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APPLICATION FOR CERTiFiCATE OF OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
GUP�R7INO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•buildinq(a�cupertino.orq
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADDRESS .APN T � ��[� + DAT '�
p t �`i �� j L t� V�^�, CUPERTINO, CA ' o Z� v ( I ��
O\'��NER�.AME PHO\E 7 &M IL
7i? ,�
4 i �-� ���O �'�� � � ��� ��t -?-7��. r l��' , ,,�,y,,t.r
STREET r1DDRESS CITY, ST.ATE,ZIP
��� -
CONTRACTOR N.4ME � � � HONE `�,`�� E-n1.4IL
�
, -
-t�v- � z-�� ��� �=C��x�`��'''`- �u�� ��r� � ' �� � �v��� n��-� �� �i�m�
STREET ADDRESS CITI', STATE,ZIP
MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery):
CONTACT�;�A,�tE � , PHO?�E J I .!)�� x,��G, ✓�'.!7•,' E-�IAIL 1 ,7 , .`� C`.T��r�,
� �' /.� � L '� V �� �� � �.,
i i L� � 7��� �L' �iY�-!' �
STREET ADD ESS CITY, ST.ATE,ZIP
LIST ALL BUILDiNG PERMITS ISSUED FOR PROJECT:
PERMIT NUMBER DATE FINALED INSPECTOR SCOPE
� 1
1 � � � � ,7� S5 , ��' -"� �'J�I.I�� C'�a� G
2 . �
3 .�
4
NOTE: Please attach a copy of BOTH SIDES of the signed inspection job card to this application.
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy of Job Card Attached(both sides)?
Pennit signed off in system?
No other pennits open or expired in system?
CofO Application.doc rei�ised 07/01/18
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�TIY OF CUPII2TIN0 BUILT)L�IG YEiN�TI'iNSPF7CITON CARll
IBtiILDIlVGADBRFSS
,l0371 SCFNICBL�D CONTRAL'TOR PII2NffTN�
�(.�JPIRT,T10,CA 45014-2?19 1TTAN C�rr=�.4.T.COi'VSTRUCl'ION INC 2017-(i431
OW�i'FR'S:VAb� 1�7L9 SCINICBLUD UIPERTINO CA 95014272d PIItNfftISSUID:
SCH1v7C(320UP iI.0 OCa�23l2017
iOWNIIt'S PHO;� � PHONENO:
�— �JQB DFSCRIPTION:
� CONSTRUGT(N)2 STORY"SFD(4,OE3 SF.);ATTACE�D('v1RAC�(489 S.F:1;ppRC��{729 SF.)
TYPE INSPECTOR DATE
. . PLUMRGVG.-..
WUFRG20Li[�ID GAS PIPING
UNDFRGROIJI�D WATII2 � I
Ut�IDE[LQtOUI�ID S � � � � .
iII�FLNR
iROLJCH PI,LIMBII�`G �
iSHOWIItPAN
IWATER HEPSIIt
I WAT�t SII2VICE
iGASPRESSURETEST 2 'L'� �
IGAS MEI'Ek RIIFASE ��� � �L�L t�
PROPFRTY LdNE CCcANOLT
PI ZIMBING FL*IAL
� :RLF,CYRICAI. ::�,
��� TO ARRAN(�INSPE('ITON
�,D���� Ca11777-3228 bet�een 7�0 am and 3:30 pm Monday throngh Ztil-iday,at least 24 hours before required
inspectioa Jobad�ess andPernritNumbers aze needed�rtten requesting an inspection
�tn�roFttf r�Yt
(� CUPIIYl'INO SANIfARYDLS'IRICI'
�Rcxx3-I II.ECI'RICnL Qosed circuit adeo ins ction of hne ctean t of connection
Pe Ir�nY �Poln
�;Q„�ptv,Ry ppph.�z ppLE and street lateral requiredirior to pessing F7NAL CLI1'nLL1118ING
INSPE(.TfON.Call the Dish�ict(408-253-7071)for an appoiuhrent
SERVICE U:Q2ALE
�.crx�c t„�rf 2��vsE ,� NO BUII DINGFIl�IALS INSP�7CIIONS L�NTIL ALd.RDQTJiFID
BLSINFSS LICINSFS AREOBTAIN�D
FLF.CTRIC FINwL
��';MEt�nruc�[, �:� PII2M[T A'PIltES IE WORKLS NOT STARTID WITHIN 1R0 DAYS OF PFRNIl�
��L� ISSUANCEOR 180 DAYS FROMLAST CAIS.ID INSPF7CTION.
Rot7c3i ME�,^ti.�ta[Cnt IMPORTAIVT When a per�t has ex�ired,a charge Qotaling one-half the fees to obtain a newpernrit
I must be paidin order to reactivate the pernat 3f a pernrit has deen expred for snore
�F�tarr.�t.c�
, — than one year,a charge totaling the fiill fees to obtain a nawpernut us�st be paid
�AL4.C�NDTTIONE[i ` to reactivate the perffit
��I300DS � � � �, ��� y�'yy)[„rV .�r/►�1�V`
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�� GARAGE SLAB �,� r.� !l"� � .r,AS METER RFLFASE kIGE�LC OF WAY .7, ,�^1
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HOOAS FIRE LIFE SAFEfY
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�INSULATION _ � �LUMBING — TAUSSES
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FI-00�.`U+IIJSHF:ATHING
CAL SL{OI�/CARBONMONO�DE C�tT OF (
ROC7!'1I-I PLL't�ING � � COA�LIANCE
�IRGiJc�i?vtEC'iAN:CAL ��-�,- � `L7ICDING WATER FIXfURE CIIiT OF COMPUANCE
�I-- . � � ENERGY COMPLLANCE FORMS
�ROIiC�fiE_EC"CRII'AL � � _
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CALQiIIN ivtANpATORY TTFMS CEIE(,'IQ1gT
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