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APPL[CAT[QN FQFi CERT[F�CATE OF C3CCUPANCY
'` OR CERTIFlCATE �F C011tlPLETEON
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CU�'ERTINC7 ALBERT SALVADOR, P.E., C.B.U., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO: CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinaia'�cupertino.orq
COMPLETE A SEPAILSTE APPLICATIOI�T FOR EACH BUILDlIvTG:
PROJECT.4DllRESS � C1� /�� c�� �,��^/Q���� ,�p*� /5 �v(� //� I DATE /, I ��p `�I �
Ys Y
V vV'kJl l T !
O\�'�ER_\Ai�1E �"'- � PHO\� ��^U E-�L41L
__ J O�JZc'fU �.i� ' e Sf5 -- �� __ ¢°�` ��-G ���
STREE'I ADDRESS CSTI', ST.-1TE ZIP F,�a
�cT o N � ��� � 2�;� Cu .�.rvt C� ����14
CO'�TR4C;OR�A�IE �(t��„ I PH�'��� ����� ���5� E\ZAIL
[� ` kf; C�vYtr:t�JQ(^'C'j Y'G(�l'I1 s �t°(�'1
STREEI'��DDRESS � ' CITY', S?.ATE,ZIP p�� p.a,�
��z�l G511% Gtz �S� �.� �G r��GS C� ��'"��
I�-1AIL CERTIFICATE TO: (Please allow up to 10 business aays for delivery):
CO'�'IACT\.4A1E %� l / T��r PHO\'E� , j C E-\ZqIL _ �r� ^ �
���� - ' - 1 ����' ?.��. � �� , �j���� C �--�1y� � .-�s ,, C���
—T —
STREET ADDRESS / (� � GT1', ST.4TE,ZIP(1 g,�a
l ��'CL� ��Ut� /V�' �%(� •Jt- Ui` e� D �kt-x �V��f�C� �/ `' �`�'C� � "l ?:3 1 �.5G5-
LIST ALL BUILDING PERiVIITS ISSUED FOR PROJECT:
PER'�1IT SUB!!'IIT ISSL'E D�TE i 1NSPEC'rOR SCOPE
?�TiI'17BER_�_DATE DATE FINALED ' _
1 ,7. �,C�/ ( C( � L' ,Zc/ �—,�—, -/ �� ��_
. � 7� ���5.�_��� .�V�l l7/Z�I/�i�L(Gvli��� ��GI(i1rG l'V� ".
Z �--- 7
3 ---�— - -i --- — -------
OCCUPAi�TCY DATA:
liSE OCCUPANCY T�'PE PLOOR AREa OCCUPANT LOAD
1 �rr��i,t ��� '(� � _ � _Z � � 6 G 3.S� .-- /3 f
, - -
3
4
BUILDII�TG DATA:
#ST012IES �STORIES i O��E.RaLL ?�1AY OCCliP.�.\'I' FIRE SPRI\KLERS FIRE SPRInKLERS
BELO\V GR�DE ABO�"E:GR4U1�: FLOOR AREA LOAD REQliIRED (1'�S OR�O) PR0�7DED (1'ES OR NO)
C� L,�---�-�, ;6 3 5 t l 3 ( � `c�s _
�P.AI2KI:�G #ST?,,'�'DARD/CO!1IPACT m ACCESSIBL�
REQUIRED P.-uzhI1G PRo�1DED PaRK1\G PROVIDED .�OTE: ATTACH A COPY OF THE SIGti'ED
INSPECTION CARD TO THIS APPLICATION.
- OFFICE USE O\LY-
SPECIAL STIPULATIONS OR CONDITIOI�rS: CHECI�LIST:
Copy of Job Card Attached(Uoth sides)?
Pennit Siened offin svstem?
?�'o otlier pennits open or ezpu ed u�system?
Location of.Approved Office Set?
CofO Application.doc rerised 0�/17/16
,�-
f��� ��,r� CI"tY OF CLP�21'IN�BiJII.DING Pr1LVIIT INSPECI"ION CARP, ----,
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I�UBTLATO L�T�ECTS 1 FTAL 10600 N DEAtiZA B,'.VD L,ivl I'200 C[JPIIZTIIvO,CA 95014 PFRtYII'I'ISSUFD:
iUVdN,�12'S PHO�TE __ --- PHONF:NO: �
, JOB DESCRIP"i 10\: -1
� __ YAYOI-T.L TO COM}?L:�STE 20682&STE 20684 TO CRF.�TE(':d)RESTAURAi�IT(2,663 SF.) i
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;ir•�R��,��` --�- must be�xud ia ar3zr to reacti�ate�he�ermiG Ii a permit hac beer.e:s�aredfo;nwre �
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