Loading...
08050137 CITY OF CUPERTINO BUILDING DIVISION PERMIT GO�TRAG�ORINI OItMATION ? MIT NO. Bu11niN&�r��Ess ESTATES DR C & C ROOFING PER 08050137 ER'S NAME: - PERMIT ISSUE DATE NE FENG LI—CHIEN AND ALICE A 89 S 21 ST 05/16/2008 P ONE: SANITARY NO, CONTROL NO. ARcxlTEcryFrcI19EER: RE-MOVE SHAKES ADD 1/2 CDX BLDG ELEBcl-r��RMmums MECH u o p LICENSED CONTRACTOR'S DECLARATION E= O O O I Wrathy affirm that I am liecound otic,pmviskns of Chapter 9(commcnNng Job Description ;iwins Section 7")oftliviuon 3 ofthe Business and Professions Code,and my licen4 is . to full fora and effpt 2�' Z� Z . rd License Class L ,�Lk.L L— Dam Comraclor e ARCHIIECPSDECLARA ON e7 tl i u I utkenund my plans dull W used as public mcartla g C Licensed Professional 3 OWNER-BUILDER DECLARATION .�i E I h eby aRres than 1 am exempt from tW Convenors License Law for use i o following mason.(Satins 1031.5,Business and Pmfesska Code:Any city or county which am.a permit to con swct.alms improve,demolish,nr mpur any arum. prior 0 its issuance.also require roc applicant for such permit to File a signed summate < thn W m Eared pursuant to the provisional of ft Connectors Luanne Law(Chapter 9 Sq.FI. Floor Area Valuation Ey 1--$ (commarengwithSader7 )of Oivision3ofthe Business Rofessiom Cade)or — Jut W ue somp theedrocaxd f basis for the alleged uwpdon My violation of Section 1031.5 by airy applicants fa a permit subjects the applicant to•Civil putafty of APN Number Occu tet men man It.Wandmd dollars(5500). panty Type ❑Le,o-xtmrof die pmpmy,amY employees wtthwagns rmic(Sm.�om.Burd , anddothewart.and thnhe com Varointendedcraffartal e L,.dotarok(Sae.to ad, .of W PmfuenaN Code or Tpa Convcme.r and who nes dans rot apply lf an ownv of Required Inspections pan erywho Wilds or sucmwwn,Ndwho da notfin such wort himuJfotiumgp his own employe,provided nsasuch impmsemvns are not intended muttered forsake If, builder nse Wilding eimpavemvinuhathwithinons year or mmPletian,tluaveof builder will haw the WNen of proving that he did not Wild or improve for purpose of alk.). ❑1.as owner,of ft property.am eatluuwly commenting with Seemed conusmae m cominum f project(Sec.YOU.B..and PmfessiaN Code:)The Cow ntseces U. arm Law dor am apply to an owner of property who Wilda o,lmpww a theme,and. who convene for such po jeers with a convamer(j)licensed panus,to f Con,m,m,, l.kenee Law. Q lam a map,under See ,B B PC far this auom Daus WORKERS COMPENSATION DECLARATION 1 Waby affirm under peaty of pejmy rine clubs following declaruiata ❑I low and will mountain a Cerdfram ofConsem to self-lnsumfoWansuesCompen- cation,a provided fm by Section 3100 of the IsWr Code.far Ju lam omtume of Jte woh for which this Permit is bound. ❑1 haw and will munWn Workers Compensation Insurance,as acquired by Section 31r0wf nse Latmr Code.far nse Pert=.of f wort for which this Pem1,u issued. MY Workers Compenudon lnsuema artier and Policy number am: - Caruer.G/ATE FU AI Poll,No.: /y�z� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE fria&aecooe eased ambe completed ifthe Permit Is rwronehumdrrl do0an(5100) o leu) I certify mo,to the perfmmanee seg the work for whlcb this permit is issued.l shall nut employ any Noon in any manner an as to become subject in ft Worrmy Compecol Laws of California.ate Applicant, NOTICE TO APPLICANT:If,after making this Certificate of Esemption,you should became Subject to the Worker's Compensation pmYisima of the Isbo Cod,you most .J mZ forthwith comply wins such paviunns or this Peed,shel be dermad teased. .za O A CONSTRUCTION LENDING AGENCY I^ l lauabywhich that mea u s ed(Sectinn kmmng ageney ter the Perfw,manco N LYS the wohfm Which titian pemituiaad(Sre.3097,Civ.C) G Q Lenders Name a z 1<naers Merest V Q I carifY that I low rad this application and sum Nat f aWw irdormauan is; Uycmasm I agree m comply with til city and county oNlnenas and state kws elating id C) SV-' Wilding rnNuucuon,sad hereby Nmones eprexnuuws ofthu city to cnurupnn me Fabme-mamtianed property fee hupecdm purpasew y (We)agree to sew,indemnify and trep harmless the City of Cupertino agonal to liabilities,jWgmenu,costs and expenses which may in any way acauc gaInst send City IJ z to mauccloaa of the granting of this permit / ti SOULLICANT UNDERRS�SANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date [' i� �/Bc C:: -� 5--/6-o8 Re-roofs SttN,urc of AppinanvComracto Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant or Imus building e,Chalon, more o handle 11 JNOr material u defend by tie Cupertino Municipal Code,Chapter 9.13,and the Health and Safety .Scctiom'5532(.)