06050106 (4) CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
Ul - 0 O Date:
Building Address:
C C-r
Owner's Name: Phone #:
s 4c79
Contractor. F'Cur Siea2OnS R�P1 License Contact :Cupertino Business License #:
Thomc+SPi�dr� - 21323
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
e0 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles Ek Wood Shingles
❑ Other(Specify) O Other(Specify)
Number of existing coverings Cl Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Unde stand and Will Com 1 With Cu ertino's Tear Off Policy:
• Job Description: p ) ha as I )hs Kit Dx and Cb A
ResiCentitrr ❑ Commercial p
Fire Zone: Yes ❑ No O Confirmed with Planning Dept. if
there are an restrictions: LJ
T
Cost of Project: ype of Construction: Occupanc grou
CSD � R
Qty. if
A licable Fee ID Fee Descri tion
BPERMFEE Fee Grou
Bid Petmit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•