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• • �
APPLICATION FOR CERTIFICATE OF OCCUPANCY
OR CERTIFICATE OF COMPLETION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
C U P E RTI N O 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.orq
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADDRESS ��('1` -; / �A�<<''�'� (�C f AP\= �I` n' O����� DATE`'� Z� /21 f
� l� f ;� l\,r�
ONNER NA�IE PHO\E E-M.AIL
I Y�I L1,'
STREET ADDRESS CITl', STATE,ZIP FAX
CO\TRACTOR NAME �,��'C� (�r4l.�C,`';r'' �-�Y�1�"i�✓-C'��'YZ �-�`��c;�l PHONE n E-MAIL ..
v 1'I f / /;�1
� ��. `S'1"� �' .� `� .g" �,� /It'�l'l�i✓ G'�C:� f(.iY L�tY'✓I
STREET ADDRESS CITY, STATE,ZIP FAJC
MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery):
CONTACT NAME �� '�1 �� P}iONE ,�-r �� E-MAIL -�
i
S�fii� ' �° 1 / ` �1a �'l� . � � C�.�;�'�v� i`v/ �`' %�►�r/4
STREET ADDRESS a . .. CIT1', STATE,ZIP C� Fr�
�� o/��'�c��'t"�� �e' l�s�,t �Lu,n � I���
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PERMIT SUBMIT ISSUE DATC INSPECTOR SCOPL;
NUbIBCR DATE DATE F AL ll
1 _ � :za � ��
2
3
OCCUPANCY DATA:
USC OCCUPANCY TYPE FLOOR AREA OCCUPANT LOAD
1
2
3
4
BUILDING DATA:
#STORIES #STORIES OV�RALL NIAa OCCUPAN7' PIRE SPRINKLERS FIRE SPRINKL�RS
B�LON GI2ADE ABOVE GRADE FLOOR AR�A LOAD REQUIRED (YES OR NO) PROVIDED (Y�S OR NO)
#PARKING #STANDARD/COYIPACT #ACC�SSI6LE
R�QUIRED PARK[NG PROVIDGD PARKING PROVID�D 1�'OTE: ATTACH A COPY OF THE SIGNED
INSPECTION CARD TO THIS APPLICATION.
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy of Job Ca�d Attached(both sides)?
Pemiit Signed offin system?
No other pennits open or expired in system?
Location of Appcoved Oftice Set?
CofO Application.doc revised OS/17/l6
-T�- -
CTi'Y OF CU}'FI2T'IlVO BUIl.DING PII2�1�I'L'�iSPECIION CARD
BL'�T.iiNGAUllR�S -- —
COT'TCLICTOR PFR.�tiT NO
I 1��G3 R'GLFE RD BES'I'FORfiV�Z2 CONSTRUCI'ION COMPANY &2017-0�18
;C�iP�t"IZ'�IO,C,A 95014-0517
� PFRi�IIT ISSLJ�D:
�OR'V��2'S NAi�T� p(>i�p/2017
F RI 'NII2'S PI30NL_ �_ PHONENO---_
i JOB DESCI2IPTION:
HAPFY LF1�40N-I II�iIT 30-T.I.-F1FST F'I OOR RFMOVAL OF FRONT PONY WAII,F1vvIPLOY�
FESTROOM;(I�')F P;(I��COU?��I'FRS/COVFJFfZL1IPMFNT/PONY W ORK(180 S�
��` TYPE J INSPECI'OR DA7'E
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c.ns a-u.;er.:��::ASE
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iYLL;,4F;It�'G FC'A� �
ELEC7"k;C;V, —— -- I
��`'�� � I TO ARRAT'GEINSYDCITON
���Q,a,��,,m v -t-- � —i Cal1 777-3228 bet��een 7:3U:,�n and3:30 pm Mondaythrough FYiday,at least 24 hours before required
�j---.------- � iflspection.Joba�}ressandPerrrutNumbersareneededn3ienrequesfinganinspection.
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�nou��t a.zcrRc�.
