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APPLICATION FOR CERTIFICATE OF OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINQ 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228•buildinq(�a.cupertino.orq
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADDRESS APN� DATE
�v`%S.S 5-1-�i�,- � G��e-�k ��i vza CUPERTINO CA
� i c; �. :� /' �t
OWNER NAME PHONE . ,� E-MAIL ` �
- �L�� � sr��,.s-t'l. _ c�.,u,;,v_�§��a, c�4�-i
w�,�1� �c�r ��vl z�..e,�t� s/� -�;�i ��- 7 `? L-S_ �'.
STREET ADDRESS CITY, STATE,ZIP -
�"�3�o r-I ���. A,�e._ L-,�,��-� �G 1�, �� -�
CONTRACTOR NAME PHONE E-MAIL
� ,�
STREET ADDRESS CITY, STATE,ZIP
MAIL CERTIFICATE TO: (Please allow u to 10 business days for delivery):
CONTACT AME �, PHONE -,; � / E-�[AIL � �.� : ��rv-� t 1�� L `ti;�^'�C-1"- ��-2���-S "'ti�
.�F.�;r-�i ��_.... ,..�j��v,;���l-� .`.���J � �j j ' 7 r t"i J � .. _. >`.
STREET ADDRESS CITY, STATE,ZIP_,._
.��5`2(:' Y�G,•"_,�U✓� f}�.�_ �rYl�'��:F.�.s t�l<' C �
��'�'Yl ' �.ti>�v`u'�C.�:�..;;j
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PERNIIT NUMBER DATE FINALED INSPECTOR SCOPE
1
2
3
4
NOTE: Please attach a copy of BOTH SIDES of the signed inspection job card to this application.
Crr�-�.�'.�a,� �8- o cw��..,c,�. � � �I'�'�.c, o�-�.�,.r.�,l � ,l t,J a� �.ca.
bti,l Ll �v� �+a '�.c.. S�c�.c.¢� �-� 2 C� 0 7 .
- 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? �
Verification of payment for certification?
CofO Application.doc revised 08/08/18
CUPERTINO Receipt No.: 262541
10300 TORRE AVE
Receipt Date: 10/29/2019
,��P�R,3.��� CUPERTINO, CA 95014
Telephone: Cupertino, CA 95014
RECEIPT
RECORD&PAYER INFORMATION
Record ID: BLD-2019-0538
Record Type: Commercial Alteration
Property Address: 10300 TORRE AVE,CUPERTINO,CA 95014-3202
Description of Work: MISC BILLING
Payer: jennifer smith(whole foods market)
Applicant: BUILDING DEPARTMENT
CUPERTINO,CA
PAYMENT DETAIL
Date Payment Method Reference Cashier Comments Amount
10/29/2019 Credit Card HALEYM $357.00
FEE DETAIL
Fee Description Invoice# Quantity Fee Amount Current Paid
Occupancy-Certificate of Occupancy/Compl 48602 1.00 $357.00 $357.00
$357.00 $357.00
AA_Receipt_Tempiate.rpt Print Date:10/29/2019 Page 1