05070007CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFO( IRMATFION
BUILDING ADDRESS:
ADMIRAL CONSTRUCTION
PERMIT"005070007
79 WATERFORD OR
ER'S NAME:
PERMIT ISSUE DATE
JAMES SHENCHU YEN
1711 BLOSSOM
5
PHONE:
SANITARY NO. CONTROL NO.
(408)309-5981
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
O
I hereby of no Net w t 1 limmand under provisions of Chapter 9 lcommenein{
p
withSection 7ar1o) of DlvWon 3 ofdm Bualneu ud Pmf,uam Code, aha my causes,
infall to= aadeaees. 2 5 Z
tie"
REMODEL KITCHEN/2 BATHS &
Dam Comranv —
ITTE
ADD RECESSED LITS./UPGR
D ION
ARCHnECi'S DEC
�
In sound my plans shall be used As public meords
ri
Licensed Pmfesdonal
OWNER-BUILDER DECLARATION
/
m 1 am excmpl from the Consommes Ucca m Law far ft
" 1 hereby affirmu
2005
fallowing more. (Secdun RD L5, B,ineu and Professiom Cade: My city ler county
which requires a pori, to com ouch, alter Improve, dcmollh, or repair Any awcture
prior to its iuu me.alau mqulres Lha applicant frsueh permit to file a signed Ramment
that bel licensed pursuant W the provisions of the Conummri Uccr se law (Chapter 9
Sq. Ft. Floor Area
00
(commencing with Section 7000) of Division 3 of the Busineuand Professions Cade) or
Ws M u exempt therefrom ted the tubs fm she alleged excempdu. My Aall'of
APN Number Occupancy Tylx
Section 7031.5 by any Applicant, fail peri t bj=, den applicant W a civil pemity of
not mom dun five hundred doll.({500).
36617030.00
❑ I. As owner of the property, or my employe, with wage, As their In compeumtan,
Required Inspections
will do the woW, ted the awctum Is not munnded or offered An, sale (Sec. 7044, Bmimsa
and Pronasion, Cade: The Contractors Lkeme Law does no, apply to an owner ler
prepeny who Wilds or improves lhemon. and who donauch work himselfor through his
own employees. provided that Rush am not intended, offered for sale. if.
however, the Wile log or improvement is sold within ohm year of completion. the ownef-
Wllder will have dm burden of proving tis, he did nm build or improve for purpose of
Role.).
W 1, as owner of the Property am exclusively contracting, with licensed commitment in
camwet the project (Sec. 70", Business and Profession Code:) The Coolness Li,
eche Law does not apply W an mune of propeny.who Wilds or Improves Ihemon. and
who comets for such projects with a eontracmr(s) Imosed pursuant W the Contractors
Lice a Law.
Clem e,e Iorder sea. .B$P rm'thiWs m/assn
•gw..P.e S
Dale
WORKER'S COMPENSATIO5CL1RAT10 ((//
I hereby aflirm under penalty of perju ane of tm following dechoatimur
❑ 1 have ted will malnuin a CWfteamaf Conserv W self-inum for Warmer's Compen-
sation, u provided for by section 3700 of the lab, Code. far the performance of dm
work for which this permil is issued.
❑ 1 hove end will maintain Workers Compensation Inurance. As acquired by Section
3700 of the Labor Cade, for she peRormanee of the work for which this permit is Issued.
My Workers Compensation Insurenco cuter and Policy number are:
Curter. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7Tbssectan aced not W ca pteml If the permit is forommomm rut dollars ($100)
or kat)
I unify the, in the perfommue of the work fa which Its permit is Lou". I shall nm
employ any penton in any manner m As W bocumc object to the Workers' Compensation
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If, after making this CWfi,m of Excerption, you should
become subject in the Workers Compenugan prevWom of rite Lahr Code, you an"
forthwith comply wish such provision or this permit shall be darned meted.
CONSrRUCDON LENDING AGENCY
1 hereby alarm that them is•.m tion lending agency rat to Performance of
the work for which this permit II= (Sec. 3097, Civ. C.)
