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APPLICATION FOR CERTIFICATE OF OCCUPP,�lCY
OR CERTIFICATE OF CO�PL.ETION
COMMUNITY DEVELOPMENT DEPARTMENT� BUILDING DIVISION
CUP�RTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildina(a�cupertino.orq
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROIECTADDRE55 /DU�� ry � �TjJI���I �IUCI �'�3 �NN DATE �/l���'�
F
OWNERNAME PHONE E-MAIL
�imm L� W�NV L.0 4aN �'7v-��31 ,}�.'^"'y�HeM�sW� 66dj°abm, ca��
STREET ADDRE55 CIiY, STA'CE,21P FAX
CONTMCTORNAAIE PHONE E-MAII. ,
rl; �c�n �lo yo°7o634� �I�unvbQ ,��;(���
� STREETMDRESS C1iY, STATE,Z� FAX
MAIL CERTIFICATE TO: (Please allow u to 10 business da s for delive ):
CONTACTNAME �iMµY I�f PHONE `IA61o.,rY'�'F�1,3I EMA� I�MM C�PrH'�ST" to�d�rAI1o0� CS��
�- J
STREETA➢DRESS p :�y ��� CITY, STATE,ZIP . �_46 �A p,d�,.� FAX
'Zt�20� CbQK1r (i�L- ,Sc�.✓c� sa� �� !
LIST ALL BUILDING PERMITS ISSUED FOR PRO7ECT:
PEIL�IIT SUIINIIT ISS[J� DATE INSPECTOR SCOPE ,
NUMBLR DATE DATE PINALED
� ��oz�� e 1�.,� rZl 1��3 Sr�RI���
2
3
OCC PANCY DATA:
USE OCCUPANCY TYPT. FLOORARCA OCCUPANTLOAD
1 � �
2
3
4
BUILDING DATA:
N STORIES k STORIES OV�RALL MA7C OCCUPANT FIRE SPRLYHI,ERS FIliE SPRINHI.ERS
BGLOW GRAD� ABOVE GRADE PLOOR ARGA LOAD .REQUIl2ED YES OR NO PROVIDED YES OR NO)
!
p PARIQNG #STANDARD/CONIPACT #ACCESSIBLE
R� UIRED � PARKINGPROVIDED PARKINGPROVIDED
- OFFICE USE ONLY(To be completed by inspector of record)-
SP�CIAL STIPULATIONS OR CONDITIONS:
� CojO Applicntion.dac revised OS/04/17
CITY OF CUPERTINO BUILDI�tG PERMIT INSP�CTION CARD
8U[LDINGADDAESS:10011 N FOOTHILL BLVD STF. CON1'RACTOR:4+HH---�O,.BE �� PERMITN0:13080211
113 F„T,_�R,"-:T*s_+.
ONNER'SNAME:JTMMY LI � ����� ��c UATEISSOED:12/03/2013
'C-� I ov�I
� O�i'NEH'SPHONF,:4086744631 PHONENO:
INSPECIIONS," %'_' t; DATE "._ �.SP,%Cl'OR
FouNDnTroNm��es�xus. BUILDING PERMIT INPO: RLDG� ELECT� PLUMB� MECtI��
IvFERCxoUNU � RES1llENTIAL� COMMERCL4L�
PAD/SET BACK•CERT JOB 1)ESCRIPTION:
GARAGESLABS/PREGONITE �
LU DENTAL- COMM. T.I 1865 SF TO INCLUDE WAITING
PDURNQCONCRETEUI4',1',ICABOpF'NASB6SNSIGNED- - -
[1NDE2GROUND/SLAB
EA, RECEPTION, EXAM ROOMS, NEW LAB SPACE. .
