BLD-2025-1616_SignedPermit.pdf ITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS: 22116 CLEARCREEK CT APN: 326 18 022
PERMIT NO: BLD-2025-1616
OWNER'S NAME: HSING GEORGE Y AND JOANNE C TRUSTEE
OWNER'S PHONE:
CONTRACTOR: ON -TIME AIR CONDITIONING & HEATING LLC DBA SERVICE CHAMPIONS
CONTRACTOR PHONE:
DATE ISSUED: Jul 15. 2025 ISSUED BY:Kim Dunbar VALUATION: 10427.49
JOB DESCRIPTION: REPLACE AC UNIT WITH HEAT PUMP IN REAR RIGHT SIDE YARD
LICENSED CONTRACTOR'S DECLARATION:
NO: EXP DATE: 08/31/2025
817040
7000) of Division 3 of the Business & Professions
CONTRACTOR: ON -TIME AIR CONDITIONING &
I hereby affirm that I am licensed
Code and that my license is in full
HEATING LLC DBA SERVICE CHAMPIONS LICENSED CLASS: AND ACOUSTICAL, LICENSED
C20 WARM -AIR
HEATING % 2C
under the provisions of Chapter 9 (commencing with Section
force and effect.
one of the following three declarations:
maintain a certificate of consent to self -insure for Worker's Compensation,
the performance of the work for which this permit is issued.
maintain Worker's Compensation Insurance, as provided for by
the work for which this permit is issued.
the performance of the work for which this permit is issued, I shall
to the Worker's Compensation laws of California. If, after making
provisions of the Labor Code, I must forthwith comply
as provided for by Section 3700 of the
I hereby affirm under penalty of perjury
❑ I have and will
Labor Code, for
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subject to
with such provisions or this permit shall be
I. I have and will
performance of
❑ I certify that in
become subject
the Worker's Compensation
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
requirements under Chapter 6.95 of the California Health
M I have read the hazardous materials
will maintain compliance with
handle hazardous material. Additionally,
Air Quality Management District
Sections 25505, 25533, and 25534.
the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
should I use equipment or devices which emit hazardous
I will maintain compliance with the Cupertino Municipal Code,
EPA LEAD -SAFE DISCLOSURE
will be responsible for this project.
Firm Certification No:
❑ An EPA Lead -Safe Certified Renovator
Certified Firm Name:
✓ No EPA Lead -Safe Certified Firm
is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm under penalty of perjury
(Section AV7, Civil Code).
that there is a construction lending agency for the performance
Yes El No
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
and state that the above information is correct. I agree to comply
and hereby authorize representatives of this city to enter upon
and keep harmless the City of Cupertino against liabilities,
of the granting of this permit. Additionally, the applicant
Municipal Code, Section 9.18.
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may
understands and will comply with all non -point
I certify that I have read this application
laws relating to building construction,
purposes. (We) agree to save indemnify
accrue against said City in consequence
source regulations/]per the Cupertino
Signature LV I S SORUIV Z4
Date J u l 15, 2025
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.