'
Name
,
LmL•eadera
Wer's Address
I comfy that 1 Mw mad this Application and sum that de above informNm u
coma I agree W comply with kr city and county antinuas and sum law rtltin{ he
Wilding rohwuction, ted hereby uthon. aepmsenuuvcv of this city Is user, upon de,
71A,ve-mentioned property for inpection purposes.
(We) agree W um, indemnify ted keep humkss the City of Cupcntno agunsl
liabilities, judgmenu, core ted ecp roses which may In coy way ucom agalml said City
in consequence or tie granting of this Permit.
APPLICANT UNDERSTANDS A WIT. MP WITH ALL N 0�
Issued by: Date
SOU EREGUWTIONS.
-Re-roofs
Type of Roof
um of ApplianVContrm Dam
HAZARDOUS MATERIALS CLOSURE
Will tmappliam or fnum building uccu team, handle hvsrdaos mamrial
find by the Catamount Municipal Cade, Chapter 9.11. and the Health and Safety
Section
.[3Yrs
❑
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will We applicant or ffug>fNo u'tture Wilding oecupam dm equipment or devices which
emit hauadnu air conuminsnu As dirtied by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yea RN"
1 have mad the hamolons mamdalucquanmenu underompmr6.95 of the Califon
no HmdM& SafetyCadc, Secumu 25505,15533 and25534.l understand thulrthe Wilding
tats tit currently have a meant, that It ismy res nihility to nodry the occupant of the
,bureauswhichm,lbemet toiuu a h tiro r.
/?
Signature of Applicant Date
All roof coverings to be Class "B" or better
er or Authorizeds Agent _ --
•CUPERTINO
I WTO
I
CITY OF CUPERTINO
PERMIT APPLICATION FORM
OS -D70" ",
APN # _ o 3 62 d C7
Date: / -2-�S—
I
Building Address:r f-�-, q Mailing Ad ess (1T different from building address):
BAPPLOTHER
Owner's Name / h�� �N� Cyd �E��
�//7
Phone #: / �� u�
Contractor:
C car✓S ,PGrC.7 e9
License #:
S'28 732
Contact:4�r /, Phone:(/4W; 9 -,fes
Cupertino Business License#:
I�E/( Fax: 8J -o
MECHANICAL
Building Permit Info:
Bldg ❑ Elect K Plumb R Mech.❑
Job Description: /1&1
Residential E ` Commercial ❑
Sq.Ft. Floor Area:
MECHANICAL
Cost of Project:
Occupancy Group:
ype of Construction: �i�
Please check this box if the project is a
Construction Tax
second -story addition: ❑
1% &Z(.�rir
hid/Off/Comm/Quasi
Pro'ect Size: Standard ® Large ❑ Ma or ❑
4e
-
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler > 500K to IM Btu
MECHANICAL
BBOILER4
Boiler> 1M to 1.75 M Btu
MECHANICAL
BBOILER5
Boiler > 1.75M Btu
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
hid/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax - Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= 1000A
ELECTRICAL
BELEC1001
Elec 600V > j000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
1 of 3
#, �,,z0b
�3W.36
CITY OF CUPERTINO
t1, ini-nTul� PERMIT APPLICATION FORM
%-UrcrN1nw
uanti Fee ID
Fee Description
Fee Group
BMISCELL
Miscellaneous Fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
BOVERTRvIE
Inspection Overtime
BUILDING
BPBACKFLOW
Atmospheric Vacuum
PLUMBING
BPCESSPOOL
Cesspool
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPFIXTURE
Pblg Fixture
PLUMBING
BPGAS
Gas Piping System Fee
PLUMBING
BPINTERCEP
Ind Waste Interceptor
PLUMBING
BPLANCHK
Plan Check Fee
BUILDING
BPLANCKADD
Plan Check Add Multi
BUILDING
BPLANCKREP
Plan Check Repeat Fee
BUILDING
BPREPIPE
Re i e Of Fixtures
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSPRINK
Lawn S rinklerBackflo
PLUMBING
BPSTORM
Storm/Rain Water
PLUMBING,.