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Clas ed circait�i�o inspection of�ruperty line cieanout,point of cunnectiou
�TFtvmoR�tY Po'�tR'R Yot.z I and street lateral required prior to p�assing�AL CI7'Y PLIIM'�3LJG
--- ---�'- - - i INSPECTION.Ca:]tlie Bistrict(408-253-7071)for ui apEwintment
'SIItV[CE�P(�TJ•DE I I
��c�R:c?.�r�.a�[�ti,c NO BCIII.D�G FL\'AIS L\'SPECl`IONS TA�"ITL ALL REQL'[R�
��-----�� �! Bi�I�'ESS LICFIVSFS AREOBTAINFD
F.LECf 7iC FLM1I. I �
' — — �
����:cH,s.�2cu. _ i YDZ'�11T A'PII�ES IF WORKLS NOTSTART'ED�Vl"I'HIN]80 DA15 OF PFR'14iT
t' n�r-.art.a�R I i ISSUANCEOR 180 DAYS ITY20b4LAST CALL�l�SPFJCTION.
i�(�L'Gi��?I=��{'4'�'I�ti —I ii IMl'ORTAI�"I'R'I�en a permit has e�ired,a charge totaling one-half the fees to o6tain a newpermit
!FUar�avcE _ i must be�idin order to reacti�ate the permit If a permit has been expired for more
than one year,a charge[otaling the full fces to ohtain a newpernut mzist be paid
� reacti�ate the permit
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I�PRE INSPflC!'[ON —� � I
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iNAIl.U:G �� .
��RA'CT TS--— -- --_
� TITE II�SPC(TOR DATE TITE I?�SPECTOR DATE TITE IIASFECIOR DATE
�_i0U'�DATIO\ PL�iBL1G SA.V'ITARI'Il�SPECTIO\S
,CJI'AJGS SH0�1'ER PAN UNDgRC�plp•ip
IIUFR R'A7IIt f�ATIIt HYDROFLUSH
�lII2S WATER SERVICE
GRADE BEAMS GPS TEST PLBLiC R'ORKS
RIGH"I'OF WAY
GARAGE SLAB GAS 1.�]'ER RII.EASE
GROU�D/SITE�VORK'.. GRADAr'
IUi�DII2GROUND E[.FCIRICAL I ELF_CTRICHL RETAAIQJG WAL[.
LINGERQtOUIdD GAS FIPA�G TFIMP POWER POLE
�LP.�?RGROi1ND WATEk SIIiVICE UPGRP.DE FIItE DEPAKCAfEAT �
SITP COMPLSANCE
UI�EFGFt0U1�SE1VIIt PV SYSTEM
',�. SII'E R'_ai.LS _ FIRE MAIN SYSTEMS
EV SYSTEM
�F(X)TING — F1RE SPRII�I[Q�ERS-RWQI
�IMASONR�RfAAR h1EQIA1r1GAI, FIltE SPRII�IIQ.ER-FINAL
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IDRAINAGE FURNANCE — FIRE ALARM FINAL
�
CM[J\�AISS BOII.ER STANDPIPE SYSTFMS
� ---U'�T�ERFC,OOR I i AIR COND]TIONER
.ENCiII.'EGItID FIItE PR01"r,CTION SYSTEM
UNDIIiFLOOIi YLU,�fBING �—_�^ --
—_— HOOAS FIItE I.IFE SAFETY `o.���.�� �"_y�� _
Ut�'DIIiFi00R ME:i.'HANICAL �
�— — LN.K,"I'WRAP
iU�IDEStFI.00R h,LF.CTRICAL—�---- -- D()Ct)MEi!'CAITON
UNDERFLOOR FP✓�,�fAlG I .1._B� PAA'SECBACK CERTIFICATION
LiNDERPLC�IZ INSIJLATION PLUME3RvG TRUSSES
--- �"��`� -- ELECTICAL 'SPECIAL Q�SPEGTIO'.J REPORTS
iFLOOR nniUSFiEnTIitNG ,SMOI�JCP.RBON MONOMDE CERT OF
-- HAT�'(CAL COMf'LIANCE
�ROL'GH PLiA4FiA;�} ' �
BUIL'DII`G i WATER FI3CI'URE CERT OF COMPLViNCE
ROUr3f-I MECHA'.ICAI.
1 F� ENERGY COMPLIANCE FORYLS
IROUGH II.ECTILCAL '�� i'
CALGREEN MANDATORY ITEbfS Cf�.CHI,iST
RWGH FRAT.9.*!G 5��'L'�fiffnG POOL
���T�-AII'ERIOR Sf1.4R RIINFORCEME.�`T DEPAR'['MERT FIIV.4LS
- — P/Ivf/E . -- --
PLADII�iII�G CALL.777-33J8
R'r.T�.AISULATiON ELEC.TWCAL BO�1NG PUBLSC�VORKS-CAT.L"/7i-3354
�1LAIG II.SLiLATI0�1 �I Dp�q�
i IF[RE-CAI.L,3'8�010 ��t�=rp ��_y��'�_
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ROOF NAII.C`G BAC3�II.L HEALTH-CALI.408-9183A00 �(VYV�^� O��-1�1
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SHEcTROCK
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T[LE BnCKER I'IEAR OFF _ --
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