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APPLICATION FOR CERTIFICATE OF OCCUPANCY
� � OR CERTIFICATE OF COMPLETION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUP�RTiNO 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:
PROI[CT�AyDDRGSS , � )`A� /� �/1 /�i� APN= DAiG 1 I
2 V �' Q � V'/'/ Ce �� 'J � � I�c� � � '��
ON' ER NA 1E PIiONt: F-MAI[.
J ���� /�'c �rS /�T N� Ert�S ��E� ���3t�"-zJ
/i, ,�,���L� ti/ i.��� .6�-i�i 2_i�►- ��vc� Z�v ci�.ysJr��re.�77/`�� C�" �S�/ �jL r.��
C VTRACTOR NAA�IE PHONG E-.\LAIL
�'r� - I'►'��`� �LC��ZT/�'� ��i�r f i"; � 1?� 2 c� 1 E�� �J C�1fi�«�r C�C�Z����/✓C-<<� ,`'�/, 'I� ,�Cl�
ST T ADDRESS CITY. STATE,ZIP F;\�
rt� � �qy2 j�'i�i�- �� �f�.�/�trn�Lr/�t7 � " �1��
MA1L CERTIFICATE TO: (Please allow up to 10 business days for delivery):
COATACT NA\�tE PIIONE E-�tAIL
mii ,e � f�S���.�V (�s� 1r�,�� i�- • 3 �»�c��i-�z (� ��ic���s�z,�es',
sZ�r,aoo�sO /� ��.�,�� _ Y✓ 2�? ciTv. sr.�TE.ziP , r;�� C_.£)Y�^
C v;�E�Ti� C/9 �?Lb S<
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PER�11T Sl'Bb�IIT ISSUE D�1TE INSPECTOR SCOPE
Nl'J1BER D:�T'E llATF, FINALED
1 -24/�' L�J�'' ��� ��• I���C I i �
2
�
OCCUPANCY DATA:
USE OCCI'P.a\'Cl' Tl'NE I'LOOK AREA OCCI'P:1N7�L0;1D
� ,e��t.� � c. �i-, /�.:� ,s�z s. �=�, <3 �5�
2
,
�
4
BUILDING DATA:
#STORIES #STORIES O\'ER:�LL �IA\OCCUP:1.\"C FIRE SPRINKLERS FIRE SPRItiKLF,RS
BELO��'Glt4llE .aBO�'E GRADE PLOOR:�RE:1 L0:1D REQI'IREll (YES OR VO) PR0�7DED (1'ES OR\O)
� �� G S�z- � `/S� j'f:-'.� �"'��:S ,
#P:IRKING #ST�\D_1Rll/C0�1NaC7' #:1CCESSIBLE
aFQLixE� r:�ah��c rxo���En P:�RKING PRO�'IDED NOTE: ATTACH A COPY' OF THE SIGNED
���- ��� � � INSPECTION CARD TO THIS;�PPLICATION.
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy ofJob Card Attached(both sides)°
Permit Siened o�t�in svstem?
No other pennits open ar expired in s��stem?
Location of Approvcd Office Set°
C'qfO:lp��liccrtion.doc rei�rsed OJ 17�16
'�_ ' (71'Y GF CUPFRTINO BUILUING PIFMI7'INSYFY:ITO�V CARD � �
B LI[,DING ADllRFSS --- CONI'RACI'Cl2 -_-�- - �_— PII2NIlT NO v—
�2G590 HO�L•STFAD P.D CRpF['SMFTI COLLLCTIVE CONSTRLJ(TION &2 0 1(i 2 9 8 0
CUPETZTINO,CA 95014-6302 _
OWNIIZ'S NAME 10600 N DE ANZA BL�D UM1'200 C:[JPIItTINO,CA 95014 p�T LS SUID:
SOBRATOINTERFSTS 1 EI'AL O6/16/2017
OWNII2'S PHONE `�_ � � PHONENO:
JOB DFSCRII'TION: '
FIIZST FL.00R;'C.I.(9,99�1 S.F�-PEI'(7�JII �
;�yr� INSPECTOR nn�re ��V.� / ��O f' 00+�/�/ CE7t-/�!6 FZ7le T�✓a
pLtm�n��c
UNDERGROUND GAS PI}'ING . "(7 A�r!/e'�D�S� D FF/CF �Nn E k /T C�O��/OQ l2�
urro�caoun�H-nT� _� C Y TC-�2/D� cS 7-v C C� -
/SJve"� B'I�.i/i� �
UNDERGROl1ND SE.'WLR
11NDERFI.00R , � .
