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�•F._ - - - �
APPLICATION FOR CERTIFICATE OF OCCUPANCY
OR CERTIFICATE OF COMPLETION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUF'ERTIt�lO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building a(�.cupertino.org
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECTADDRESS APN# �� --�'�;I�C — �V'�'��� DATE f��� i/�,����"'i
•��: —. ,—�t,S �.�'tt�L$L.�J D �,a �`� �
OWNER NAME PHONE E-MAIL
`'F����� �'������ CU> t= � ��j �'F7��'j����'�C;�`�; ��„'�. L.,.
STREET ADDRESS CITY, STATE,ZIP FAX
� (�� +���`�CI-C�� 1 �110 �'\� � �� � � U _
CONTRACTOR NAME PHONE E-MAIL
l \v�ci Y '.�-�\���l'v'"� � Y L � �)�
Z�2 ��'��dr��:t, ����cr;��}L� �;�„�v�
STREET ADDRESS CITY, STATE,ZIP FAX
n`�'Z-� s ;�1 1� '� 5 U.S�ci 1l; t4i�LY�'�r10 !h � i��:� �_
MAIL CERTIFICATE TO: (Please allow up to 10 business da s for delive ):
CONTACT NAME PHONE _. E-MAIL
- ��� ,-- �-L - ��Fs �,<<Z__ ;b ' ��r�-�r^I�i`S �v'_�'V��rv��l t� �.��.�t
STREET ADDRESS CITY, STATE,ZIP C FAX
C'>1;L=� �,1 d • 1 CI k ��_' S��'i��__ i ll�F-3 a_ ��.}�n 0 C ���'1
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PERMIT SUBMIT ISSUE DATE INSPECTOR SCOPE
NUMBER DATE DATE FINALED
1 �;_.2��t'I-a�►"I �fi-�Z�� ►� Cal�'�Y. -
2
3
OCCUPANCY DATA:
USE OCCUPANCY TYPE FLOOR AREA OCCUPANT LOAD
1
2
3
4
BUILDING DATA:
#STORIES #STORIES OVERALL MAX OCCUPANT FIRE SPRINKLERS FIRE SPRINKLERS
BELOW GRADE ABOVE GRADE FLOOR AREA LOAD REQUIRED (YES OR NO PROVIDED (YES OR NO
#PARKING #STANDARD/COMPACT #ACCESSIBLE
REQUIRED PARKING PROVIDED PARHING 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 Attached(both sides)?
Pennit Sia ed off in system'?
No other permits open or expired in system?
Location of Approved Office Set?
CofO Application.doc rei�ised OS/17/16
--� ---�- - - CiT'1�OF CL�i'F1iTL*�J F3L�IL.DLtiG PPRAII":L�,SPECI'IO'�CARD --
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I i�?4?�';'i L.'ENS CRF��-�BL�7� �CO_\"I'R:��;flR
'C:�'1�rT:TINO.CA 95014 i
B-2017-;O1?
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O�•,''��42'S:�.AA1E PFR!\'IIT LSSIIID:
� !�Csi�'A�D 7-III�_27 STE 341 nSE�TLG PRRK CA 94025
;t+1ALT�S7'REEr CUPERTIIvO 06%14/2017
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�O�x7�TF12'S PHO'�'E I PHO\'E\O:
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II T:PE I1�SFECI'OR DA7'E �i
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,P�EK7'1'LLNE CLEAI�OLT
!'i.LRdBL*1G FI1vAI,
�_ ELECIRIC*�L
� � 'I'O ARRANGE L\S PDCTIOn
G�F.R
I,,�^7WeCROUn� Ca11 777-3228 bet�een 7:30 am and 3:30 pm Aionday throueh Frida��,at least 24 hours before required
�u� �_ _ inspection.JoU address and Permit Numbers are neec�d�tihen requesring an inspecriur.. �
IlJ'v-UEFtF1AOR i
I�'— - CLlPII2TP.v0 SA.\IT.ARI'DlSTRICT �
IR.ouGH E[.ECTRIC41. —�- Closed circuit�ideo inspection of properh'line cleanout,point of connec�on ;
�'r���ottqttY ro��1�a�oLE I and street lateral required prior to pas sing F1I�AL C17�'PLL!15F31NG �
---� C�SPDCI"fON.Call the District(408-253-7071)for a�a�,oinhncnt
IISEBVICc UPGRP.DE
� '��—� NO BUII.DING IiNALS Il�'SPFXf'I'fONS i�'TII:ALL UiRED
ELECTRIC;��LFTERR�;SF, , �, � k�Q
��---- - - i BUSL�`�SS LIC�SF�AREOBTAl'�'ID �
��F'ipC7F.IC FiNAL � �
I� _ ��F,CH��ae,a. ��- _ PII2A'IITElPIf2FD IFR'ORKIS NOTST.AItT'FD\�1'ITI��180 DAlS OFPEP•\�1" i
I;tr�r txt�ooa. I
LS 5 iiANCE OR 180 DAl'S FROA4 LAS T CALLFD L\S P�CTIO�. �
1: �--- -
�!Rc���;H rgCiia�7C.v. � L�IPORT.�'vT«'her.a pe:mit has eapirecl a charge toialing one-ha11'the iees to obtaic a ne�ti•pc rnut I
j�-- J� �� i must im paidin order to reacti�ate the permit If a permit has l�een ea�redfor more i
F..Rr',ANCE � I
L— . I i than one year,a char;e totalin�the fu�l fees to oUtain a ne�rpermit must t�paid
;nIIt c�J�vrrlo?tER � to reacti�ate the permit I
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I�.,.FR �l'ATER HEP.TER HIDROFLL'SH - _
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IIGR�DE BEAMS GAS 7EST 7 PL'BL1C�VORiiS
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iP.DERGROL�'D\�'ATER SFR\�CE UPGRADE ~ � F����T����
IP,.'DERGROUI�'D SE�'�'ER YV S1'S rEAA SITE COMPLIANCE
SITE�i'ALLS - � � FIItE T9,4A Sl'STEA15
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DRqWAGE FURNANCE FIItE ALARM FL*IAL a
ICA�1U\i'filLS BOII.ER STA.�DPIPE SYSTEMS I
L U:v`DERRi..O�R A1R CONDITlO'JER iEJGL�EFRED F1RE PROTECTlO?.'SYSTEM
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