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APPLICATION FOR CERTIFICATE OF OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
GUPERTINO
(408)777-3228 • buildinq@cupertino.orq
COMPLETE A SEPARATE APPLICATION FOR E C �UILD
PROJECT.4DT)��S^. � V /'� � n �V ( 7 ` UP - � O� APN4 �(� VS VS� DATE�
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MAIL CERTIFICATE TO: Please allow ,p to 10 business da s for deliver ): ,�j� y ��d(�(��,��� �
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S� D�SS �. �.('�- CIT �STAT���ZIP�� �� `���
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LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PER�4IT NU�IBER DATE FINALED INSPECTOR SCOPE
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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: /
� � wO ��� � � w Copy of Job Card Attached(both sides)? �
Q Pcrmit signcd off in systcm? �
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No other pennits open or expired in system'?
CoFO Applicatiai.doc renised 07/01/l8
CITY OF CUPERTI�O B li1LDL\'G YFRA'llT I\S pCCI'IOti CARD -
BULDL�G.ADDRGSS 10e05��'OLFE RD CUPERTII�O,CA 95014 COnTRACIOR P.ATRIC;<J W ILL'A1�9S P[72;��IIT NO�-2017-2028
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SCRATCH COAT ue�,�n��T r�v4[.s
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POOL PRE-DECIC PUBL.[C W ORKS-CALL(408)777-33�4
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POOLPRE-PL1S ER SAi�11TARY-CALL(403)253-7071 �
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PERMIT FEE RECEIPT
Case # B-2017-2028
Date Printed: 08/09/2018
CUPERTINO
CITY OF GUPERTINO - FEES RECEIPT
Case Number: B-2017-2028 Permit No: B-2017-2028
Project Valuation: 475000.00 Date Submitted: 11/27/2017
Permit Type: Building
Address/APN: 10805 N WOLFE RD STE 104 CUPERTINO, Receipt#: 217961
CA 95014(316 05 056)
Scope of Work: YOGA POD-T.I.;YOGA STUDIO(3095 S.F.)
• Contact Type: Applicant
Full Name: Patrick Williams Primary Phone: 949-859-0898
Address: 23682 Birtcher Drive Lake Forest, NY 92630
Email: cupertino_epians@cupertino.org
Contact Type: Property Owner
Full Name: CUPERTINO VILLAGE LP
Address: 3333 NEW HYDE PARK RD#100 STE 104 NE1/�
Fee Information Amount
Certifcate of Occupancy/Completion $329.00
CERT OF OCCUPANCY
Payment Information Payment Date Patron Payment Type Amount
Certificate of Occupancy/Completion 08/09/2018 ROBIN MCDONALD Cfedlt Card $329.00
FEE TOTAL $329.00
AMOUNT PAID $329.00
BALANCE DUE $0.00
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