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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.ora
COMPLETI�� PPLICATION FOR EACH BUILDING:
PROJECT ADDRESS � " ����� ��;7; ApN# �� / '7�` �)� DATE C, ////',�J
�� �/�� � v � �
OWNERNAME ' �
/,r , y��t/ ��� /��,n j 1. �PHONE E-MAIL
� {•t �\ CJUj�c'Y
STREETADDRESS (s.'7 /;� �L.� ��� II CITY, STATE,ZIP /� ���(,� `�Nt �� QC���,j FAX
t �v �,�� ru �, a � -�� ,
CONTRACTOR NAME /'_� /',_s,��`' ' ��L � ��L PHOVE J�/`% �'2 Lj�F1�/� E-MAIL
(� lS r� 1��L f � � ( [✓ (G
STREETADDRESS ��J%(� //�,�j/'� /L_p C�U'�� 'I� CITY, STATE,ZIP �I_�� /�� (/+��/,�/'7 Fq}{
�r �� ����.� i L �r�� c �c, �s
MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery):
CONTACT NAME �� �����- PHONE�� /I�� �j'� E-MAIL
v� � i L. K�
STREEi'ADDRESS L���� /_ ��� C.'-�-�C _� � CITY, STATE,ZIP �/ _��i� /� "� SZ`�i•/ FAX
/ G� � /I/ v� (t�'L �J/CJ�
LIST ALL BUILDING PERMITS ISSUED FOR PROJECT:
PER1�lIT SUBMIT ISSUE DATG INSPGCTOR SCOPG
NUMBER A E DATE FINA D
1 f .��vir3 �� i I�r }. �e Ty��, :�,�,;���r�L���—
2 }3.-z�����-�. u u ,7 �c �� 7�µ��, r��i����
3
OCCUPANCY DATA:
USE OCCUPANCY TYPE PLOOR AREA OCCUPANT LOAD
1
2
3
4
BUILDING DATA:
#STORIES #STORIES OVGRALL NIAX OCCUPANT PIR�SPRINKLERS FIRE SPRINKLERS
B�LOW GRAD� ABOVE GRADE FLOOR AREA LOAD RGQUIRED (Y�S OR NO) PROVIDED (YES OR NO)
��� ��
#PARKING #STANDARD/CONIPACT #ACCESSIBLE
RLQUIR�D PARKING PROVIDGD PARKING PROVID�D NOTE: ATTACH A COPY OF THE SIGNED
INSPECTION CARD TO THIS APPLICATION.
- OFFICE USE ONLY-
SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST:
Copy oFJob Card Attached(both sides)?
Penuit Signed off in system?
No other pemiits open or expired in system?
Location of Approved Office Set?
CofO Application.doc revised OS/17/16
CITYOFCl,PQ2TL\O BUILDQ�G PFR:IIIT I.\SPECI'ION CARD
BU[LDING ADDRFSS
�0558 STE\�S CREEK BLVD CO\'[RACTOR PFR'�IIT NO
CUPERTINO,CA 95014-2130 14030113
O��'1VFR'S nA�\�
MARDESICH CO CROSSROADS LLC) 11208 STALIFFER LN CLPIIZTINO,CA 95014 P���S�'
� 08/07i2014
O�'1'I�'II2'S PHONE
(408)437-3772 PHONE NO:
JOB DFSCRIPTION:
SPROUTS-COMM.T.I 20,986 SQ FI'CC�OCERY STORE TCO GOOD TILL 8/?J2017
T1PE° I�SPECTOR D.�1TE . �
PLU11B1NG
U'dDERGROI,TD GAS P[}'LNG � �
���
UNUERGROUIJD�\'ATER - ��
UDIDGRGROUIJD SE�\'GR
UtJDERFL(bR .
ROUGH PLIPubBIVG
SHON�ER PAi�
N'ATER IiEATER
N'ATLR SL-R\9CE
GAS PRFSSURETEST
G.4S�4ETER RELE.ASE � � �
PROPERTY LQdE CLEAIJOUT
PLI.:MBLVG FII�.�L �
ELECTR7CAL
uFrR TO ARRANGEL�SPECI'lOV
�?��DERGROI,T'o Ca11 777-3228 behtieen 7:30 am and 3:30 pm!1londa�through Friday,at least 2-1 hom s befin e required
inspection.Job address and Permit Nwnbers are needed��fien requesting an inspection.
