06030073 • CITY OF CUPERTINO /
6ml REROOF
� OF
UPERTINO PERMIT APPLICATION .FORM
APN # � Date:3 — N-00
Building Address:
Owner's Name: 1 II II Phone#:
Su PA a� _ iw e h l� a
Contractor: Phone#: License#:
oo 'A Ca, 0(So
Phon #: Cupertino Business License#:
Contact:
W,v Ifo -fao:f`lR
Type of Roof Covering:
Existing: Proposed:
❑/Built-Up Roof. C2 Built-Up roof
B" Asphalt Shingles B'�Asphalt Shingles
❑ Wood Shakes. ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide 1.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With. Cu ertino's Tear Off Policy:
Job Description:^ ofd' I La e/ Ca,% SNS ec e ><<S Residential Commercial ❑ A
Fire Zone: Yes ❑ No a Confirmed with Pthere are'any restriCost of Proet: Type of Co truction: Occupancy�oup
Qty' if Fee Grou
A licable Fee ID Fee Description
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Encrgv BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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