06050111 (4) . OCp05pl I 1
CITY OF CUPERTINO
• a1nTVOF REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # _ Date:
Building Ad es
o
wner's Name:
G S Plhone 4(�
Contractor. FOUr 2LOa2W!S R�1 License
Contact IC Cupertino Business License #:
ThofYlGiS Pl�dre� 21323
Type of Roof Covering:
Existing: Proposed:
Cl Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Er- Wood Shakes ❑ Wood Shakes
❑ Wood Shingles a- Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ 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 Po icy:
Job Description: p tiq es t h s R �Z D x ,o nd A
s b C tis
Residenti ❑ Commercial ❑
Fre Zone: Yes ❑ No Confirmed with Planning D�t, if
there are an restrictions:
Cost of Project: Type of Construction: Occupancygroup:
CSD �' RG� c f2
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE =Fee
ees BUILDING
BENERGY BUILDING
BSEISMICRE Res BUILDING
BSEISMICOM mercial BUILDING
BPLANCHK ee BUILDING
BUSLIC ense BUILDING
•