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APPLICATION FOR CERTIFICATE OF OCCUPANCY
OR CERTIFICATE OF COMPLETION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinaCa�cupertino.orq
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADDRESS �`�� �� APV n D,�TE �/ � %
OIVNER NAME PHO\B p��,.,� E-bLA L �
G�G , � — `�CJ� �1�C�1G .� Li� � ��l Y OG� C�--�.„
STREET ADDRESS CITY STATE,ZIP FAX � /v/
2 Z �3 � � ci-z.�t�� - ��-{-��t�Lv ��y°C`� �
CONTRACI'OR NAbtE PHODIE E-�1AIL
STREET ADDRESS CITI', SI'ATE,ZIP FAX
MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery):
CO\TACTNrL�1E �� A I-IS� rl_���-�� E-MAIL —
._��� ��a L, � C� •�
� �'��1
STREET ADDRESS C[TY, STATE,ZIP FAX
� 3 b Ov�7_ �o�-�-�� ` � -�c C� � �
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PERNIIT SUBM[T ISSUE DATE INSPECTOR SCOPE
NUNIBER DATE DATE FINALED
1 I � I I D ZlZ ( - � � ` c�,�--�
2
3
OCCUPANCY DATA:
USE OCCUPANCY TYPE FLOOR AREA OCCUPANT LOAD
1 i C�� ' � ��J Z S
2
3
4
BUILDING DATA:
#STORIES #STORIES OV�RALL MAX OCCUPANT F[RE SPRINKLERS FIR�SPRINKLERS
BGLO�V GRAD� ABOVG GRADG FLOOR AREA LOAD REQUIR�D (YES OR NO) PROVIDED (YES OR NO)
�" 2 S
#PARKING #STANDARD/CONIPACT #ACCESSIBLE
REQUIRED PARHING PROVID�ll PARKING PROVIDED NOTF: ATTACH A COPY OF THE SIGNED
� INSPECTION CARD TO THIS APPLICATION.
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy of Job Card Attached(both sides)?
Perniit Sig�ed ott in system?
No other pennits open or expued in system?
Location of Approved Otlice Set?
CofO Applicntion.doc revised OS/17/16
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�E(JPLDL^1GADDRESS ��" ;� } iPIIiMCCNO
�10334 S TA?�'T.4L AVE ICO1V17LACT(1R r� ` � �„(�:; �'`� f �t,j;, ,�., "� �F %„� �
(C[,�ER'I'�JO,CA 950143544 i - �I15110172
OVVN�2'SNAME -i — PIItM[T'LSSLJ�D:
10334 S TA1v rAL'A VE CUPII2TTN0,CA 95014
�ILI ANSHAN Ei'AL 02�2?J2016
rV4fi'II2'S PHGNE � i------ — PHONENO:
JOB DFSCRiPT'10?�:
�CONSTRUCT"I�NO STORY RESiLE'10E(3727 SQ F1�;GARA�(489 SQ FI`);COVII2ID PORQ-I(616 SQ FI').
(SUI�'NYVALE SANPTARI�
TI'PE IIVSPECTOR DATE .
PLIPI7BLVG �` ��
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Uv�ER:�.'20UI�D
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�IUNDERFLOOR ��
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�'ROUc�[C.F�'I1tICAL _� Ciosed circuit�ideo inspection of proper:y line cleanout,point of connectioa
�� � andstreetlateral re red ior to sin FL1AL CI"CYPLiJ�1BI�G
�TE'.vfPORARY POW"rR POLE � Pr Paz g .
INSPECTION.Call the District(408-253-7071)for an appoinhnent i
iSER��7CE LTGRADti �
^ �� ,.,—,��. ''� ' NO BUII.DLNG F�AIS INSPDLTI0IS U�"TII,ALL REQLIRID �
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�` ---- �. � f ISSUANCEOR180 DAYS FROMLASTCr17.i.ID L�SPECI'[O�v, i
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2oUc:����!cHA;tcn_ I II��ORTAIVT When a permit has espired,a charge totaling one-half the fees to ot�eain a nesapernut
�-��"-�------ must be paidin order to reacb�ate the permit If a permit has been ez�ared for more
�IgUR\n*1CF
,L____._�___-.�.__ than oae year,a charge totaliug the full fees to ohtain a newpernut must l�p�aid
�nl�Ce'W71T?u�TM�ft to reacti�ate the perrmt
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