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13040039 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21475 MILLARD LN CONTRACTOR:SOLARCITY PERMIT NO: 13040039 OWNER'S NAME: SCHROTENBOER RONALD BAND MARY 3055 CLEARVIEW WAY DATE ISSUED:04/04/2013 OWNER'S PHONE: 4087334255 SAN MATEO,CA 94402 PHONE NO:(650)638-1028 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Clio Lic.# O MECH RESIDENTIAL COMMERCIAL Contractor 0 c&a Date q /13- 1 hereby affirm that I am license under the provisions of Chapter 9 JOB DESCRIPTION:BUILD A 50 AMP CIRCUIT FROM THE MAIN PANEL& (commencing with Section 7000)of Division Sof the Business&Professions INSTALL NEMA 14-50 EV STATION 100 AMPS IN THE Code and that my license is in full force and effect.- GARAGE-FLUSH MOUNT I hereby affirm under penalty of perjury one ofthe following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compen"sation;Insurance,'as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$800 permit is issued. APPLICANT CERTIFICATION APN Number:32644062.00 Occupancy Type: I certify that I have read this application and state that the,above information is correct.I agree to comply with all city and,county ordinances:and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes: (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and.will comply 180 DNYS FROMT C LLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I Issued by: * 1_3 Date: Signature A ate ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the,.Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code): ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow �or authorized/ nt: forthwith comply with such provisions or this:permit shall be deemed revoked, r` d n `' �� Date: APPLICANT CERTIFICATION. CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representativesof this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant:understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date. Licensed Professional � Sly C� • ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 <:UFERTtNfl (408)777-3228•FAX(408)777-3333•building4cupertino.org 30 PROJECT ADDRESSf _713- l 11 Q.J P OWNERNA'E Ma c bo o' -73 '9Z S� B- rp s� �bo f. STREErADDRESS l l�I`lvV ` I =Y. A;� .ao Cf� �s 0 i c f FAX CONTACT NAME 1,, PHONE E-MAII ��'.�272 - 0853 J`N`n-H-uc,k@ Soia.rc', STREET ADD CITY, TATEIS CLt -V Ct7NL ❑OWNER ❑ OWNER-BUILDER ❑ owNERAaBNT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHrTECT ❑ENaNEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC S CONeANY NAME So` r1 1� C a E-MAIL, ;AFAX 1`M •W �� v So�cs-r f� -Cd STREET ADDRESS CITY.ST TE ZIP PHO 3C11T-as`�r CL �l�d sir Ci Eft CN401 ARCHIIECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL. FAX STREET ADDRESS CIPY,STATE,ZIP PHONE USE OF J7*SFD or Duplex ❑ Multi-Family PROYECr IN WILDLAND PRO ECT IN sTRUcnw: ❑ Commercial URBAN R•1I WACE AREA ❑ Yes YNo FLOOD ZONE ❑ Yes XNO ❑SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING OTHER:t -S� FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KIIAWATTS(CONSIERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK +`a P� GVCM1 ql n S {{��,(( , /' rl� U ` 5b Chu By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalIK I have read this application and the information I ha rovided is conlem I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ding