13020153 TCOCUPERTINO
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 (408) 777-3333 • build ingacupertino.orq
APN
BP#: 13020153
DATE: 08/21/14
PROJECT31491,100.00
SITE 10093 S. Blaney Ave.
ADDRESS:
OWNER'S NAM
PHONE #: 650. 931. 3457
Prometheus Real Estate GroupFAX#:
650.931.3657
MAILING ADDRESS (if different from site address):
1900 S. Norfolk Street, Suite 150 San Mateo, CA 94403
CONTRACTOR: Johnstone Moyer Inc.
PHONE #:650-570-6161
11 APPROVED
FAX#: 650-570-6144
CONTACT: Brice Schillling
PHONE#: 650-762-4486 Cell
FAX #:
TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION
BOND TYPE: ❑ SURETY BOND AMOUNT (1% VALUATION I/' (BLDBONDS] CODE
❑ CHECK ❑CASH BOND OF BOND: 5K min -10K max $ d `� ' $160 EDITION:
EDITION:
TCO EXPIRATION FEE:
��Lj$286.00/mo TOTAL FEE: $ _ �j� [1TEMPOCC]
DATE (6 MONTHS MAX): e-1
USE
TYPE OF
CONSTR
FLOOR
AREA
OCC
LOAD
LEVEL
COMMENT
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❑APPROVED
1-1 APPROVED WITH CONDITIONS"
OTHER DEPARTMENT / AGENCY APPROVALS:
Planning
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Signature: .........................................................
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 undersigne covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or
buildings complqte and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration
date specified.is Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non-compliance
may result in n rcement action.
Owner Contractor 08/21/14
Signature:.......'. 1-944 ...... Signature:... Brice D. Schilling .Date: ......................
........................................... Date:..
This tempo crtifica ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and
approved for the ecific area of the build'ng specified above to provide a reasonable degree of safety to the occupants from fire and
similar emer enc s.
Buildino Official:.. ............ . .... .......................Print:... .....yzj ........ Datet
�........�............
DEPARTMENT ACTIOWAfter deteFmination, copies to: 1) applicant, 2) permif file
TempOccForm_2013.doc revised 717114