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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• buildinq(cr�.cupertino.orq
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECTADDRESS 19409 Stevens Creek BIv���20. �P\� DATE 01/18/2018
3!C� ~ 2�� I � 2�.
o�v�eRnaMe Hai Di Lao Hot Pot I l D PHon'E �-�r�"" robinbiz@gmail.com
STREETADDRESS 400 S Baldwin Ave Ste 205 CITY, STATE,ZIP FAS
Arcadia, CA 91007
co�TRAcroxnn,-�E Mavin Builders, Inc. P"o�`E 310-873-3325 E-'�`A"" anthony@mavinbuilders.com
sraEEr,�ooaess �309 Post Ave c�rv, sTATe,z,P Torrance, CA 90501 F�`� 310-868-2803
MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery):
co�r�crr,�:�fE Robin Li PHo�E626-203-1997 E-"'A"" robinbiz@gmaiLcom
sraEET nDoxess 19409 Stevens Creek Bivd#120 c�rv, sT�re,z�r Cupertino, CA 95014 F�'Y
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
P�RMIT SUBMIT ISSUE DATC INSPECI'OR SCOPE
NUMBER DATE DATE FINALGD
1 B-2016-2999 12�1.&/'f7� Gary Strea TI for Restaurant
Z jZ/Z�
3
OCCUPANCY DATA:
USE OCCUPANCI' T1'PE FLOOR AREA OCCUPANT LOAD
1 A2 Restaurant 5162sf 2�9
2 S2 Storage 4
3
4
BUILDING DATA:
#STORIES #STORIES O�'ERALL NIAX OCCUPANT PIRE SPRINKLERS rIRE SPRINKLCRS
BEL0�1'GRADE ABOVE GRADG P'L.00R ARrA LOAD REQUIRED (YES OR NO) PROVIllGD (Y�S OR NO)
� 2 YES YES
#PARKING #S'I'ANDARD/CONIPACT #ACCISSIBLE
REQUIRED PARKING PROYID�D PARKING PROVIDED NOTE: ATTACH A COPY OF THE SIGNED
INSPECTION CARD TO THIS APPLICATION.
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy of Job Card tAttached(both sides)?
Pennit Signed off in system?
No other pennits open or expircd in system?
Location of Approved Office Set?
CofO Appliccdion.doc revised OS/17/16
�_
r CITYOF CUPII2Tli�iO BUILDEVGPF3tMITINSPb7CIION CA,RD
BUILUL'�G ADDRES S CONI'RACl'OR PII2DIlT N0
19409 S1'EVINS CR�II:BLUD MAVII�1 BUIIDERS L\C B-201Cr2999
CUPFRTINO,CA 95014
O�VNII2'S NA.'�fE 2882 SAND HII1.RD ST'E241�A PARK CA 94025 PII2MfI'ISS[)ND:
�1:4AW STREci'C[�FFRTINO 06�07/2017
raWNII2'S PI30�tE PHOiVENO:
� � JOB DF�CAIPTION:
SUCI'E 110 HAIl7UA0 HOT POT;T.I.(�RESTAURANT(6389 S.F.)
TYPE INSPECi'Olt ll.4TE
..::��PLUrIDI:�G
Utv'DL7t(.320U1dD GAS PIPAIG
1R�DEZCdtOUND WATIIt
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UI�IDERFLOOR ..
ROLIGH PLU,�LtiG
SHOWFJ2 P/u�l .
WA7FR k�1'CEFL �
I A7'ER SERVICE
GAS PRESSL'itETEST � �
Gn5 MEI'Efi RII.EISE �- y�
FROPERTY LINE CLEATvqLTf'
PLCID�IBING FL�IAL
- ���ELEL,TR[CAL; �; —•—'--- - �
�m TO ARRANGEINSPELTION
�����,D Ca11 777-3 2 2 8 betaeen 7:30 am and 3:30�w Mondmy through�Yiday,at f east 24 hoars before required
inspection.Job ad�ess andPernrit NumUers are neededalien requesting an inspectioa
�tnvvExfz.00a
CUPIIYI�IVO SANITARYDISTILICF
Ro[�I IIEc"rRICnt Clos ed circuit�ideo inspecaon of property line cleanout,point of connecti on
��TRSORARY POWII2 POC.E and street laferal required lrior to pas sing FINAL GTTY PLUMBING
s�vtl--�tnDE INSPDCiTON.Call the Dish-ict(408-253-7071)for an appoinhnent
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n3etH;1.v[Gu,��;.; PFFR1��ffI'II�II2ES IFWORKIS NOTSTARTID WTI'HIlV 180 DAYS OFPII2MfI'
iL,�n�.-� ISSUAI�CEOR i80 DA15 FROMLAST CP.IS.ID L\SPECI'LON.
R��M����- IMPORTANI'When a per�t has e�ire�a chazge totaling one-half the fees to cbtain a newperurit
��,�N��, mus t be paid in order to reactivate the permit If a pernrit has been expred Yor more
than one year,a charge tofaling the full fees to ohtain a newpernut must be�eid
nIIt CONDITIONL•R to reactivate the periTllt
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