construction. I a r' a erltati tes of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED I PVApp 2011.doc revised 03116/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: DATE: 04/04/2013 REVIEWED BY: APN: BP#: 3 *VALUATION: $800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RE USE: PERMIT TYPE: WORK residential ev charging station AQ ,M • SCOPE ul' #- ,€ 1 h �2E4xzi*'1c 0 v d 4 "ii Rs Mech.flan Check Plumb.Plan Cheek Elec.Plan(:'heck Mech. Permit Fee: Plumb.Permit Feer. Elec. Permit Fee. Other:t9ech.Insp. Other Plumb Imp. Other Elec.Insp. Li Aaech.Insp.Fee: Plumb. Insp.fee: Flee.Insp.Pee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the relimina information available and are onlyan estimate Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 7111121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Alternative Energy System Suppl.PC Feer (F) Reg. ® OT 0.0 hrs $0.00 $102.00 ICHRGSTA EV Charging Station. PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. ® OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? ®Yes 0 No $0.00 1 1 E) Advanced Planning Fee: $0.00 Select a Non-Residential 0 7i-rxvel DocumentationTecw: Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item. Bldg Stds Commission Feer 1BCBSC $1.00 o,_ $1.50 $102.00 = TOTAL ti $103.50 Revised: 04/01/2013 INSTALLATION NOTES Scope of Work Installation Component Build a 50A circuit out of MP located Breaker(s): Siemens Q23050CT2 on the right exterior garage wall Wire Type: Positive: #8 AWG THHN-2 Quad the 30A breaker with the new Negative: #8 AWG THHN-2 50A circuit breaker Neutral: #8 AWG THHN-2 Ground: #10 AWG THHN-2 Punch into garage and run the conduit above garage doors Conduit: 3/4" EMT-30' Install the NEMA 14-50 outlet on the Romex: None W Q � column between garage doors New Panels: Non J C: a Other Material: N z � �? 04 Contract is for $750 cr a W V W 0 �.+. C-) LL m CONFIDENTIAL-THE INFORMATION HEREIN �B-9501598 AH't Of Cupertino ��M CONTAINED SHALL NOT CE USED FOR THE EL p Mary Schrotenboer kayNOR ST OF ANYONE IXCEPT SgAROUE INC., MARKET: MNN PANEL S�RWCE RATiNk 21475 Millard LaneNOR SHALL IT BE DISCLOSED IN WHOUE OR INPART IZ OTHERS OUTSIDE THE RECIPIENTS p�CTMANArGER:.r CRCUT VOLTAGE/AMPERAGE Cupertino, Ca,95014 ORGANIZATION,IXCEPT IN CONNECTION WI1H THE SALE AND USE OF THE RESPEcnvE Colin Fl n 240V 50A (408)733-4255 3055 Clearview Way SOLARCITY EQUIPMENT,WITHOUT THE WRITTEN DRAFTER:: CHARGER: San Mateo,CA,94402 PERMISSION OF SOLARCITY INC' Hadi Rismanchi NEMA 14-50 maty@schrotenboer.com Tari)-Sa�rrczes-zas9)www.wiarcity.can N W E House S MARK UP KEY MH-lNTA1iV ��WA�- a � (N) NEMA 14-50 Outlet � Main Panel Q Sub Panel For Electric Vehicle Charging Height Between 1.5' and 4' ® Q J-Box No Ventilation Required DOIE ® AC Disconnect (3) #8 AWG THHN-2 EV Outlet (1) #10 AWG THHN-2 3/4 EMT 30 Q Transfer Switch Conduit &LOonductors (E) 200A Main Pane ��Trench ¢ ,� oZi zv a; 0 �� P a " W Millard Ln V ° T 113- Cc:) IY60 o CONFlDETIAL-THE INFORMATION HEREIN JB-9501598 'City of Cupertino PREMISE OMNI CONTAINED SHALL NOT 8E USED FOR THE Mary Schrotenboer Vew NORBENEFITSH OF ANYONE EXCEPT IN VMOLE INC., MARKET: MAIN PANEL SERWCE RA1M4` �� NOR SHALL IT BE DISCLOSED IN WHOLE oR IN 21475 Millard LanePART TO OTHERS OUTSIDE THE RECIPIENTS 200A Cupertino, Ca, 95014ORGANIZATION,EXCEPT IN CONNECTION WITH PO ECGE: =T VOLTAGE/AMPERAGE �THE SALE AND USE OF THE RESPECTIVE Colin FI n 240V 50A (408)733-4255 - pVay SOLARCITY EQUIPMENT,VATHOUT THE WRITTEN �poPERMISSION OF SOLAROTY INC. DRAFTER:: �"" mary@schrotenboer.com 9 z Hadi Rismanchi NEMA 14-50 www.solarcity.com yak Vaecui cal Service \Icu Screed by a W^RNI .C+ . v z .