11050025I CITY OF CUPERTINO BUILDING PERMIT I
IBUILDING ADDRESS: 10760 JOHNSON AVE I CONTRACTO : - I PERMIT NO: 11050025
OWNER'S NAME: DAVE ROWE I '�.&:p y (-G 0/,�i'VI I DATE ISSUED: 05/04/2011
'NER'S PHONE: 4082558404
E� LICENSED CONTRACTOR'S DECLARATION
License Class
}�^^ — /0 Lic. # 78
Contractor V�I'►'I� VP e— Date
_ 1
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the 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 Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date l
I v OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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 Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
lemnify and keep harmless the City of Cupertino against liabilities, judgments,
.,sts, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature.
Date
PHONE NO:
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH F_ RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: PANEL UPGRADE 200 AMP, GROUND EXISTING OUTLETS
NEW
110 VOLT CIRCUITS AND OUTLETS
Sq. Ft Floor Area: I Valuation: $8600
APN Number: 375310005.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE,
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 375310005.00
DATE ISSUED.......: 05/04/2011
RECEIPT #.........: BS000013375
REFERENCE ID # ...: 11050025
SITE ADDRESS .....: 10760 JOHNSON AVE
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER ............. DAVE ROWE
ADDRESS ..........: 10760 JOHNSON AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: SylviaM
COPY # : 1
RECEIVED FROM ....: SIERRA ELECTRIC
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ...........
CITY/STATE/ZIP ...: ,
TELEPHONE .........
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-ADMIN
-------------
HOURS
----------
1.00
----------
78.00
----------
0.00
--------------------
78.00
0.00
1BCBSC
VALUATION
8,600.00
1.00
0.00
1.00
0.00
1BREMMISC
EACH
2.00
252.00
0.00
252.00
0.00
1BSEISMICR
VALUATION
8,600.00
0.86
0.00
0.86
0.00
1BUSLIC
FLAT RATE
1.00
115.00
0.00
115.00
0.00
lEPERMITFE
FLAT RATE
1.00
42.00
0.00
42.00
0.00
1ERT2001K
UNITS
1.00
63.00
0.00
63.00
0.00
1TRAVDOC
FLAT RATE
1.00
42.00
0.00
42.00
0.00
TOTAL PERMIT
----------
593.86
----------
0.00
----------
593.86
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
593.86
---------------
593.86
VOICE ID DESCRIPTION
-------- ----------------------------
103 UFER
505 FINAL ELECTRICAL
REFERENCE NUMBER
--------------------
2003
VOICE ID DESCRIPTION
-------- ----------------------------
304 ROUGH ELECTRICAL
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333• building aacupertino.org
MEP
M1 SC
l �
❑ PLUMBING ❑ MECHANICAL ELECTRICAL [-]MISCELLANEOUS I(/05C
PROJECT ADDRESS10-760 , f D 1„ � o ki A- /
APN l� —1
OWNERNAME Dave, �% o -Y ^
1�
PHONE 0�_29S— D4
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
❑CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME3a/l n
LICENSE to
LICENSE TYPE _ I D BUS. LIC tk
COMPANYNAME!�� � �,n-C
EMA11�`1errUr'// e�, L FAX
STREET ADDRESS ZrS �
A
CITY. STATE, ZIP ��h {�j� re C� fj�/ PHONE,j ,2> -OW �+
UVJ K J /
ARCHITECT/ENGINEER NA VIE
LICENSE NUMBER BUS. LIIC�k
COMPANY NAME
E-MAIL FAX
STREET ADDRESS
CITY, STATE, ZIP PHONE
'JSE OF SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ CoIIImercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK
� \✓ #npM ih
(vu t cirovnd ,� iS�
!;�A 6 Panyj r ✓1 at -a
l Y12t✓ //0 llGi �Lk� �� C)c.-r�-
TOTAL VALUATION:
�
RECEIYtEi�BVia
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 behalf. I have read this
application and the information I have provided is correct. 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:--ji—
SUE41LENENTAL44NFORMATION
PLOT PL":s
CUCYED BY
PLANNING DEPT
REQUIRED
_ AMR M
*#ATE
n t.'
