13020151 TCOTEMPORARY CERTIFICATE OF OCCUPANCY FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION l
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
its 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • build ingpcupertino. org
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BOND TYPE: ElSURETY BOND FAMOUNT (1% VALUATION (BLDBONDSI CODE
El CHECK El CASH BOND BOND: 5K min -10K max $ �� EDITION:
TCO EXPIRATION FEE: $286.00/1'110 TOTAL FEE: $ [1TEMPOCC]
DATE (6 MONTHS MAX):
USE
TYPE OF
CONSTR
FLOOR
AREA
OCC
LOAD
LEVEL
COMMENT
APPROVED WITH CONDITIONS'
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.......... Date:........................
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...................... Date:.. .........�.�
OTHER DEPARTMENT / AGENCY APPROVALS:
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❑ APPROVED
APPROVED WITH CONDITIONS'
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.......... Date:........................
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❑ APPROVED
APPROVED WITH CONDITIONS'
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APPROVED WITH CONDITIONS' ,
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❑ APPROVED WITH CONDITIONS'
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`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 regulations and ready for inspection prior to the expiration
date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non-compliance
may result in an enforcement action.
Owner Contractor
Signature ............... Date:......... 9nature:.
This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and
approved for the specific area of the building specified above to provide a reasonable degree of safety to the occupants from fire and
similar emer encies.
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Building Official: ate' -, ....I.....Pnnt:l /z ..,<.... .r...:=.'.�..........................
DEPARTMENT ACTION: After determination, copies to. 1) applicant, 4permit file
TempOccForm_2013.doc revised 717114
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