B-2018-1974 - CofOCertificate of Occupancy
This Certificate is issued pursuant to the requirements of Section 111.2 of the 2016 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): B-2018-1974 Application Date(s): 11-19-2018 Issuance Date(s): 05-01-2019
Address of Building: 23650 Via Esplendor
Scope of Work: (N) 2 STORY MEMORY CARE SENIOR LIVING FACILITY (10,000 SF); ATTACHED
PARKING STRUCTURE (16,500 SF); ADMINISTRATIVE OFFICES (1,100 SF) – THE
FORUM
Use: Memory Care Occupancy: R-2.1 / B / S-2 Occ Load: 352 occ (Total) Construction Type: V-A
Floor Area: 10,000 s.f. (R-2.1); 1,100 s.f. (B); 16,500 s.f. (S-2) Fire Sprinklers System: Throughout
Current Property Owner: The Forum at Rancho San Antonio
Current Owner Address: 23500 Cristo Rey Drive, Cupertino, CA 95014
Final Inspection By: Antonio Torrez, Building Inspector
Final Inspection Date: 09-26-2022
*SPECIAL STIPULATIONS OR CONDITIONS: Separated Occupancies (CBC 508.4)
____________________________________ *10/10/2022 *
Albert Salvador, P.E., C.B.O., Building Official Date Issued
NOTICE/POSTING: No changes shall be made in the character of occupancy. This certificate shall be posted in a conspicuous p lace on
the premises, and shall not be removed except by the authority of the Building Official.
CofO Application.doc revised 06/01/20
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADDRESS CUPERTINO, CA APN # DATE
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP
CONTRACTOR NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP
MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery):
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PERMIT NUMBER DATE FINALED INSPECTOR SCOPE
1
2
3
4
- OFFICE USE ONLY -
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Permit signed off in system? ________
No other permits open or expired in system? ________
Verification of payment for certification? ________
APPLICATION FOR CERTIFICATE OF OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building@cupertino.org
23650 Via Esplendor
342-54-052 On Plans
642 54 999 On permit 09/26/2022
The Forum at Rancho San Antonio
650-944-0200Nancy Kao nancykao@theforumrsa.com
23500 Cristo Rey Drive Cupertino, CA 95014
Quiring General LLC
Gahum (Jay) Algaheim 925-341-8360 galgaheim@quiring.com
6660 Owens Drive Pleasanton, CA 94588
Nancy Kao 650-944-0200 nancykao@theforumrsa.com
B2018-1974
Cupertino, CA 95014
Antonio (N) Memory Care Building On An Existing Assisted Living
Campus. Memory Care Living Component Over Parking
And Administrative Spaces.
09/26/2022
23500 Cristo Rey Drive