UNDE2CROUNDPLUMBING
UNDERGROUNDELEC7RICAL � y`ty � _� /*
J� 4r .�
DO NOT POUR FIiO.RUNTIL A60VE �S�BEEN SIGNED : -
_.., _
UNDERFLOORPLUMBAIG . � � �
UNDERCLOORMECHANICAL
uivocar�ooa e�ECTiucai. WILDLAND URIfAIY INTERFACE FIRE AREA� ER#
UNDERFLOOR FRAMMG VGNTS �
TO ARRANGE INSPECTION
UNDGRPLOOR MSULATION Ca11 77 7-322 5 behveen 7:30 em and 3:30 pm Monday through Friday,at least 24 hours
e�ce-�vosutiu��oRtm�ru.neovstiasHEexsicrven '- -= before required inspection.Jo6 address nnd Permit Numbers are needed when
RoOe SHCAT[iWG requesting an inspaction.
ROLGH PLIIMBMG
�i "``��°��" CUPERTIRTO SANITARY DISTRICT
�7vas�stiowearnN ' Closed circuit video inspection of property line cleanout,point of wnnection
;xoUGH rotecl�iANICnL v-�� and street laterei required prior to passing FINAL CITY PLUMBING
C.'. 7t.% , L.
�_ `t_ I • INSPECTION. Call the District(408-253-0071)S'or an appointment.
ROf7GHELECT2iCAL/1'OOLBOND_ -�!),+� - y.���
i
s� et /
�FRAMING/ TNRS/L.E.�RESS 7�, NO BUILDING FINALS IN5PECTIONS UNTIL ALL REQUIRCD
- � a- - BUSINESS LICENSGS ARC OBTAINF.0
MSU4ATIONNENTILATION A .y
JV
covex no wpS��vKTic anovE xas sEEn' 1�rveu' . = pERMIT EXPIRES IF WORK IS NOT STARTED WITHiN 180 DAYS OF PERMdT
EXTERIOR SHCAR/HOLD DOWN ISSUANCE OR 180 DAYS FROM LAST CAI.LEp INSPECTION.
INT6RIOR SHGAIt/f{OLD DOWN
SHEGY20CK/SHEETROCKSHEAR _91 IMPORTANT
J When a permit has expired,a charge totaling one-hulf the fees to obtain�new permit must
axTea[os[.nx[vw-sct�co n be paid in order to rcactivete the permit.If a permit has been expired for more
iN7'&�i�ox tqiti than une year,a cl�nrge totaling the fult fees to obtain a new permit must be paid
�OTAPEORXLASTER�UNT14A8qVE7iAS�EENSIGNED i toreaCtlVatetllep¢rmit.
��SCRAICHCOAT � � �
sewsaiwnrcK � NOTES:
�IRAIUMEC[i/ELhCTnHOVECEIL � � ( �,
F1NAL5 "
qrisCi'kiCtiscrraaELeASE � SPECIALINSPECTIONS Inspector: Date:
���
(aAS TGST/MGTLR RF,LEASE
.----- -- . ._ .. - ROOFINSPECTIONS
G/tADE-PUBLIC WORKS PRE-INSPEC7'ION:Inspec[or. Date:
FIRE-CALL(40S)378-4010 '�+� TEAR-OPF: Inspec[or: Dnte:
PI,ANNING(408)777-3308 '
PLYWOOD: Inspector: Da[e:
SANITARY(408)253-7W I
y
���,,..._.....__ ._.. . _ �� � ' d' '� A7"CENS: Inspector: lla[e:
GL•LECTTAICAL ,� ,
� IN PROGRESS: Inspeclor. Date:
MECHANICAL ,/ ,�
PLUMBIMG FINAL: Inspmtor: Date:
HANDICAP NOTT:OSHA APPROVED ACCLSS TO ROOP SI�ALL BC PROVIDED rOR INSPCCTION.
ENERGY ^OCCUYANCY Ol�ISUIGDING NOT PERMITTCD UNTIL BUILDING FINAL IS SIGNED BY
BUILDING �) � �NSPECTOR �
CPRTIPiCATE rOCWPANCY• ',/ I
�
__ � / J