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• `•`
APPLICATION FOR CERTIFICATE OF OCCUPANCY
OR CERTIFICATE OF COMPLETION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADDRESS v �. ��� � ApN} DATE�� ��
� f
�
OIWERNAME PHONE E-b4AIL �
STREET ADDRESS CITY, STATE,ZIP Fr1X
CONTRACTORNAb1E � _. P ONE . ���`�y � Y I E-bIAIL�� `� . L r� ����`i�
G91 1 �
1l y
STREET pRESS CITY, ATE,ZIP C.G�
U�(v vt/ Sv� r �� � w �,�.� �� �� �� ._�,�
V�fi,�K�' � �
MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery):
CON"CACT N� E � HONE �f /'��/ E-MAIL
i l V ��� ` �
STREETADDR SSS � /`, ��i ,,9� CITY,1STATE,ZI_P '^ � FA3C
✓ 7 V G ��/7
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LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PERMIT SUBMIT ISSUE DATE INSPECTOR SCOPE
NUMBER DATE DATE FINALED .
1 ' �' U v2�� ��'
2 ��'T \ !7� � `� I.✓l G
3
OCCUPANCY DATA:
USE OCCUPANCY TYPE FLOOR AREA OCCUPANT LOAD
1
2
3
4
BUILDING DATA:
#STORIES #STORICS OVERALL MAX OCCUPANT PIRE SPRINKLERS FIRE SPRINKLERS
BELOW Gi2ADE A130VE GRADE PLOOR AREA LOAD REQUIRED (YLS OR NO) PROVIDED (YES OR NO)
�:✓� f V C� •� � ^
#PARKING #STANDARD/CONIPACT #ACC�SSIBLE
RGQUIR�D PARKING PROVIDCD PARKING PROVIDED NOTE: ATTACH A COPY OF THE SIGNED
G,VU � ��, , f� INSPECTION CARD TO THIS APPLICATION.
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy of JoU Card Attacl�ed(both sides)?
Penuit Signed off in system?
No other pennits open or expired in system?
Location of Approved Office Set?
CofO Applicatioi7.doc revised OS/17/16
� �
C177'OF CUPERTINO F L1IL.DL�G PH3ZMIT'INSPEG'ITON CARD
�L7LDING ADD[2�S
10815 4VOLFE FD COl�"I'E2ACI'OR PF+RMfI'NO
CUP�tTINO,CA 95014 �'�S SEL FIxI'URES @-2Q17-Q?�`!
o�NN���s Nntv4: PII2MlTISSLJFD:
CUPII2TIN0 VIIZA(�LP 3333 NEW HYDE PARK RD#100 STE 103 NE.'W HYDE YARiC NY 11042 p�pg/2017
OWNIIi'S PHONE PHONENO:
JOB DESCRIPTION:
T-MOBILE-SiJITE 103;T.I.-REI'AIL(2402 S.F.)
�E INSPECfOR DATE
PI.UM1IBING'
UTIDERQtOIlh'D GAS Pa'ING
i1N�ERGROUND\VATIIt
UNDLRQ20UND S�.IVCR ---
UImERFIAOR .�r.._ - �,��
ROUGH PLCIMBWG
SHO�I'Q2 PAN
WATER[�,ATL7t
WATER SERViCE
GAS PRGSSURE TFST � - , +
�GhS MEI'ER REI.HhSE • �,
�-'--
IPROPERTY LI1JE CLEANOUI'
L
�PLUMBING FQJAI,
,
ELF.,�.'TFtIGAl;
�L'�� TO ARRANGEINSPF7CCITON
��wneRc�touNn Call 777-3228 betneen 7:30 am and 330 gn Monday through FYiday,at leact 24 6ours 6efc:re required
�-------- inspection.Jobad�hess andPermitNumbers are neededwt�en requesting an inspection.
I;uw�a,L�xx�
I Rou�[F.[ECr1uCa.r� CUPII2TIlV0 SANITARYDISTRICi'
{ Closed circuit tideo inspection of property►ine cleanout,point of conneclion
(IT�tPGrultY POwF1t roLF and street lateral required�ior to pessing FIlVAL GITYPLiJMBING
� — INSPb7CTION.Call the Dish�ict(408-253-7071)for an ap�winhnent
IISF�ELVICC UPC�2ADE
ifr��ecr�c�az��RF[.F,as�; ; ;<� ,� �.�C��—t NOBUILDINGFINALSINSPDCTIONSUNTILALLRE7QUII2ID
--- BI�INFSS LICINSES AREOBTAINF�
ILLECI'k[C F�IIY.4L
ME.�n:'i�CnL PFRMITII�IRES IFWORKIS NOTSTAR�D WII'fIIN 180 DAYS OFP�'VIIT
ur,��ut.oax LSSUANCEOR 180 DAYS FI20MLAST CALLFD L*ISPECt'ION.
