14100103-FUTILITY RELEASE REQUEST FORM
UCOMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
IALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ingacuoertino.oro
PL`RPOSE
For residential single family or duplex construction, there are cases where gas and electric utilities are
requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the
building inspector, the City of Cupertino is allowing both utilities to be released prior to the .final sign -off of
the building.
INSTRUCTIONS
1. Download this form at: http://www.cterrino.��rg/index.aspx?page--217.
2. Complete the form and obtain signatures from both the owner of the property and the primary contractor.
3. Fax, E -Mail, Mail or hand deliver the original signed form to:
City of Cupertino
Building Division
Attn: Utility Release Request Form 408-777-3228 office
10300 Torre Ave. 408-777-3333 fax
Cupertino, CA 95014 building( cupertino.org
4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please
note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release
inspection.
BUILDING INFORMATION (Please complete the following information):
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OWNER'S NAME -PHONE
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FAX #:
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CONTRAC
PHONE #:
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CONTACT: --,PHONE*
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I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of
the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of
occupancy for the building.
Owner'.. ........ Print: ... C Qt-. .............. Date:..
Contracts ...............Print:.....!.. L.f..1.1 f .... .,...,.... Date:...�..% ../...1..
UrdiyReleaseForm 201 Ldoe revised (18/09/11