Please print legibly or type
DATE: PROJECT NO: CASE NO:
HP
PROJECT ADDRESS (NOT MAILING LIST): HISTORIC DISTRICT/LANDMARK NAME:
APPLICANT’S NAME: PROPERTY OWNER’S NAME:
APPLICANT’S ADDRESS: PROPERTY OWNER’S ADDRESS:
CITY, STATE, ZIP: CITY, STATE, ZIP:
TELEPHONE (INCLUDING AREA CODE):
TELEPHONE (INCLUDING AREA CODE):
Please check the appropriate boxes below.
Only check a box if it accurately and completely describes your proposed work, otherwise leave boxes blank.
See other side for additional information.
1. ROOFING TYPE:
a.
The existing roofing material is composition shingle, wood shake or shingle, tile or metal.
The new roofing materials will be:
Existing Proposed
3
0 year (min.) dimensional composition
(SPECIFY OLD/NEW COLOR)
W
ood shake or shingle
(FIRE TREATED)
Clay Tile
(SPECIFY OLD/NEW COLOR)
Built-up
Metal
(SPECIFY TYPE AND FINISH)
Tar & Gravel
Substitute material, simulates one of the above listed materials in texture and appearance.
(SPECIFY OLD MATERIAL AND COLOR/NEW MATERIAL AND COLOR)
2. GUTTERS:
a. There are no existing gutters.
No new gutters are proposed.
New gutters will be provided.
(SPECIFY TYPE AND MATERIAL)
b.
The existing gutters are fascia gutters.
There is no change proposed to existing gutters.
New fascia gutters will be provided.
Gutters will be repaired/replaced to match existing.
c.
The existing gutters are ogee gutters.
There is no change proposed to existing gutter.
New ogee gutters will be provided.
Gutters to be repaired/replaced to match existing.
3. RAFTER TAILS:
a. There are no expose
b.
There are no existing gu
c.
Rafter tails will be repaired/replaced to match existing in material, location, and appearance
4. VALUATION AMOUNT:
Number of squares
_______
Valuation of Work
$________________________
I, the undersigned, declare under penalty of perjury under the laws of the State of California that the information on this application is true and correct.
Signature: Date:
FOR DEPARTMENT USE ONLY BELOW THIS LINE
Approved
COA Fee:
$
Issued By: Date:
Denied
9.3% Surcharge:
$
Referred to HPO
TOTAL: $
This information is available in an alternative format by request to the Development Services Center at
(562) 570-6194 – Visit our website at longbeach.gov/lbds
Certificate of Appropriateness Re-roofing Application
Development Services
Planning Bureau
411 West Ocean Boulevard, 2nd Floor, Long Beach, CA 90802
562.570.6194
click to sign
signature
click to edit
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