WDERFLOOR
ROUGH GLGCTRICAL CLPII2TLVO SA.�'TT.4R1'DISTRICT
Closed circuit�ideo inspection of property line cleanout,point of connection
reMPolt�a�'Powea po[.E and street lateral required prior to passing FIlVAL CITl'PLiJMBL\G
INSPI�X'ITON.Call the District(408-253-7071)for an appointment
SER\'ICE UPGRADE
ELEC1 RIC METER RELEASE � � � NO BLIILDLVG FINALS L�SPEC"IIONS U1V I�II,ALI.RFQUIRFD
BCSL1'ESS LICEVSES AREOBTALVID
ELECTRIC FI':J.AL
n�cR4�7c,�[. PIIL�IlTEKPIRFS IF��'ORKIS NOTSTARTID WI"I'IILV 180 DAYS OFPFRVIIT
ut�veaFLooa LSSUA�'�'CEOR 180 DAI'S FI20�4LASTCALLID LNSPDLTION.
aouG�i MEc1t.a���Cnt. ID4PORTAt1T R�I�en a permit has eapired,a charge totaling one-half the fees to obtain a ne�i•��ermit
FimnAncE must be paid in order to reactl�ate the pernut.If a permit has been expired for more
than one}�ear,a charge totaling the full fees to obtain a ne«permit must be paid
nut COND]'rto?��Ek to reacri�ate the permit. ,
H��S � ��f�-T,��� I������i��-�-,� �1`_`�`f�`�-
\�CHANICAL FL1AL NOTFS: �'{ r [�,�p;
T-B.4R �''9 '
���=\,�������� �-)�E(,���� ��r��,�
PLU'vIBING �����j!��` �'.
FLECTICAL 9
�/ �1��� �� L����{,j 6 F�i
?��fEClir1\9CAL ��"�.f� './'`-�yfl���•1�j �,1�1^�`l�`� �6��1�-I�
BL1LUl�'G 4'��`�~���'f�s1 t��([ ��e
i
FII2L-
� ..SR7NID9l\C POOL �:
REC�'FURCEME\T
P;\4/E
ELECTRICAL BO?��LVG
ROOFf'VG
PRE 11�SPECTION
TEAR OFF
NAILI?JG
BAi'TF.1�'S
'C]PE I\SPECTOR DATE T]PE I1�SPECTOR DATE ,T1'PE INSPECTOR DATE
FOU:'QDaTIOS PLC�IBING S.4VTARY WSP6CT70\S
FOOTCJGS � � f� � SHOWLR PAN , Ui.'DGRGROLND
UFER �\'ATER IiEATER � a 1-Il'DROFLUSH
PIERS N'ATER SER\7CE
GRADE BEAMS GAS TEST PUBLIC WORKS
� RIGHI'OF 1\'AY
ESL4B AS METER RELE4SE
�.�.GROiI\'D,�SITE-��'ORK�. GRADRvG
L`�DGRGRO�T'D C-LeCTAICAL ELECTRICAL RL-TA[t�'L\G\YALL
U!JDERGROI,TD GAS PIPA�G TE\dP POR'ER POLE
WDERGROLT'D W'ATER SER\'[CE liPGRADE PIRE DEFART\fE\T
lJ!�'DERGROUIvD SEN'ER PV S1'STEtvf SITE COMPLIANCE
SiTE\V:1I.LS FII2E T�SYSTE\�iS
EVSYSTEM
FOOTING FIF2E SPRAIKLERS-ROUGH
MASOhRI'RLBAR �..�.:hIECH.ANICAL�. FIItL SPRINKLER-FiNAL
DRAINAGE FUFL\ANCE F[FLE ALARM FII�'AL.