ROUGH PLUMBING --- - � � \•
SHOVIER PAN '
WATER HEATE2 -
WATER SERVICE
GAS PRESSURE TFST '-'�-` . .
GAS METER RELEASE
PROPER'1'Y IA'Ei CLEANO�JI'
PLUMBAG FPI.\L ^
---- F.J.F.C1'kt(:AL � �
�� TO ARRANGEINSPDGTION
ui�'ot.Rc2oLNn v'^� Call 777-3228 behtieen 7:30 am and 3:30 pn Monday through FYiday,at leasi 24 hours before required
_ ___.__ _ inspecrion.Jobaddress andPermitNumt�ers are neededwt�en requesting an inspection.
UivUERF[.00R
kc.uc�i�.r.cr[ucnr. CUPIIZTINO SA!VIfARY DISTRICT
_�_______ ____ _ Closedcircuit�ideo inspecNon of property line cleanout,pnint of connecUon
rr't,moua,ttv,owFR POCF andstreet]ateral required prior to�rassing FINALC7I'YPLUf1�ING
-- -�-- ----- INSPFX,'ITON.Call the Dish�ict(408-253-7071)for an appointmenL
SERVICE Uf'(�.ADE
E[.�cruic hirrm ar�a�e , NO BUIL,llING FINALS INSPDCTIONS UN1a,ALL RDQUII2ID
----- ---- — BL�INFSS LICINSES AREOBTAINID
er.ecrKtc�iw�.
NECHe�Ntcn[, PIItMCI'F�PII2F�S IEWORKIS NOTSTARTEn WITf�V 180 DAYS OFPIItMt'I'
E
I��I:�� LSSUANCEOR180llAY5FROMLASTCALd.IDIlVSPECTION.
kot1GF�h'¢�t�nn�[�A` IMPORTANT When a perrtrit has eapireci,a charge totaling one-half the fees to obtain a newperrmt
�eimN�h,�E A . � must be paid in order to reacdvate the permit If a pernut has l�een esry'red for more
- -- -- v than one year,a charge totaliug the€ull fees to obtain a oewperarit must be paid
�Ant Co�rrloNEa to reacdvate the permiG
HOOQS ----
'ti:ECHAi.'ICAL FIN.aL NOTES:
7'-RAR
PLIR.�BiN(: �
FLFA'TICAL !
�-----�----
�MECiiAi�,CAL
I3UIL.DINC .v� _ .
�F�aE � �Y I
tiRT:11117iNG POOI.
1 RF:IM'OIiCIiMFTT� -V-- �
�-.-'_---'�A_..�__._---
?�M/C
�''Li:Cf'RICALB(N�UIT'G A
—'-----`---- -
� I<UOFIVG . _�.-- _ -
PRE WSPG(71'tON
TE.�R OFF �
�_� _
,�TTENS--'�"=- —y- ----- --_- — �— —
F
f
�6 TYPE � IhSPECCOR DATE TYPE� �VSPF.(TOk DATF, TYPE IIVSPF.C.TOR DATE
FOLIM1T7ATI0`i PLIni6IIvG SA`7['['AAYINSPE(TIOtiS `
�F(IOTPiC�S SHOWLR PAN -----�-- —! � UNi)F�E2UROt1M)
. UFE7t WATEIt I-IEATER--- - HYDROFLUSH �
I PIf7L� -- ' WATFR SERVICE y_' �
IGRADE SE4DAS — — GAS TEST ") 11 , � � . P��C WORKS
('y�DahP�SLAB '�� . GAS h1ETIIt RII.EASE � �' WGNC OF WAY
GROUND/SITE WORK ���'
UNDERGR(H1ND II..E(.'CP.ICAL . ELECI'RiCAL� RETAINING WALL
-- i .