BPTRAP
Kitchen Trap
PLUMBING
BPVENT
Alt of Drain & Vent
PLUMBING
BPWATER
Install/Alter Water Pie
PLUMBING
BPWHEATER
Water HeaterNent
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BREINSPECT
Reinspection Fee
BUILDING
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <=10,000 cfm
MECHANICAL
BREMAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BREMFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
Relocation of Furnace
MECHANICAL
BREMFURNOV
Relo Furnace > l OK btu
MECHANICAL
BREMHEAT
Heater Installation
MECHANICAL
BREMINHOOD
Installation of Hood
MECHANICAL
BREMMISC
Mise Apparatus
ELECTRICAL
BREMNRAPP
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
BREMPOWER
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Rc tl Switcb & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Repair/Alter Heating
MECHANICAL
BREMRESAPP
Remodel Res Appliance
ELECTRICAL
2of3
(War
CUPER,TINO
CITY OF CUPERTINO
PERMIT APPLICATION. FORM
Quantity Fee ID
Fee Description
Fee Group
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Remodel Signs, Marquee
ELECTRICAL
BREMTHEATR
Theatrical Lighting Fix
ELECTRICAL
BREMVENFAN
Vent Fan Single Duct
MECHANICAL
BREMVENSYS
Ventilation Systems
MECHANICAL
BSCBLVD
Scb Specific Plan
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSPECIAL
Special Inspection
BUILDING
BSWIM
Swimming Pool
BUILDING
BTEMP
Temporary Power
ELECTRICAL
BTEMPPERM
Temporary Bldg Permit
BUILDING
BTEMPSVCS
Temp Dist Svcs
ELECTRICAL
BUSLIC
Business License
BUILDING
ELECTRIC
Electrical sq foot
ELECTRICAL
- EPERMITFEE
Elec Permit Issuance
ELECTRICAL
MPERMFEE
Mechanicals . foot
MECHANICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
PLLONGRNGC
Planning LR Comme/ Multi -Faro
PLANNING
PLLONGRNGR
Planning Long Range Residential
. PLANNING
ZADDCHG
Address Chane
BUILDING
3 of 3
J
•
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36617030.00
DATE ISSUED.......: 07/01/2005
RECEIPT #.........: 30206
REFERENCE ID # ...: 05070007
SITE ADDRESS .....: 7579 WATERFORD DR
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OPERATOR: conniew
COPY # : 3
OWNER JAMES SHENCHU YEN
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5233
RECEIVED FROM ....: JAMES YEN
CONTRACTOR .......: DAM KIEU LIC #'22513
U
COMPANY
..........:
ADMIRAL CONSTRUCTION
ADDRESS
..........:
1711 BLOSSOM
HILL RD
CITY/STATE/ZIP ...:
SAN JOSE, CA
95124
•
TELEPHONE ........:
(408)309-5981
FEE ID
----------
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
BENERGY
-------------
PERMIT FEE
----------
223.56
--------------------
107.31
0.00
----------
107.31
----------
0.00
BPERMFEE
VALUATION
15,000.00
223.56
0.00
223.56
0.00
BPLANCHK
PERMIT FEE
223.56
298.34
0.00
298.34
0.00
BELEC200
METERS
1.00
29.43
0.00
29.43
0.00
BSEISMICRE
VALUATION
15,000.00
1.50
0.00
1.50
0.00
PPLBG
SQUARE FEET
628.00
50.24
0.00
50.24
0.00
ELECTRIC
SQUARE FEET
628.00
50.24
0.00
50.24
0.00
EPERMITFEE
FLAT RATE
1.00
38.37
0.00
38.37
0.00
PPERMITFEE
FLAT RATE
1.00
38.37
0.00
38.37
0.00
TOTAL PERMIT
---------- ----------
837.36
0.00
----------
837.36
----------
0.00
METHOD OF
PAYMENT
AMOUNT
NUMBER
-----------------
OTHER
------------
837.36
------------------
M/C
TOTAL RECEIPT
837.36
U
aCOF
,kEIIN0
C.
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
artment
JOB ADDRESS: 7S -Z9
, /� ov I PERMTT # 06-0700,07 6-0%OQ,O7 1
OWNER'S NAME: �I PHONE # ((4a,?% S<S4h — Zh rI
O
CRNFRAT.CNTRACTOR: .4aAOi/?Al //rTi FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following, ormation:
Owner/Contra r Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
X
Cement Finishing
Electrical
i
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
I(
Owner/Contra r Signature
Date
I
_ I
TA 4^0 s. f
T
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