CMLJ\�'ALL$ BOILER STAI�DP[PE SYSTEMS
I.�DERFLOOR AIR CONDITIO\�R ENGL\'EEAED FIRE PROTECTIOV Sl'STEM
UT'DERFL.00R PLU�4BQ�G
I100DS F IKE Llf E SAF E"C Y
LTDERFLOOR��ChL4NIC.AL
DllCT N'RAP
UND[RfL00R LLECTRICAL
DOCL;�tEn7'ATIO\�.:��.
U[�'DERrLOOR FRA:WNG P.�'SETBACK CERT�ICATION
T-B.4R
U�DERFLOOR INSUL.ATION PLIMBLVG TRUSSFS
����G ELECTICAL SPECLAL L'JSPECTIOV REPORTS
FLOOR V.4IL'SHEAT[�iII�G
NiP.CHAI�7CAL - MOICF/CARBON MONOXIDE CERT OF
ROUGH PLUh1BING t- ' I O\4PLIANCE
y �-� � UILDII�G N'ATER FA'TURE CERT OF CO�LIANCE
ROUGH MECH/u\ICAL / �i �
�,�5 F� ENERGI'COW'LL4.\CE FORMS
RWGH ELECTRICAL �� .
`� t� ' � . CAL.GREET MAI�DATORY ITF�1S CHECKLIST
ROL'GH FRAbIQ�G U�,�
f M SR7A'PiIRG POOL
Q TERIOR SHE4R RELNFORCEME'�IC
DEPART�iF.1�T FINALS
E�TERIOR SHEAR P!M!E PL4I�TWG-C.4LL 777-3308
\\'ALL I'�'S[JLAT101 LL[CTRICAL BONDII�G PUBllC N'ORKS-CALL 77'7-3?54
CEILL�G L'�SUL4TION DE�40LITI0'.V FRiE-CALL 373-0�IO
ROOF N.4ILIIJG BACY.FQ.L 1-�.AI,TH-CALL COR-918-3a00
Q�l'ERIOR FI\'ISHES
� �C � S.AATTARS'-CALL 253-7071
SHEETROCK { ROOFI.'�'G
TILE BAC'KER UIJDERLAY;'�iE!YI' YRE I\SPECTION
BC7LDIIG FIne1LS��.
TiLL-BACKLR TEAR OFF PLLNIBL�'G � � � ��� !�
V
I;�TER10R I.ATH N,qILI'�'G ELECTRICAL � �� ��
':.�'. E�TERIORFII�7S[iES . I3.�TTE\S
//�� MECHAI�7CAL, { �
Ea'iERIOR U1TH �� � y
TE\•II'ORARY OCC�TFu\CY �� t �
SCRATCH COAT d
SIDMG I BL'ILDING ��` '
}.��;��-�7`.' 1�� �j ���IE.�- ,
�.�ni�(��f f�-i rv�rJ���.,—� � �a J��.
C��;� i���.i�� it����i��i�� ���-,1.� ��f j� ,
�:�� �- �'1 (I�5 ��:� .���� �" �f���o�—.� � � I���- .
� �s
��� �V��� �" �� � �� ���{` .
�,�� �t�=������ (�`���;;� t,������ ��---�--��C�rl����: � �"I ij-(-�—�.:�,
R�u:C�P��I�i�� ��-� C��c��� ����i� ��«�t�►r�'�;.����I�-�—�`.
�i���� i.�����.����'�+�� ������, �� ���J ty-
, ���. �:�iC� �t- �v��C�G�� C������� -��
C��� i'�. ��'�'� �;��[.n� �
C?TY Og'CUPIItTINO BUILDWG P}32MfT II��SPDC.'ITON CARD
BUILDIIVGADDRFSS
20558 STEVh'NS C.REr'T.C BLUD CONIRACI'OR YIItNIlT NO
C[JPII2T[N0,CA 950I42130 �T�Urf2FAU INC B-2016-291
OW:�TII2'S NAME
11208 STAiJf�FEEtIN CIJPIItTINO,CA 950145150 Pm��S�'
tifARDESICH COMFANY CROSSROADS LLC 04/26�2017
dVVNER'S PIiONE PHOh'ENO:
TOB DFSCR�TION:
T.I.;(I��TRASH INCLOSUREBIIIIND BLTIIAWG-SPROUTS(ORIQNALPERMIT#14030113)
�— T]'PE IIVSPECTOR DATE
PLUA78L�IG��.
