06090929/5 (2) CITY OF CUPERTINO 0 QGq()Q�
REROOF /4 —
• CUPERTINO PERMIT APPLICATION FORM
APIC# Date:
°J - j% -M I ff-p-op
Building Address: /036 1"^ t,7/ems C+re e-A-- P4
Owner's Name: Phone #:
�te,t Gha� & 5"0
Contractor: Pbane# License#:
n oal-f v$ a-86 -Qs90 6-;z f/fa
Contact: Phone#: Cupertino Business License #:
cz 8 to -?9fo
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles _'_,4r—Asphalt Shingles
Wood Shakes o Wood Shakes
O Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
9 To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: rc,*"wu, 0-a in.cS a/11rti z psl3W►*�1
('Gtd�rw�-8>rnd.- p� � cwr�l, l�t�-fin.► D�rn�r,Ston�P Gov. .p -bio;, Sl�
Residential IR, Commercial ❑ L(69. —
Fire Zone: Yes ❑ No a Confirmed with Planning Dfft. if
there are any restrictions: lJ
Cost of Project: Type of Construction: OccupancX group:
p r e --no a-�c S'r [c_
Qty. if
Applicable .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
•