BLD-2021-0567 - CofO _T-
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This Certificate is issued pursuant to the requirements of Section 111.2 of the 2019 California Building Code certifying that
at the time of issuance, the portion of this structure described below has been inspected for compliance with the
requirements of this code and with the various ordinances of the City regulating building construction for the occupancy
and division of occupancy and the use for which the proposed occupancy is classified.
,� Building Permit Number(s): BLD-2021-0567 Application Date(s): 03-24-2021 Issuance Date(s): 12-21-2021
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Address of Building: 19540 Vallco Pkwy, Suite 110
Scope of Work: TENANT IMPROVEMENT (1400 S.F.) - PELICANA CHICKEN
Use: Restaurant Occupancy Classification: B Occ Load: 43 occ
Total Floor Area: 1400 sq.ft. Type of Construction: I-A Fire Sprinklers System: Yes
Current Property Owner: Main Street Cupertino
Current Owner Address: 965 Page Mill Rd., Palo Alto, CA 94304-1013
Final Inspection By: Bob Sabich, Building Inspector
Final Inspection Date: 03-29-2022 �-���
*SPECIAL STIPULATIONS OR CONDITIONS: None
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Albert`Salvador, P.E., C.B.O., Building Official Date Issued
NOTICE/POSTING: No changes shall be made in the characfer of occupancy. This certificate shall be posted in a conspicuous place on
the premises, and shall not be removed except by the authority of the Building Official.
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.8.0., BUILpING OFFICIAL
CUPERTINO �0300 70RRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•buildina al�.cupertino.orp
COMPLI:I�E A SL;PARAT�;f1Pl'LICl1"I,ION I�OR T�ACII I3Y11I,llING:
PROJECT ADDRESS ApN li DATE
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ME1IL CERTII'ICA"TE T0: Please allow u to 10 business da s f��r dclivcry :
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LIST A�,L BUII.11ING PERIVIITS ISSi1L'U FOR PROJI;C'1':
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- OFFICC USC ONLY-
SI'l�C1AL STIPULA"1�IONS OR CONDI7 IONS: C}II:CKI,IST:
Pcrmit signed off in rystem?
No other pennits open or exQired in system?
Verification of payment for certification?
CoJt�Application.cloc revised 06/Ol/20