UNDF..RGROUND GAS PII'ING TFMI'FOWLR VOLE
LINDERQtQUNDWATER � ' SERVICEUPGRADE —`— ---- F11tEDEPARTIITEI`IC
IUNDL-R(H:Oi1ND StiWQt � � V.SYSTEM -� SITE COMI'LIANCG_�`_—
— ����y�� �FIRE MAW SYSTEMS ��
� � EVSYSTEM �
POOTING � � `--- — -- F[ItE SPRINKI..ERS-ROiJ(�-1 jy�;�.,(+j���i�i,l�:"'' �:�...,q., ��i��Z i"
MASONRY RGBAR ' FIILE SPRII�tf4..F.R-FINAL � ��'r��� �
MECH�L�CAI, � .
DIiAINR� v FCIEiNANCG � FD2E ALARM FA]AI. � �w� �
CM[J WALLS BOII.OL . STANDPIPE SYSTFIv1S
��"�'nvR `�� --- A6t CONDITIONQt FNGMEEREI7 FIRE PR07'ECTION SYSTEM
Utv`DER}'LOOR PLUMI3QJG —
-----. — —_ HWAS FIFiE LII'E SAPEi'Y
LII
Ji.DERFL00R MECFIAN[CAL — ��
-'— — DUCT WRAP
IfNDFR}'LOOR ELEC"I'RICAL. —
DOC[ANF:(YI'ATION
lfnDERFLOOit F.RAMQJG .�._�� — PAD/SEI'6AG!C CERTL ICATION
Ut�'DERFI.00R MSULATION PLUMSAIG ' TAUSSFS
���G ELECTiCAL SPECIAL INSPECTIGN REPqRTS
F[.00R NAII/SFfrAT"r1ING � SMOKE/CARBON MONOJQDE CQtT OF
�------ _ MECHAN[CAL
�R(X1G}[PLUMBING COMPI..IANCE � --
�-- — �_—_ BUfCD4JG WATER FIXTURE CERT OF CO;vfPLIANCE
�ROUGH t�'.CHAMCAL
--- F� Etr'ERGY COMPLiANCF.FORMS
RWCriiEZF!'TRICAL. ----- � -
- CALGFLEEN MANDATORY ITEMS CHE(:KI,IST
ROUGFI FRAMING SWIhtM1fQ�G P(�L
Q�fI'ERIOP.SI-IEAR RIIt.'FORCQvfQ�Il'
� ! DEP.�RTINENC FINAI.S �
�EXT'ERIOR SHPAR P/M/E PCAM7¢�G CAIJ.,777-3308
WAL.L WSLII.ATION Q.F.CfRICAL BONDAG PUBLIC WORKS•CALL 7773354
CIILING INSULATiON DEMOLTf10N FIRE-CALL 378-4010 � / p
`�1'^ ( / ,..,
ROOF NAR.A}Ci BACIffII,L � }[gpLTH-CALL 40N-91&3400
INI'ERIOR FL�i[SIISS
— SAM'PARY-CALL 253-7071
SIIIEE::CROCK - �---�+-!-�-� � —
R(�FIIiG . ," 1_.r6'\:'�'1 �:. �-y
TILEBA(.'K�EIi[.TJDERLAY,'v1E.N1' PREINSPECTION 1..�.fit°�S,j.�j��,:•''-: 'r C —I i t��'lk �"'�Y
E
- — � Bf1II.DING BINAIS
� TQ.E BACKER . TEAR OFF PI.UME3ING
2�,� � -12-I�S
r�Q�Tf7t10R LATH � �� NAO.,AG p_,g���pt, ,�.�—
-�.._r -�j�i �'-
��.�atok Fv�as�s Bnrr�s n���inNicnt. '�.f�"L � `���
Eai'ER?OR LATH
— TIM['ORARY OCCUPANCY -
SCRA1'(,'H COAT
�--�'--'-- I BUQ_DING r ,j�t" �/�l��
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