?❑Ya 2ro All roofs shall be inspected prior to any roofing material being installed. wR den,app0amor farm building occupant mW Nulpm a,vdcdeN which If a roof is installed without first obtaining an inspection,I agree to remove ... huudons ers r commiams as defined by f Bay Area Air Quality Managemmen all new materials for inspection. ❑Ya 0Wu I haw and the heoudeca numriusrequimmeau undcrChpmr6.95oftha Caifor. nu Real"SafpYCwdu Sepia 25505.25533and 25536.IerdctRaM ten Rile Wilding does ma pmemly haw•soman,Jut it u my rulmodbtlity W mdfy f ca,c m wf the mquiremcn s which mvn W mat prior 0 i ace of a Certificate of Occuparmy. �iryc < _off Signature of Applicant Date OWmer wramhmivrtdegcm mm' All roof coverings to be Class'W'or better X-M., Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY Of Fax(408)777-3333 0UPEkTINO Building Department JOB ADDRESS: r- PERMIT # 1121Wiff no o� 3 OWNER'S NAME: L / - r cry PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 46-09- Owner/Contractor irOwner/Contractor Signature Date Green Building Plan Check Index of Green Building Points/Categories A. Category Example of an Index or Table of Green Plan Sheet or Page Points Building Points Categories that must be shown and referenced on the Project Plans See below B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points 11. Permeable Paving, Note L-1 2 points C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points 5. Use Truss with heels, (detail) S-2 2 points 6. B. OSB Sheathing, detail S-2 2 points E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points 4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points 5. Tankless W.H., (Note/Spec.) A-2 2 points 11. A 2500 Gal. Tank, (Note/Spec L-1 10 oints G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point 3. Energy Star Refrigerator, (Note/Spec. A-3 1 point P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS 40 points �Od'IS B � LI m U Plan Review Process Work Book Page-12-Revised 3/25/08 Green Points Rating System for Remodeling Projects • Due to the diversity of remodeling project types,assigning a'total points'value to a project to be considered environmentally friendly is not feasible. However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with ease of implementation and relative low cost. These measures can be used as a starting point for'greening'your project. A.Site 1.Recycle Job Site Construction&Demolition Waste I65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0 2.Salvage Reusable Building Materials } 4 Resource pts y=yes D 3.Remodel for Mixed Use,Adaptive Reuse,and Historic Preservation 4 Resource pts y=yes 0 4.Protect Native Soil 2 Resource pts y=yes p 5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0 6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0 B.fiijign Resource-Efficient Landscapes and Gardens- _� 4 Resource pts y=yes 0 9.Reusa Materials/Use Recycled Content Materials for Landscape Areas 2 Resource pts y=yes , 0 10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0 11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0 1 1 1 B.Foundation • 1.Incorporate Recycled Flyash in Concrete 25%Recycled Flyash=2 points;Add 1 point for every 10% increase of flyash,up to 5 points up to 5 Resource pts 0 2.Use Recycled Content Aggregate 2 Resource pts y=yes 0 3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes D C.Structural Frame 1 1 1 1.Substitute Solid Sawn Lumber with Engineered Lumb� 3 Resource pts y=yes 0 2.Use FSC Certified Wood for framing (For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0 3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0 4.Use Web Floor Trusses 2 Resource pts y=yes 0 5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes 0 6.Use Finger-Jointed Studs for Vertical more 2 Resource pts y=yes p 7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes p S.