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04070133 CITY OF CUPERTINO 3 REROOF CUPERTINOPERMIT APPLICATION FORM APN# 3 A 4 3 o 4 2 Date: Building Address: 1 Owner's Name: Phone#; Shoo k9Y\ Qyo$) 39 - 34- AA Contractor: one #: License#: I D gq -t CO �Contact P one#• Cupertino Business License#:Hoch Qi(o9) SGS g8� a Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles X Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ; 1 ^ ,• 'I ❑ Other(Specify) 3-lOther(Specify) lra Number of existing coverings ❑ Provide I.C.B.O. Report# ro S 6 To be Removed ❑ Provide Mfgr. Installation Specs. •I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: '( hern000- ,Nooc� S�na�sie ue��c�ca VI1CQ� J9 ItU-CL v, c\ Residential Commercial ❑ A AGGG G n TcDo # 16 pS � 3 CSI Fire Zone: Yes ❑ No Confirmed with Planning De pC if .. there are any restrictions: p Cost of Project: Type of Constructio Occupancy group: $ 13 loo— Jze _ C oo Qty A ii le Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING � � 3 � 7