Utility Release Request Form_B-2018-0029DocuSign Envelope ID: 25 FAD EBF-365F-486C-91 5 E-2F87201371 843
UTILITY RELEASE REQUEST FORM
COMMUNITY DEVELOPMENT DEPARTMENT * BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPER INO (408) 777-3228 ® FAX (408) 777-3333 * building, cuPertino.oLa
For residential single family or duplex construction, there are cases where gas and electritc, utilities are -
requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the
building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of
the building.
INSTRUCTIONS
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pertino.org./Iti e x.asp x4" page=")
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2. Complete the form and obtain -signatures prom both the owner of the property and the primary contractor.
If-, i I signed forni to.
3. Fax, E-Mail, Mail or hand deliver the original
City of Cupertino
Building Division
Attn: thility .elea-se Request Fon-n 408-777-3',_2'2.8 office
10300 Torre Ave. 408-777-33333 f�x
Cupertino. CA 915014 buildinty,;cupertino.orgy
4. Schedule a Gas Meter Release inspection (#40-3) and/or Electric Meter Release inspection (#404). Please
rote, a Gas Test inspection (#_506) is required prior to or at the same time of the has Meter Release
inspection.
BUILDING INFOR-MATION (Please c-omplete the following inforrnation):
request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of
the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a ceifificate of
occupancy for jjjebuilqtq.
I
Owner, .................
...... Print: .
-Tracy
.. . ...............
Hsu
... ............
2/10/2019
Date:.....,....
('.nntrnrto
22CB
....................
..... .... ..Print-,
Bruce
Lau
2/11/2019
Date:.............................
E.e84-!982a_D844,'7
(;WhivRelease [,.Orin 201 ].,doe revised 08 09 1 J