Iaou3H Mr:C7 tqrtlCn[ IlVIPORTAIVT When a permit has e�ired,a charge totaling one-half the fees to olkain a new per�rit
�F�JRNArcF must be paidin order to reacti�ate the permit If a per�t has been eapiredfor more
-- than one year,a charge totaling the fiill fces to oUtain a newperrtIIt must be paid
^.at cot�[��t[on�x reaclivate the
pertat
HOGllS l , J�`�� �s I� e��� �����U� •
h�:,rnca�.ru�ni. NOTFS: �
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RF,11�'FUY.C�iF.IvT
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ROOFING
IYRE INSPECI'ION
I� ---
iTEAR OFF
NAILIIJG --
(' —
BATTENS
���.�
��.--- Tn'E INSPECCOR DATE TYpE T1V�YLCTOR DATE� .
I� FOiJ�DATION PLIIAiBIIAG � �E 11VSPECfOR DATE
FOOTPIGS � S�'V7'['ARYINSPEC1YOiV5 �
I �� r (j� , �—f� SHOWII2 PAN LJI�'DIItGROUND
UFER �— .. WATER HEA7ER HYDROFLUSH --
P� WATER SERVICE
QtABE BEAMS GAS TFST � �PUBLIC WORKS �
GARAGE SLAB ��.�RFI FACE �(�T OF WAY
GROUND/STI'E WORK CiltADING
UNDIItQ20UND IIECI'RICAL. ELEC.TRICAI. RETAINING WALL
UNDERQ201.IND GAS PIPING TDNP POWER POLE
UNDtRGROUNDWATER SERVICEUPGRADE �� FIREDEPART!1�hT
UNDERC�20UND SEWER PV SYSTEM SITE COMPLiANCE
�.��.SIT'E'.WpLLS EV SYSTIM F��'SYSTEMS
FOOTiNG FIItE SPRII�IQ_IItS-ROiJQI p`,e y�.�y �� �; -,
MASONF2Y REBAR MEQfAN[CAL FIRE SPRA][Q.Ett-FWAI. .� .,+� '�`� 'v
DRAINAGE ^ FU[tNANCE e
FIRE ALARM FINAL �,�y -j ���"���;-
e; �
('`�W�'I� B�Q-m STANDPIPE SYSTFMS
�F (JTiDERFLOOR
Alft CONDTTIONQt INQNEEFt�FIItE PROTECfION SYSTEM
UNDERFI.(X)Et PLUMBING
� ' H�S FIRE L[FE SAFETY .°
i1NDIItFLOOR MECI-IANICAL
��.Fn. ��� "€
DUCT WRAP
UNDERFLOOR�.ECI'RICAL p(kUME,N�'ATION
I U\DFRFL60R FRA,�AIIJG . .j,_B� PAD/SEI'BACK CERTIFICATION
iJh'D;ScFL0012 INSUL�TiON pLLIMBING TRUSSES
��--+' FT.A:iIING�. . -
ELF.CIICAL �� a SPECIAL INSPECfION REPORTS
FLOOR NAII,'SF�ATHRv"G �
` pAMCpt, SMOKFJCARBON MONOXIDE CEItT OF
�RQtiGH PLLtiSBING J ` COMPI.IANCE
I ---- _.. s _ '� �.f BiILLDA' �.
i ROLSGii MG(:HA'V�CAL ",� p I
<�� VJATII2 FIXTURE CERT OF COMPLIANCE
—--- �r� �, ENERGY COMPLiANCE FORMS
�ROL'TiFI iT_.L'.Ci RICAt. �
I � CAi..(3REEN MANDATORY TT'EMS CHECHI.iST
IIRCUGHFRM4IAIG �� �3a�� � SWII1fM17[NGPOOL
�IP�'fFRIOR SFIFAR RIINFORCIIdII�TC
-- DEPARTMEI�L FINAIS .
EX!'FTZIJR Sl�l}�.:nR P/M/E PLANI�DNNCi-CP.LS,7773308 * �
D '' ', .�-. �.�'�`� �
'W.4':.L R.'S(iL4Tfi!N II.ECTRICAL BONDING PUBLIC WORKS-CALL 77�-3354
��CII[JNG INSULATION DFMOLITION FIltE-CALS,3784010 - ` .-;�
''�''� , "'� �'] ���l;;,
iROOF:VAII.itiG gp�p�y - t �
� - HEALTH-CALS.408-9183400
� -�.-L�TI'EPSOftFL'�II,SHES�'
�5FD_ETk(K;K SADfIT'P.RY-CAL.L 253-7071
. . _ - �� ROOFGYG �
'fII.E�iACKER(;17�EFtIAYMMEtvE.N1' PRE A]SPECI'ION � ING FINAI.S �
TT;E B.4CKER TE�AR OFF PLUMBIN O R
,�NfERIOF.LA':H G II,ECTRICAL
�.-EXCF.RtOZ FINISHES BATTINS I�CI.W�ICAy �
�EX'I'EItIOR LATH —
�ISCRAT(.'H COA'I TIIviPORARY OCCUPANCY
(r— BiJQ.DIN f � �.�y�_
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