I�UNDERCil20UND GAS PIPING
�UNDERCd2CAJ,"vD WATER — .�_.) �=i .a-=,'� � .( ,3 ,�,;._.--
UNDERGROUNU SE�VER. — � "-� :-, I:� �� �,L_� �!�. `�""`.P'�'�.,.
�`1 L�' '
lP.�'DERFLOOR � .
ROU('�[-I PLLRffiIN(i
. F:-r ;� ��
, , . 1 /
SHOV✓ER PAiv' _ �''� �C� � "" ��r._ C
I1'�'ATER HEATER } � � � ���,
WATL-k SERVlCE
GAS PRESSURE TEST
GAS MFTi:R kFS.EASE I
P� RCWERTY LNE CLEA,*I(XJI'
4—
�PLU.MBING PCW�
EI.ECfltiCsT'
�� --- -- �,��'�; TO ARRANGEINSPECITON
������ Call 777-3228 betKeen 7:30 am and3:30 pm l�bnday through FYiday,at least 24 hnurs before required
a . inspection.Jo6adch�ess andPermitNumbers are neededahen requesting an inspecrion.
I trt�ERFLoo2 � I
Ro�r�,fr et.�r,^.�Cnt CUYII2TLN0 SANII'ARYDISTRICI'
�—�� t7osed c;rcuit�ideo inspectiou of property line cleanou�poir.t of connection
ITi�n�OR.vtY��o��'rt Pot� and street lateral required Ixior to pas sing F7NAL CIlyPLU119BING
I� INSPDCITON.Call the Dish-ict(408-253-707])for an a{3wintrmnt
is�.vx.-�urcnznnr-.
�r�ecrktc uerui�cs[.r-�,sE. I NO BTJII DINGF�'.AIS INSPDCPIONS TJ.NTQ.ALLREQUIRID
--- I BL�P,VFSS LICL'�'SES AREOBTAiNID
�HC,ECTRIC FIW.L
�i�t�scaA:�TCAL � PFR:�ICT II{PIl2ES IFR'aRKLS id0 i'S1'A.RTFI)��'17'HIN 1�0 3AY5 OF PFI2MfT
��� � V I35UA1\CF;OR 180 DA15���.L°4T L�ll�;SPECIYOIV.
�������'`���- I1�IPORTANT When a pernrit has expred,a ch:u�ge totaling one-half the fees to oblain a newpernut
� . mustbe paidin order to reacti�ate the permit Ttapermit has been e�iredfor nwi•e
������`� than one year,a charge totaling the full fees to oblsin a newpernrit must he paid
t'�ITIONER to reactit9te the permiL �
I HOUAS
i�,n�xa��[cntF!rut. Y NOTES:
j r-�s�vi /"� ' '� � .,-y '�
`-7�',>� �`�' � (
PLUMI3ING — - — ( � / � / �/ � I
r
I�,CCICAL '--- I I
Inlccx�.�c,u. , ' � �
r ,{ �
BJ[LUQJG �,'��`-t-% ..�.
�---
FIRE
. SR'[RLwTLVG POOL �� � S
/ j,.j {�s i %��', `� �� -, � .�
IRE[NFOFCE�t�7T — _ � - ,/ f +,=' / "' `--I
�p/M/E �� � + i.�
� — -- � � � �� j ��E, ,.s,L�
FLE(:l'RIC.4L 80'�D]NG � I��� �r ,($ L'��., I
. ��.. RCN3FL\G —�— t�l T--`}-
PREINSPEC'I[OV I ;� .�,-' ��!,�
�TFAR OFF — ---- �/�� .,� 1> � 1"% '7�� `..��1�� �
� 1C� � I
��-�`°� �`+ � �
� / e.�� f �..�� �'�. "a� �.��C�
II9ATTETS I '"�'(�� "` `�.-', - , fW.y- �
L�_—==_� __— __
TIPE ASF�T�'.CCOR DATE - T1TE INSPECTOR DATE TYPE IT�5PECTOR DATE
FOi7n�ATLON PLUi16ING SA.'V[TARI'IhSPELTIO'�S
�FOOTSNGS ��y�1'� �f�f,,� SHOWER PAN I UNDFRGROUND
—� —
i1FEEt WATER HEA7ER �HYDROFLUSH
PIERS ��Y:r:��:,!'P� J���,+"�"r WATER SERVICE
GRADE BFA1�7S � GAS TFST PUBLIC R'ORKS
� RIGf�f OF WAY
GARAGE SI.AB GAS MEI'II2 RELEASE
GROCJ!�/SiTE�t'OFiI{ ���'
UVDERGROL7ND ELFI:TRICAL FT FCI'RICAL REI'AII�IA7G WAi 1.
