BLD-2019-1328BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21123 CHRISTENSEN DR Cupertino
APN: 326 54 011
PERMIT NO: BLD-2019-1328
CONTRACTOR:
SANDIUM INC, 4223 VERDIGRIS CIR SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 11/7/2019 1:36:42 PM
ISSUED BY: JARCHBOLD
VALUATION: $27500
JOB DESCRIPTION
SAME LOCATION; INSTALL (2) NEW AC UNITS - SIDEYARD
REPLACE (2) FURNACES
LICENSED CONTRACTOR DECLARATION
the following
for which
this
be deemed
C-2 INSULATION AND ACOUSTICAL, B GENERAL BUILDING CONTRACTOR
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
SANDIUM
LICENSED
C20
LICENSED
888119
EXP
12/31/2020
I hereby
force
I hereby
INC
CLASS:
WARM -AIR HEATING%2C VENTILATING AND AIR-CONDITIONING,
NO:
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall
three
to self -insure
Insurance,
this
certificate
revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
9.12 and
under
the Health
Code,
project.
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
for this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this
Certified
v
CONSTRUCTION LENDING AGENCY
is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there
No
V
Lender's
Name:
APPLICATION CERTIFICATION
that
of
judgements,
all non
/-%.
this application and state
authorize representatives
Cupertino against liabilities,
and will comply with
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.