1510017 METER RELEASE REQUEST FORMUTILITY RELEASE REQUEST FORM
CUPERTINO
PURPOSE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
Af BERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildin-gacupertino.org
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 format: http://www.cupertino.org/index.aspx?page=297.
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 bui lding a cupertino.org
4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please
note, a Gas Test inspection (4506) is required prior to or at the same time of the Gas Meter Release
inspection.
BUILDING INFORMATION (Please complete the following information):
APN
BLDG PERMIT* _DATE:_/
/ 3'. G. Ci
SITE
�ST p�A�A%� All, CV/w/"/n, . CA
ADDRESS: OcS
OWNER'S NAME:
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PHONE #: 4Q - Gj--
FAX #:
MAILING ADDRESS (if different from site address):
en )e i`C �a.17 ��x'� C
CO TRACTOR
br//�R��� Con Sf>'UCfiOp
1CONfACT:
PHONE #:
FAX #:
�fl' A1_ a
PHONE #: Q
/12/0/2/
FAX #:
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:......................................................................... Date:..............................
Contractor. ................................ Print. .......
UtilityReleaseForm 20IL doc revised 08109111