00040173 (5) CITY OF CUPERTINOPERMIT NO.
BUILDING DIVISION PE 1 I 1 ! 1
WRDINO ADDRESS: ..
v , SANITARY NO. APPWCAIION SUBMITTAL DA'I5
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Job Description, W
S rt Floor Area
Valuation V
Required Ins tions
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Type of Roof
All roofs shall be inspected prior to any roofing, material being
installed. If a roof is installed without first obtaining an inspection
I agree to remove all new materials for inspection. Applicant
• understands and will comply with all non point source regulations.
Signature of Applicant Date
All roof coverin s to be Class"B"or better
APPLICANTS POSTING COPY