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APPLICATION FOR CERTIFICATE OF OCCUPANCY
OR CERTIFICATE OF COMPLETION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTIPI� ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinq�a cupertino.org
COMPLETE A SEPARATE APPLICATION FOR EACH BUII.DING:
PROJECT DRESS APN# r � DATE
D �C � 'IS � F �� � ' � �-(� 33 -��- 2vl �
OWNER NAME, _,-, I ^ PHO �MAII.
CN l, 1� M r l � � Gcl�f�� ' � Ll�' ' �LI �l
STREET ADDRESS CITY, STATE,ZIP r FAX
�. l. I� F "'i� �' ��l�
CONTRACTOR NAME �. P ONE E-MAIL
C, i I Sii2U'�((o1�J , �L ��- Zu� — '�'22� Nic:c R 1 ilitD� � l�a;�;C�NI
STREET ADDRESS CI1Y, STATE,ZIP FAX
MAIL CERTIFICATE TO: (Please allow u to 10 business da s for delive ):
CONTACT NAMEC I�I�V � �.�I7V PH "f�`"�--��I � ErMAIL` f � C (Ati�[r Ca7�1
STREET AD RESS CITY, STATE,ZIP FAX
I �� I�Rt� �oi�i� s,� � C� Sv'
LIST ALL BUII,DING PERMITS ISSUED FOR PROJECT:
PERMIT SUBMTT ISSUE DAT� INSPECTOR SCOPE
NUMBER DATE DATE FINALED
1 ►sd8�i� � �z'.� ��� �is �- �-�v� �rTY �F c���R7�n�� �u�►�t�u� FaMr-- �. o i
2 [ ou 3` � � - � �� zz� ` -_1�2oi5� T� i�wrY U U NI
3 �52� t�3"3 -� � o_ _z, i�-I -��o fi is� —s'i�� � (�ouS� CI�tE i N
OCCUPANCY DATA: �����a
USE OCCUPANCY TYPE FLOOR AREA OCCUPAi�1T LOAD
1 3— � � '1�'� 2 � b l��c �
2 _..—,
3
4
BUII,DING DATA:
#STORIES #STORIES OVERALL MAX OCCUPANT 1�`IIiE SPRINHI,ERS FIIiE SPRINKLERS
BELOR'GRADE ABOVE GRADE FLOOR AREA LOAD REQUI�ED S OR NO PROVIDED S OR NO
a2 �;. �b �,�� ,�S
#PARHING #STANDARD/COMPACT #ACCESSIBLE
�Qu��D PARHING PROVIDED PARKING PROVIDED NOTE: ATTACH A COPY OF THE SIGN�D
INSPECTION CARD TO THIS APPLICATION.
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy of Job Card Attached(botlt sides)?
Permit Signed off in system?
No other permits open or expired in system?
Location of Approved Office Set?
Cof�Application.doc r•evised OS/17/16
-----�- - ---�,_.� ----- --...�.�_�_ - ,__..� ��_:_...�.�..:�.��._
CITY OF CUl'�RTIN�O BUII,�s:�I� PEKMiT �NSPFCTION CARll �
-t�I3.DING ADDRESS: 10685 CIJLBL-RTSON LR ('ON")tt 1C'I'pR:NfCE&RIGHT �P� ERi`fIT 1�0: ►�CSOOi3
�C�)'vS,R�CI�ION[\C �
p'�NF.R'!i`::1`fE:f_fA�Ctf1EN C ANf�MA CHU� - �C?i30X 225� ;ATE ISSUED:09/11I20I5
0�4'NER'S PHO\F�:408SSS9Eu8 �Ct�PFRT'INQ.CA 9i01� �PHON�\O• (d03)361-0925
.tiSi�Ec:�c[C3NS i i n,�` Tz;-� �i�SPrCrOR ,ip(3:?F,SCI21YT10I�: RLSlDI:`v"{�IAL [] C01i1►IERCI.4L❑
FOUN[)ATtUNiP(61ZSlItD.S. ����� � C- , I
� `j ^ � �� �� CONSTFUCT A 2 STOflI'SfD 19R9 S I-T);:LTTr\CFIFD !
UFER<;ROUh'D s/; , . - � � �
�,t- �; ' ,t., "�,�� TARAr�E��76 sc;r-T�;covr_Rr;n poRcrlrs;s�,:�sn F-r�.
