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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(c�cupertino.orp
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADCRESS , � � e APN= �� � /'� V�i D.ATE /�J � �
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O\VNER NAME PHONE E-b1AIL
t �iv1-� ?,j�r ��i�'��'��� �v�}c'1 hL�.� � vnc��l. c
STRL-ET AD��S �•- �O��� ' � CITy, STAT�P� t�J ' CI�� �_v� FAY ��
CONTRACTOR NAbtE PHONE E-M L
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STRE T DRESS CITI', S �TE,ZIP Fr1X
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MAIL CERTIFICATE TO: (Please allow up to 10 business days for deliveiy):
CONTACT N �4E P}{ONE E-MAIL
o �1 � w�� �-�� 1��i �.-!�3 -2-3�-h�'o�- eviv�.h�t n � v�'r�-I- ��i�ss
STRE T�ADDRESS Y `� l (/ GTY, STATE,ZIP Fr�X
� V_Vl"j' C l`�v(Vl �i OIVI/ �11� {-y�'CVI� ��'-I'
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
P�RMIT SUBMIT ISSUE DAT� INSPECTOR SCOPE
NUMBER DATE DATE FINALED
1 g_�_c�� - �/�Gt !1" �� l Z fo� fif.le_t.-,-v�w�i.�v�7�c_t-t� S-{-� i'� .
2
3
OCCUPANCY DATA:
US� OCCUPANCY TYPG PLOOR ARCA CCUPANT LOAD
I , lPS ��lov f'� I (�"} ',''�,b
2 `l (� \ � v o �'J :�1k=�- �t, G'��
3 �-cC�41�s �:� �
F�.
4 .G j � '�
BUILDING DATA:
#STORICS #STORICS OVERALL NIAX OCCUPANT PIR�SPRINKL�RS I'II2�SPRINKLr12S
BELO�V GRADG ABOVE GRADE FLOOR AR�A LOf�D REQUIRED (YES OR NO) PROVIDED (YGS OR NO)
��� 4'e s -
#PARKING #STANDARD/COMPACT #ACCLSS]I3LG
RGQUIRED PARKING PROVID�D PAI2KING PI20VIDED 1�TOTE: ATTACH A COPY OF THE SIGNED
�P S . INSPECTION CARD TO THIS APPLICATION.
�E S
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy of Job Card Attached(both sides)`'
Peimit Signed off in system?
No other pemiits open or expired in system?
Location of Approved Oftice Set7
CofO Applicntion.doc revised OS/17/16
CIT1'O}-rLPtiR"[7N0 BL7LDL'�iG PFitnR'I'INS PECI701�C.4RD
BUILDING AllDRFSS 10945 W OLFE RD CUI'ERTIIVO,CA 95014051 CONTRACI'OR MSC GII�.RAL CONSTRUCTION INC PII2MC1'NO Ci-201 A-0372
OWNII2'S nA1�1E C[JPIIZTINO V[LIAGELP PHOnE PI121VIlTLSSlJID:(L1'19'2013
PHONE;NO: .�pI2FSS:3333 NEW H�E PARK RI7�100 tiEV�'Hl'D`t PARK.NY 1 IQ12
TYPF, I\SPECTOR DATE JOB DFSCRIPTION:
` Fotln�n.artowStrE woruc SPRI:�'T-I ST FLOOR;"I'.I.-OFFICE(2035 S.F.j
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FOUNDATION — � -�'��f�'�:(Sy► 5��3$.--�o ��{�.ikM� 1S I
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REINFORCENINT
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COLUMN STEII.
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L1tillER FLOOR FRAMING ,�����r � ! ����.�,�„�
RCU(�I FRAME � - f�: �-� �
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F�TERIOR SHEAR �`
INTIIZIOR SHEAR � � � \ {/- '
ROOF NA[L � \` f , �, � / � � � ``�� - 1 `
�T-BAR � _ -� / / r�.� 1 `._� ��
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:��Ctt.a�lCaL TO 4RRAI�GEII�SPFCI'IO\:CALL 408-777-3228 BEI���7:30 A,NL,�.'��3:30 P.n2
U':JDIItFLOORMECHAi�1ICAL A10:�DA1'T'HROLIGH THURSDAYOR BET1'b�7:30 A.M A\�2:30 P.�L ON IP.IDAY.
ROUC�II MECHANICAL � - �'�_� � CALL AT LFAST 24 HOUftS BF�RE;RFQUIRID L'�S PECI'10\',JOB ADDRFSS,A;\D I
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FURANCE �
AIRCONDITIONER P�uT�1RFS IF��1'ORICIS NOTSTART'ID V1"I"I'Ell.'i 180 DA25 OFYFRIIIT I
ISSliA]VCEOR 180 DAYS FROMLASTC.4LLFD L'�SPECT[0�+. I.
BOILER
HOODS NOIIVSPF�TIO\S FORBUILBL�GI'L\ALS Ui.'TU,,�,LLRDQULRI�1)B[.SI,1L1S I
DU�T WRAP
LICFi�'SES AREOBT.�1I:tiID.
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STANllPIPE S1'STE�4S �
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GP.S TEST T-BAR-FIRE
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GAS NiETER P.ELFASE _ DEMOLTTION STRUCTURE
L1SliI,AT(O\
U'�IDLRFLOOR INSUI.4TION
ACCESSIBILITY
INSUL4TION T.I_PREP
n�iuoR i ExrEtuox Fm�stns TEMPORARY OCCI,PANCY
SHEETROCK nocu��t:n'r.�riov
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CvTERIOR LATH � PAD/SETBACK CIItTIFICATION
EXTERIOR IATH EPO?CYOBSERVATIO\'L�TI'IIt
SCRATCH COAT
DEPART'�1E\T FI\4LS
PLA�r�1II�Cr CALL(408)777-�308
S�i"ID]�IlNG POOL
POOL PRE-DECK PiJBL.[C WORKS-CALL(408)777-3354
iPOOL PRE-GU;��ITE FIRE-CALL(408)378�010 •` �- �s$,,.���
POOL PRE-PL4STER SANITARY-CALL(408)253-7071
BU "G FI\ALS
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