06060005 CITY OF CUPERTINO a�5
REROOF
CUPERTINO PERMIT APPLICATION FORINT
• APN# Date:
s eh �=
Building Address:
6rZ.0oo
Owner's Nam : W, Phone#:
2 �12SeIL o 255- r y�3
Contractor: Phone#: O License#:
�00y0
Contact: Phone#: Cupertino Business Lice n e#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles •❑ Wood Shingles (1
El Other(Specify) X Other(Specify)(I S e,cc
Number of existing coverings_� ❑ Provide I.C.B.O.Report#
`y( To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will ComplX With Cu ertino's Tear Off Polic :
J b Ike cription: 1n rwv f�
D o
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are aLrresL,,
ictions:Cost of Pro ct: Type o ConstructiOccupancS6SZ v
Qty. if
A22licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING ,
—_---• —J S_ MZCRE_—__.---__._.. Seismic eeRes.--- --- __-BUILDIN-G_-_-
-- ---- -=- --.. - --._.....- ----BSEISMICOM----------•--_.-- ---Seismic Commercial--__..__- _.._ ---BUILDING--.---
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•