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()F,'NER'S NAIIIE: LAKSFIMANI(UlvIAR MLiKKAvr a.i llrr5[ iv s ;:jsil F]f \"Bi DA'tE ISSIIED : 06 I 04 120 13
rxi'NER's riIONIt : 4087 30025 5 HAYt-ti,rRD,CA 94541 PIrc\E No: (5l0) 432-6249
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Date:
fEAR-OFIT,
PLYWOOD:
BATTENiJ:
IN PROCRES9i:
FINAL:
NO'I'E: OSILT
Inspector
hlspector
Date:
Drrte:
lnspector: _,_ Date
Inspector: ___ Date
lnspector
APPROVED ACCESS TO ROOI'SIIALL BE PROVIDED F'OTI INSPECTION.
OCCI-IPAI{CY OF B TILDING NOT PIiR\IITTDD L]N'I'IL BUII-DING IiINAT, IS SIGNED BY
NSPECTOR
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.:(.LRTIiIICATE OF
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frec,e 1- F":r*./r-;: iza- i*
WILDLAND URBAN INTERFACE FIRE AREA,I
TO ARRANGE INSPECTION
Call 777-3228 between 7:30 am and 3:30 nm Monday through Friday, at least
trefore required inspection, Job address and Pel'mit Nurnbers are necded
requcsting an inspection.
CUPER'TINO S..\NITARY DISTITICT
Closed circuit video inspection of property line cleanout, point of connection
and street lateral required prior to passing FINAL CIl'Y PLIJMBING
INSPECTION. Call the District (.108-253-7071) for an aptrrointment.
NO BUILDING FINALS INSPECTIONS UNTIL ALL R.illQLl{Rtll)
BUSII{ESS LICENSES ]IR}.] OB'I'AINED
PERI\{IT EXT'IRES IF WORK IS NOT STA-RT'ED WITIIIN T80 DA}'S Oi,T PEITS{IT
ISSUANCE OR I80 DAYS FRO]VI L,{ST CALLED TNSPECT'IOI\.-.
INIPORTAI,{T
When a permit has expired, a charge totaling onqlglf the fees to olrtain a new pernril
nrust be paid in order to reactivate the permit. If a perrnit hls been expirerl for more
than one year, a charge totaling the full fees to obtnin a n,:r'; permit rnust be paid
f)tts:
ROOF INSPECTIONS
Pli.E-INSPECTION : lrspec:tor
2.4 hours
when
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CUPERTINO
U
TEMPORARY CERTIFICATE OF OCCUPANCY FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (w08) 777-3333 • build ingocupertino.org
--
APN F 5 �0? — 0 `;
BP #: [, I 0 0 6 1
I I a O � � �
DATE: �' ?
9 at IZ
PROJECT 0 O O
VALUATION: s
71L.601`4 AV. & 10419 �`._'ANTA U AV.
Ci1Pr RiINO r/1 92 0l4
ASITE DDRESS:
[:3APPROVED WITH CONDITIONS'
_PT
u Ic Works
OWNER'S NAME:
PHONE #: 4 O $ —
PHONE
7 3 O �-- a . 5 ►i)
LAKSOMANKUMAR. MUKKAVjI —LII,F-
—a
MAILING ADDRESS (if different from site address):
APPROVED WITH CONDITIONS`
Signature: ,..:....V.
,
CONTRACTOR:• C 5fA 1 ��
PHONE #: 10
- +49
CONTACT:
a E�TAM f N 0 V i f
P N
10
6 q
TEMPORARY CERTI
BOND TYPE: ❑ SUR
ANCY INFORAANJ
n1viuUIV 1(1 - V V Ivry
OF BOND: min- 0 max)
TCO EXPIRATION q &: j_j$ �� O TOTAL FEE: $ [1TEMPOCC]
DAT (6 MqVTHS4XI t� a
^'rUCM MMMADT11ACAIT / A(_CAI(`V APPPr)VA1 R*
- ... _. - --- _
Tanning
Signature:.......................................................
G. S� .,, eot ✓ Z ( S
A
Date:......................
❑APPROVED
IId—APPR0V WITH DI IONS
Ire'
Signature: .......... ...........................................
Date: .... ..r.2 ...�
APPROVED
[:3APPROVED WITH CONDITIONS'
_PT
u Ic Works
—
APPROVED
ElAPPROVED WITH CONDITIONS`
Signature:..........
t Fe r: //"
Date:..! .«....
�:-.i.7...�....
❑APPROVED
APPROVED WITH CONDITIONS`
Signature: ,..:....V.
,
.'................... Date:
*CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property
stating the list of items required to be completed for each individual Department before final occupancy
can be granted. Include approximate completion dates for each item.
The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or
buildings complete and in compliance with all building codes, ordinances and rebees-arttd-ready-fcr inspection prior to the expiration
date specified. If this Temporary Certificate of Occupancy expires, the t amount of the bond may be forfeited and the non-compliance
may result in an enforcement action.
Owner V / Con t
Signature: ............. ........�.............. Date...... ..k�..... Si nature:.... z......................... Date:..
This temporary certificate ensur s that all fire protection and life safety systems have been completed, inspected, successfully tested and
approved for the specific a e building specified above to provide a reasonable degree of safety to the occupants from fire and
similar emer encies.
Building Official: ........ ...... ...................................................Print.. ..,4 ...a.:.:.. ................Date:...-./..7'%�.`�
DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2),permit file
O ! TempOccForm_2013.doc revised 717114