04070133 (3) 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