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0 9.Use Structural Insulated Panels(SIPS) a.Floors 3 b.Wall Energy pts Y=yes 0 c.Roof 3 Energy pts y=yes 0 3 Energy pts Y_–Yes 0 10.Apply Advanced Framing Techniques 4 Resource pts y=yes 11.Use Reclaimed Lumber for Non Structural Applications 0 _ _ PP 3 Resource pts y=yes 0 I12.Use OSB • a.Subfloors 1 Resource pt y=yes 0 j b.Sheathing 1 Resource pt y=yes 0 1 1 1 D.Exterior Finis 11.Use 8ustaihaEle Decking Materials a.Recycled content 3.Resource pts Y--yes 0 b.FSC Certified Wood 3 Resource pts yeses 0 2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y=yes 0 3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0 4.Use Fiber-Cement Sidling Materials 1 Resource pt Y_-Yes 0 E.Plumbing 1.Install Water Heater jc— 1 Energy of y=yes 0 2.Insulate Hot and Cold Water Pipes 2 Energy pts yryes 0 3.Retrofit all Faucets and Showerheadswith Row Reducers i a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0 b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0 4.Replace Toilest with Ultra-Low Flush Toilets (1 point each,up to 3 points) Up to 3 Resource pts. 0 5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y--yes 0 6.Convert Gas to Tankless Water Heater 4 Energy pts Y_-Yes 0 7.Install Water Filtration Units at Faucets (2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0 6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes D 1 1 r.tiecmcen 1.Install Compact Fluorescent Light Bulbs(CFLs) (6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0 • 2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to 5 points) - Up to 5 Energy pts. 0 3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0 4.Install High Efficiency Ceiling Fans with CFLs (1 point each,up to 4 points) Up to 4 Energy pts. D 1 I 1 G.Appliances T.Install Energy Star Dishwasher _ 1 Energy pt y=yes 0 2.Install Washing Machine with Water and Energy Conservation Features 1 Energy pt y=yes D 3.lnstall Energy Star Refrigerator 1 Energy pt y=yes 0 4.Install Built-In.Recycling Center 3 Resource pts y=yes 0 H.Insulation 1.Upgrade Insulation to Exceed Title 24 Requirements a.Walls 2 Energy pts Y_-Yes 0 b.Ceilings 2 Energy pis y=yes D 2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0 3.Install Recycled-Coritenl,Fiberglass Insulation will No Added Formaldehyde ,_ ) 3 IAQ/Health pts y=yes 0 4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes D 5.Use Cellulose Insulation a.Walls 4 Resource pts y=yes 0 • b.Ceilings 4 Resource pts y=yes 0 6.Alternative Insulation Products(Colton,spray-foam) a.Walls 4 Resource pts y=yes 0 o.cenings 4 Resource pis y=yes 0 L Wm ows I1.Install Energy-Efficient Windows t a.Double-Paned 1 Energy pt y=yes 0 ! b.Low-Emissivity(Low-E) 2 Energy pts y--yes 0 C.Low.Conductivity Frames _ 2 Energy pts y=yes 0 2.Install Low Heat T'ransmis'sion Glazing 1 Energy pt y=yes 0 I 1 1 J.Heating Ventilation and Air Conditioning 71.Use Duct Mastic on All Duct Joints _ 2 Energy pts y=yes 0 2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0 3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0 5.Install Solar Attic Fan 2 Energy pts y=yes 0 6.Install Attic Ventilation Systems 1 Energy pt y=yes 0 7.Install Whole House Fan 4 Energy pts y yes D 8.Install Sealed Combustion Units a.Furnaces 3 IAQ/Health pts y=yes 0 b.Water Heaters 3 IAQ/Health pts y=yes 0 9.Replace Wall-Mounted Electric and Gas Heaters with Through-the-Wall Heat Pumps 3 Energy pts y=yes 0 10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0 11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes D 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0 • 13.Retrofit Wood Burning Fireplaces a.Install