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APPLICATION FOR CERTIFICATE OF OCCUPA�NCY
OR CERTIFICATE OF C4MPLETION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINQ ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinaCa�cuqertino.ora
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADDRESS,�� �� 5���f B j V� APN# /� 'I D Q� DATE ` ` �'
e�eh K � S
OWNER NAME �1�) S G�S��YI PHONE,^O� .��Q O I J E-MAIL
�y�
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME PHONE E-MAII,
STREET ADDRESS CIT'Y, STATE,ZIP FAX
MAIL CERTIFICAT'E TO: Please allow u to 10 business da s for delive
CONTACT NAME ���v �� PHONE��� (��� I I " 1 E'MAII.a�j; �� C 6�
,,. -( �'�'r'� G
STREET ADDRES (^ p .CITY, STATE,ZIP FAX
��� 5 'B✓2Y1 �'(�� ��J� l.�t �ML C �! C.t d✓�"�C G q �
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PERMIT SUBMTP ISSUE DATE INSPECTdR SCOPE
NUMBER DATE DATE FINALEA
1 /�J Oe� � is ►6 Wi `�.��7 3 2 � Iv/
2
3
OCCUPANCY DATA:
USE OCCUPANCY TYPE H`[,OOR AREA OCCUPANT LOAD
1
2
3
4
BUILDING DATA:
#STORIES #STORIES OVERALL MAX OCCUPANT FIItE SPRINKLERS FIRE SPRINKLERS
BELOW GRADE ABOVE GRAI)E FLOOR AREA LOAD RE UIRED YES OR NO PROVIDED ES OR NO
#PARKING #STANDARD/COMPACI' #ACCESSIBLE
RE UIItED PARKING PROVIDED PARKING PROVIDED NOTE: ATTACH A COPY OF THE SIGNED
INSPECTION CARD TO THIS APPLICATION.
- OFFICE USE ONLY(To be completed by inspector of record)-
SPECIAL STIPIJLATIONS OR CONDITIONS:
Co,�Applicafion.doc revised OS/07/12
CITY OF CUPERTINO BUILDING PERMIT INSPECTION CA►RD
BUILDINGADDRESS: 19959 STEVENS CREEK BLVD COIVTRACTOR:T$�3="�£}-�� PERMITNO: 1311U040
D�T�R�u1�D
OWNER'S NAME:PANT SUSHMA DnTE�SSUEn: 12/17/2013
OWNER'S PHONE:4082608115 , r c PHONE NO:
✓
�rs� � ot�..�.M h��� ..:� s:.� �t �.<�� ��4,':
FOUNDATION/PIERS/H D.3. BUILDIIVG PERMIT INFO: BLDG� ELECT� PLUMB r MECH�
UFER GROUND RESIDENTIAL� CQMMERCIAL�
P�w�sE'r sacx-cE[t'r JOB DESCRIPTION: TPUMPS - T.I. TO ZNSTALL NSFl EQUIPMSNT WITH
ELATED MSCHANICAL, ELECTRICAL, AND PLUMBING.
GARAGE SLABS/PREGUNITE
Pf�UR NU COIYCRtsl'S� . . "=` F$1S�: �T±tES�:
UNDERGROtJNDlSLAB
UNDERGROUND PLUMBING
UNDERGROUND ELECTRICAL
#9!(3 NO .,1'�?UR����'I�:� '��E�'
UNDERFLOOR PLUMBING
UNDERFLOOR MECHANICAL
urroERr�..00R E[.ECTTUC.e,i. WILDLAND UItBAN INTERFACE FIRE AREA� ER#
UNDERFLOOR FRAIv11NG VENTS
TO ARRANGE INSPECTION
UNDERFLOOR INSULATIQN C911�77-322H 68tWCC0 7:30 am and 3:30 pm Monday through Friday,at least 24 hour:
gi:ACE NaS�BF�t.t1b �!t'iC" �Et� �;y�. , before required inspection.Job address and Permit Numbers are needed when
RooF srtsw�G requesting an inspection.
,
ROUGH PLUMBING t�f - CUPERTINO SANITARY DISTRICT
Zvas�c sHOwECt rnta Closed circuit video inspection of property line cleanout,point of connection
ROUGHMECHANICAL and street lateral required prior to passing FINAL CTI'Y PLUMBING
INSPECTION. Call the District(408-253-7071)for an appointment.
ROUGH ELECTRICAL/POOL BOND �r S IY..
` �
FRAMING/STAIRS/E.EGRESS NO BUILDING FINALS INSPECTIONS IINTIL ALL REQUIRED
►rrsui.artoruvsrrru.nTtON BUSINESS LICENSES ARE OBTAINED
G��ERHO'4'�c� �t�T�`' ';Q�•��EE�S�c�u"'�_„: `` pERMIT EXPIRES IF WORK IS NOT STARTED WITfIIN 180 DAYS OF PERMI7
sxTeR�oR s��otD nowri ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION.
(N'i'ERIOR SHEAIt/HOLD DOWN
SI-IEETROCK'SH..'�ETROCK SHEAR IMPORTANT
EX'LERIOR LATH/W-5CREED When a permit has expired,a charge totaling one-half the fees to obtain a new permi
must be paid in order to reactivate the permi�If a permit has been expired for more
rrrrE[uoR Lw�rx than one year,a charge tataling the f 1 fees to obtain a new permit must be paid
N4 TA,rE UR P : "`,° ; 5"�E��T�VF.�,,.„ ` to reactivate the permi�
3CRATCHCOAT �;' i�"��'�"'L�O�j6%, d D�'/L�"`J �.f� ,o
NOTES:
SEWER/WATER
T-BAR/MECH/ELECT ABOVE CEIL
�I�(t1�+�. �«'
ELECTRIC METER RELEASE SPECIAL INSPECTIONS Inspector: Date:
GAS'fEST/tviETER RELEASE
ROOF INSPECTIONS
GRADE-PUBLIC WORKS PRE-[N$PECTiON:Inspector: Date:
FIRE-CALL(408)378-4010 EAR-OFF: Inspector: Date:
PLANNING(408)777-3308
PLYWOOD: Inspector. Datc: !
SANITARY(408)253-7071
BATTENS: Inspector: Date:
ELECTTRICAL
MFCHANICAL IN PROGRFSS: Inspector: Date:
PLU1�iBMG FINAL: Inspector: Date:
HANDICAP NOTE:OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION.
�GY *UCCUPANCY OF BUILDING NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY
•----��--W- 1NSPECI'OR
BUILDING
CERTIFICATE OF OCCUPANCY"
�2 �s�/� t�� �frra�. �C�.