmeM«Brice,ibkk If a roof is installed without first obtaining an inspection,I agree to remove
ammo,,.,mmmmmanu M Rfi«d by N,B,ARi Au QwRy M. ,cln. all new m s for inspecti n.
:pm No
f-
lmmm Mmows mat rt9uumlenu wukr CnyRr 695 doe CWfON
HmINL 5+1 Cope SpwRs 35 57do",3 .I mle«sunnd WUNe boths,
cora nx can ly .c a Iw. W I y .. IY R mEfY the _ — ,z
Signature of Applicant Date
m,nlnmsp umI r „ All roof coverings to be Class"B"or better
10300 Tom Avenue
CupecCno CA 95014
Telephone(408)777-3228
OF Fax(408)777-3333
CUPERTINO
Buflding De artment
JOBADDRESS:20380 STEVENS CREEK BLVD PERMTr# ��
CUPERTINO, CA 95014 1{1
OWNER'S NAME:PRONETHEUS REAL ESTATE GROUPPHONE#(916)789-8484
GENERAL CONTRACTOR:STEVE WHITESIDES FAX#(916)789-1051
I'am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring:Carpeting
Linoleum/ Wood
• Glass/ Glazing
x Heating SAN JOSE AIR (1408 )286-2047
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
T.
L
Owner/Contra or Signature Date