PAD-�;ET BAClC-CI=RT � . --.� *#SUNNI'VAI.[:S;�NITAR�'""
_ i'/,-� _��-, � I� �r'
[lAR;1GF.St;1i3S PRF:CUNII'E l ' _ ' � � S
�J- `��n.�f�., j �el.� l,.� '`� �js,i� J�_?:, T l�?i �' i'�.''`"� 4>' , -
YOUR;\p(,pNCRETE L!\"fIL ABOVE Fi.4S BFE�SIG\Ep � , �f
URCIERGROU\D�SL�1B I��—�.�
�
UNll�KGi{OU?.11 Pi_I!tv1$WG � ; ��
� i
UND'ckGROUND I:LIiCTRICAL
❑Q I�QT YQUT2 FLQQR L'y�TIL ASQVE HAS IIEEN SIt,'NEll
[RdDFP.FLOOR PT,UMAING r , --,^� - i��- �i �` ._._�...� (
� C''-- t`? ' '''
(�NDFFFI.00R MECHAN(CAI. -_
' - - :5-- .1� '- �
ur:�>[xrLoo�Ltecrtctct�L i r WILDLAND URBAY INTERFACE F1RE ARL:A � F,R#
U1:DERFL00::PRr1�lING VENTS �� t-- . r j I
(''��` '-- �' `:.��'' , TO ARRANGE INSPECTION
[.TdDl;x(�i.o�l2(i4'SULAI'1nN t(; -�; , ,- `- Call 777-3228 bet�veen 7:30�m�nc!3:30 pm I�londay thrangh Friday,at►tast 2�hoitrs �
PLACL NO SUBFI.DOR L;\'CIL ABOI'E H��S SEEN SIGNED �efore required i�spection.Job address ancl PermiY 1Vumbers arc needed when
fi(��P SHFR FHING� _ ;�,j,.> ^'� , re(�uestino an insjleMiOn_ �
R.f.�i."!�Pl.:!y1HiNG ^ � _����•�i ���� ��� _ - f
�.•- � ..� -' CUPERTINO SANITAI2}'UIS7'RICT �
r:�Uti�Sr;��«��_,;>;:•. -, � , , .
^,, �t_; � i,�-��� � Closed circuit vidco ins�ection of property line cleanout.point of'connecti�ri �
P.f?UGl!�-H:CHA?�fCAL � �����.., ;. and street lateral reyuired priot•to passin;FINAL CjTI'I'LUR1i3fiC �
� f' I '�7� v I1�TSP�CTI01�`. Cali the District(403-253-7671�for an ap���intn�ent.
;�o�;��t:Ltc�ra;ct�u�>oo��o� —, �� �
- �:��-�-��-1 l. .?_)�_
,ii.a�[�c sTAttiSiF.FG!zess , Fz -. , , -_--� � NO$UILDI�lG rINALS IrSPECT[ONS UN"I'IL AL.L REQt.IRrII !
_ f�' � : i
(�: i_�•...,�--;r. #
��4Stil.il'!'ION-VI:NT(Lr�j�pN ""-�^l--���j'-`-'�`�;— BUSII�'ESS LiCENSES ARE Of3Tti71�'�D
j.' {� ��j,�:,.
C'O�L•'F.�y0�+� :_.'�} .r�}s F Ii\S FF�'ti SI(:NEll I
cxr�ii'•oR s�iL ��fiot v�ow�� � � j; �� `"fe-- 1TLRMtT EXPfi2ES IF�.VORI{IS NQT STAR'CED WITHIN ISd llAl'S OE�YER��[IT �
�"' * � %�r � ISSUANCL OR 180 DAYS FROR�I LAST C�LLED tNS�'rC'TIOI�.
!Nil:icii�i:;(-ic1�ft�H(?L6^UCIVVA'1 __ _ , ---c--.�•
I �.-__'�. - �, +e?- ��
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Si:1;FTRt)i:i:S`I��C!ROth�l1t=AK-T--�f�""', ,� I�iPORT.4NT
{ � �� � �� � � � When a permit has expired,a charge totating one-half the fees to ol�tain a new per�izit
r-.xr��to?�_,�;Fitiv-sc_h�:�n� `� -� �: i,, `' must be paid in order to reactivate the permit, If a pennit has heen expired for more
�, �,; _; ,
3�;}����ti1zi,��'-!� �u; ; �-. , ; ` I ` than onc ycar,a ch�rae tot:�(i�ta the Full fees to obtain a new �ermit must t�c said
, �), ' ��-'�: .� � a � �
�'O'r�:r'i;OK PL.�S1'Ei2l?�iTII,Al30VE He�S BEE�v StGtit:n ,• / to reactivate thc�crmit.
SCRATt=1 COA1 -- j , 1_ .7 `� %Il , 1 -�',��`/ ��t��<.
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L�:\�__S 71 S"1�';�AL'ii:�Ki{i�;qSf; �� { j_ `' �
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1'I.A1J1�!!idG t�.OS)'•77-z:(18 �1--��� — --
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1:tC1-�,1tal��_� ------ ` �-' -} � + .�`1 � � IK'PROGRI:SS Inspc�tor:__ Date: ---
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ti:ivU`f�;U=- u` _��_V W � )' j'`o:P3�r,:i�i1[:i:1!'f'HO�'[;�l:l�'CESS 30 ROOP Sl3:�1,F_isE PRO!'ID£;)fOR f\SPe;CTfON. �
EVLP,t;Y '? �� "„—� x{}�CL1pq\Cl'G!==I;IL.11ING�07'1'F:R\R"i'TEll UN f[L SUILDiNG F1N:�L IS SIG�ED B1'
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