� I J ILO U CONFIDENTIAL- THE INFORMATION HEREINJB-9501598 AHJ.Cit of CupertinoPREMISE � CONTAINED SHALL NOT BE USED FOR THE y Ma Schrotenb BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MARKET: MAIN PANEL SERVICE RATING: ry oer '*Yyl� ` NOR SHALL IT BE DISCLOSED IN MOLE OR IN EV Charger 200A 21475 Millard Lane PART TO OTHERS OUTSIDE THE RECIPIENTS PROJECT MANAGER: CIRCUIT 1KILTAGE/AMPERAGE Cupertino, Ca , 95014 ORGANIZATION,EXCEPT IN CONNECTION WITH E THE SALE AND USE OF THE RESPECTIVE Colin FI n 240V 50A (408)733-4255 - � eanUL'Sv way SOLARCITY EQUIPMENT,WITHOUT THE WRITTEN - DRAM-: CHARGER:: San Mateo,CA,94402 M- PERMISSION OF SOLARCITY INC. Hadi Rismanchi NEMA 14-50 maty@schrotenboer.com (888)-SOL{TfY(766-2489) W.�la .�� NEC 220.83 - Adding a Circuit to an Existing Dwelling Unit Square Feet: 3,000 Panel Breaker Rating: 200 A L1/L2: 240 Vac NEC 220.83(A)(1) "General lighting and general use receptacles ... @ 3 volt/amperes per square foot as determined by 220.12" 3,000 square feet x 3w/sq ft 9,000 VA NEC 220.83(A)(2) Small appliance and laundry branch circuits @1500VA per 20 amp circuit Number of circuits 4 x 1500= 6,000 VA NEC 220.83(A)(3)(b) "Household Range(s), wall-mounted oven(s), and counter-mounted cooking unit(s)" Oven 8,000 VA Microwave 0 VA 8,000 total VA NEC 220.83(A)(3)(a) "All other appliances that are permanently connected, fastened in place, or connected to a dedicated circuit, at nameplate rating" Dishwasher/Disposal 3,840 VA Refrigerator 1,200 VA 0 VA Washer 3,840 VA Dryer 5,760 VA Pool pump 1,920 VA 0 VA 0 VA VA 0 VA VA VA EVSE 1: Tesla Nema 14-50R 9,600 VA EVSE 2: 0 VA 26,160 total VA Total of non air-conditioning loads: 49,160 total VA First 8kVA of load at 100% 8,000 VA Remainder of load at 40% 16,464 VA Adjusted total of non air-conditioning load 24,464 VA NEC 220.83(8) "Where additional air-conditioning equipment or electric space-heating equipment is to be installed...,, A/C Equipment Unit#1 9,600 VA A/C Equipment Unit#2 0 VA Total of A/C Loads and All Other Loads: 34,064 total VA Total Proposed Calculated Load: 141.93Amps UPERTING f r+ nr i 2033 JB - Schrotenb0( REVI WED SOla�it F�o �bC0MPLIANCE pyright oar Qyewed By: rnciy Charging Equipment Name VA 0 Clippei 4800 Clippei 7680' Schnei 7200 Tesla 9600 0 OFFICE C FY CUPERTINO Building Department APR 0 4 2013 REVIEWED FOR CODE COMPLIANCE Reviewed By: ^ nq p nea 4L£00l£ N 3894 0 0 o Range Receptacle 50A 126=V 11111 6 1 Flush Mount 3P 4W ~ WPownL Twyw Tn Wml Bewn to Why LbC a 0 0 AUCU ° �74M 75�C Byr.FlY19�21• �P NNo:270 Meds In 6Mtn 1 PC ISI �� 1�� 111111 7 00 8079 s - a 0C) CL— (D N Q n n cD N ' N 0 � N OFFICE CUPERTIN Building Departm APRT 0 4 2013 REVIEWED FOR CODE COMPLIANCE Reviewed By: ��1� 9 � � :A8 pannainaa 3ONVildV400 3000 NOA 03M31n321 OZ h 0 :peda(3 6uippng ilw�rcino N N N ' V V O t3 - • 4cmV 1 � s 6L08II 005pp8�� L (III��Ill�fll II��III�I 3d 1• 8LL curoNY ! gum w wm •tREtAN'u8 PW�.l..�x1 auglo0q Mt AO V09 NBC 3100374 Rev.D