EPA certified wood stovesrnserts 1 IAQ/Health pt y=yes 0 b. Install/Replace Dampers 1 Energy pt y=yes 0 c.Install Airtight Doors 1 Energy pt Y--yes 0 14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0 15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0 16.Install Heat Recovery Ventilation Unit(HRV) 51AQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAO/Health pts y= as 0 I 1 1 K.Renewable Energy and Roofing 1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0 2.Install Solar Water Heating System 10 Energy pts y=yes p 3.Pre-W re for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0 ll f Safe and Durable Roofng Materials _ 1 Resource pt y=yes p 6.Se 7.Install Radiant Bardet 3 Energy pts y=yes p 1 1 L.Natural Heating and Cooling 1 1.Incorporate Passive Solar Heating 5 Energy pts y=yes p 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes p 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0 • 1 1 1 M.Indoor Air Quality and Inishes �.'lJse LowM'o VOC Paint _ __ t 1 IAQ/Health pts y=yes D 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 r"- i3.Use LowMo VOC Adhesives __ _ S 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AO/Health pts y--yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes 0 '7 Seal all ESiWsiic1 Perfiicleboard of MDP . - 41AQ/Health.pts es D 6.Use FSC Cer ified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0 2.Use Rapidly Aenewable Flooring Mate als— --? 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes D 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 i 1 1 Total Points Available: 1 1401 1301 57 • Total Points Project Received: {�- 0 s- 0 ez— 0 G:dataiprogsrgreenbuildngguldelinestremodelerslgreenpointsfinel2.12.04pmteMed.xts CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36922018 . 00 DATE ISSUED. . . . . . . : 05/16/2008 RECEIPT #. . . . . . . . . : BS000004803 REFERENCE ID # . . . : 08050137 SITE ADDRESS . . . . . : 10815 E ESTATES DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . ' OWNER FENG LI-CHIEN AND ALICE A ADDRESS . . . . . . . . . . : 10815 E ESTATES DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4533 RECEIVED FROM . . . . : OSVALDO CAMARA CONTRACTOR . . . . . . . : OSVALDO CAMARA LIC # 22982 COMPANY C & C ROOFING ADDRESS 89 S 21 ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95116 • TELEPHONE . . . . . . . . : (408) 298-1868 FEE ID UNIT QUANTITY. AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00 BSEISMICRE VALUATION 9, 350. 00 1 . 00 0 . 00 1 . 00 0 . 00' ---------- ---------- ---------- ---------- TOTAL PERMIT 326 . 00 0 . 00 326 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 326 . 00 VISA --------------- TOTAL RECEIPT 326 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ------ ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS 605 FINAL REROOF • CITY OF CUPERTINO REROOF CUOF PERTINO PERMIT APPLICATION OP-5 /3 APN # Date: 22 UJB lX� S- t G ar= Building Address: D 2 Owner's Name: Phone #: Contractor: Phone #:y&v_z9f_ Ik61rr (' RD Fax #: �,a¢-Z`/f - 3360 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ,Er- To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: /7 Even pvc. S !+ w Iec f 14 b-0 Residential Commercial El Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the there are any restrictions: ❑ application or if applicable, include in plan set & the sheet index. Valuation: 93 sU-ov • I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature CITY OF CUPERTINO « 'got REROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B Z S 1REROOFRES Re-roof Residential B 1SFDWLROOF 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B IBUSLIC Business License B Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled IMPORTANT: 1. Flat roofs must have a minimum of 1/4"per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: G /- C'l,lCAl FEN&_ Job Site Address: 10,'/�_ f'. ES' /ATL_ f Roofing Company Name: O O tFi iy C-- Applicant's Signature: �irirG (��6c u_-�1 Date: Q r • Greg Casteel Building Official Revised 11/2/04