UNDERC�201JI�II)GAS PIPING 'IIIvfP POWIIt POLE
L'NDE2GRWAID WATII2 SERVICEUPGRADE FISiE DEPART'DfE.'�T
STTE COMPIdANCE
UNDERGROUTDJ SE."WER PV SYSTEM
SIT'E WAI.7.S FII2E MAIN SYSTEMS t� �a I .
EV SYSTIM t
FOOTII.G FIItE SFRIN[Q.IItS-ROU(�i ✓
MASOhRY REBnR b1ECHAh'ICAL FIRE SPRIN[Q.ER-FINAL
DRA[NAGE FURNANCE FIItE ALARM FINAL
ChN WALLS HOII.IIt STANDYIPE SYSTFT+LC
UI�DERFI'�OR AIR CONDITIONII2 INQNEEEtID FIfLE YROTECTION SYSTEM
UNDERFLOOR PLUMBING
HOOAS FIItE LIFE SAFETY
UNDIItFLOOR ME(.73Atv7CAL �.� � `� � .
,DCR'I'WRAP
��UNDERFLOOR EC.EC7'RCAL
___ DOCUIv1E�TAT[ON
�UI�`DERFLOOR FR4MING -t._B� PAD,'SEI'BACK CERTIFICATION
�—
IU;�DERFLC�OR INSULATION PLUMRING TRUSSES
FTL+iII�G ELECTICAL I SPECIALII�SPECI'IONREPORTS
FLOOR NAiUSi�ATF1AG SMOKE/CP.RBON MON07dDE CERT OF
- MEC:HANICAL
i RO17GH PI.TJA4BLNr COMPLIANCE
BiJ�-D'J`�G WATER FIXTURE CERT OF COMPLIANCE
I RWGfi MECHAIdICAi.
F� FJ�'6RGY COMPLSANCE FORMS
��ROliC�[{�T.ECTRTCAL
��ROUGI�I FRAI��F'G �CALGREIN MANDATORY ITIMS CI��LKI.iST
�__v_ S��'RiM11�G POOL
'
�IR�II'EkIOR SHEAR RIINFORCIIviQ�Tf DEPARTDiENI'FLN.9LS
��--
�LXTERIOki SfIFAR PMLE YLANt��G-CALL 777-3308
jWAI�.INSULATICN II.ECTRICALBONDING PUBLiCWORKS-CAi_I.777-3354 �fJJ �.Z.�i.
I'C� IILING�L�'SU[.ATION DFMOLTTION FIItE-CAIS,378-0(I10 . G -
(
f-
'ROOF IVAIL.R.Ci BACTff II1. HEALTH-CALS.408-91&3400 -
Lh'J'ERIORF7VSHE5 '--
' SANff ARY-CAL:.253-7071
SIJE6TROCK ROOFING
TILE BAC11�.R.R L'NDIIiLAYM,EP7;i PRE A'SPECTION ROILUL�G FL\ALS
TII�BACI�.R TEAR OFF PLLJMBING �
IM'ER10�Z LATH G II.FCI•RICwL
L•kTERIOR;'L\7SIII�S'�.�: BATTEhS
���� t�ff'.CHANICAL
EX"Cr�tIOP.LATH
—� ' TII.4PORARY OCCUPANCY
�SCR4TCH COA? � �
— �- BUILDING �=Ff..��� [�� -:�/.�,.� �.
SIDL\G— _
— b