15120161TEMPORARY CERTIFICATE OF OCCUPANCY FORM
CUPERTINO
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinoaa cupertino.org
APN: 316 18-02�
BP #' 15120161
DATE: f 12/1 g�17
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VALUATION PRJECT 135,000,000
SITE 10350 N. Tantau Ave, Cupertino CA 95014
ADDRESS:
OWNER'S NAME: r Mike Mills
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PHONE #: P: 408-593-9597
FAX #:
MAILING ADDRESS (if different from site address): f 1 Infinite Loop, Cupertino CA, 95014
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CONTRACTOR/POINT OF CONTACT:
Truebeck-Webcor JV / Mike Anderson
PHONE #:
FAX #: �P: 650-227-1957 P: 650-201-2696
REFUND - CHECK PAYABLE TO:
Truebeck-Webcor JV
MAILING ADDRESS:
201 Redwood Shores Parkway #125, Redwood City CA, 94065
TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION
BOND TYPE: ❑ SURETY BOND 17AMOUNT (1 % VALUATION CODE r
❑CHECK El CASH BOND 10 F BOND: 5K min- 10K max) $ [ N/A 1 [BLDBONDS] EDITION: L 2013 CBC
TCO EXPIRATION 6/13/2018 -$
FEE: 82A4Afrwe- TOTAL FEE: $ N/A
DATE (6 MONTHS MAX): � �� [1TEMPOCC]
USE
TYPE OF
CONSTR
FLOOR
AREA
OCC
LOAD
LEVEL
COMMENT
Offices & MEP Rooms
[ Type II B l
70,967
661
Level 1 ]
[ Group B Occupancy Classification
Offices &MEP Rooms
Type II B
70,967 ]
1000
Level 2]
Group B Occupancy Classification l
12-8-2018.
Below Grade Level 1 is now INCLUDED
in this TCO Application
OTHER DEPARTMENT / AGENCY APPROVALS:
Siiannmp
nature:.........................................................Date:......................
❑ APPROVED
❑ APPROVED WITHCONDITIONS-
ire
Signature: .................................................... . .. Date:. s. �1.' 1.
.
❑ APPROVED
❑ APPROVED WITHCONDITIONS-
Fubtic or s
Signature: .............................. _._ .................... Date:
❑ APPROVED
❑ APPROVED WITHCONDITIONS`
Other:
Signature: .......... ...... ................ ...................... Date: ...
❑ APPROVED
❑ APPROVED WITH CONDITIONS'
*CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property
stating the list of items required to be completed for each individual Department before final occupancy
can be granted. Include approximate completion dates for each item.
The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or
buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration
date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfei d and the non-compliance
may result in an enforcement action.
Owner (G1 «� Contractor
re:......................................................... Date:..,,.,.......,.,.. �...
.................. Date:
This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and
approved for the specific area of the building specified above to provide a reasonable degree of safety to the occupants from fire and
similar emer encie4.
BuildinA.
Official .I`.-.P.J ._. .....t^.. 0_1._......... Print:_�..L1-'.)....C.Ly._�.:L..._..._.Date:�.�.0.�......
DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file
nntp<JccFarnc 1f)l3.dur revised &22117