MEPMiscApp_2011.doc revised 03/16/11
.--- CITY OF CUPERTINO
FF,F FSTIMATOR — BUILDING DIVISION
im"ADDRESS:
10760 johnson ave.
DATE: 05/04/2011
REVIEWED BY: bobs.
UNITS
APN:
BP#:
"VALUATION: 1$8,600
PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
Amps
PENTAMATION 1 REAP3
PERMIT TYPE:
WORK
upgrade to 200 ams new subpanel at garage location add 5 new 110 volt circuits round exisitn
SCOPE
electrical system, add brach circuit for temp pool, per 2010 CEC.
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Services
1ERT2001K
201
Amps
$63
Conductors
1BREMMISC
$0.00
2
#
$252
PME Unit Fee:
$315.00
PME Permit Fee:
$42.00
TOTALS:
$315.00
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 17hrs $42.00
NnT)7- Thoco fooc aro hncod nn tho nroliminary infnrmadnn availahle and are nnly nn estimate_ Cnntart the Dent for addn'1 info.
FEE ITEMS (fee Resolution 09-051 1st'. '%1.-10
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$315.00
PME Permit Fee:
$42.00
Work Without Permit? 0 Yes No
$0.00
Travel Documentation Fee: ITRA VDOC
$42.00
Strong Motion Fee:
IBSEISMICR
$0.86
0.5 hrs
$39.00 ]ADMIN
Admin./Clerical tee
1 5
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$400.861
$39.00
TOTAL FEE: 1
$439.86
Revised: 04/29/2011
CUPERTINO
PROJECT DATA - RESIDENTIAL
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingCDcugertino.org
PROJECT ADDRESS 10-760 � 14 h 5 0ft, AV APN #
OWNER NAME PHONI�ft - E-MAIL
STREET ADDRESS 4rh� CITY, STATE, ZIP FAX
APPLICANT NAMEP N E-MAIL
ee
STREET ADDRES F / / » t CITY, S•PAci�� CA ,9
:7z- � FAX
91 1
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEvELOPER ❑ TENANT
EXISTING USE(S): 5,=PROPOSED USE(S):
OCCUPANCY(S): TYPE OF PARCEL
CONSTRUCTION: AREA:
FIRE Y N WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N
SPRINKLERS:
Existing
Proposed
Floor Area: First Floor: s.f. s.f.
Second Floor: s.f. s.f.
Garage s.f i
TOTAL: S.f. S.f.
Are there at least two 10 feet by 20 feet clear spaces inside the garage?
Is privacy protection planting required for the project?
Governing Codes: 2010 California Building Code (based on the 2009 International Building Code)
2010 California Residential Code (based on the 2009 International Residential Code)
2010 California Plumbing Code (based on the 2009 Uniform Plumbing Code)
2010 California Mechanical Code (based on the 2009 Uniform Mechanical Code)
2010 California Electrical Code (based on the 2009 International Electrical Code)
2010 California Energy Code
2010 California Green Building Standards Code
Cupertino Municipal Code
ProjectData-Residential.doc revised 03/09/11
Intelligent EV solutions
bink
Federal Communications Commission (FCC) Statement
NOTE: This equipment has been tested and found to comply with the limits for a Class B digital
device, pursuant to Part 15 of the FCC Rules. These limits are designed to provide reasonable
protection against harmful interference in a residential installation. This equipment generates, uses
and can radiate radio frequency energy, and if not installed and used in accordance with these
instructions, may cause harmful interference to radio communications. If this equipment does
cause harmful interference to radio or television reception, which can be determined by turning
the equipment off and on, the user is encouraged to try to correct the interference by one or more
of the following measures:
• Reorient or relocate the antenna.
• Increase the separation between the equipment and the receiver.
• Connect the equipment to an outlet on a circuit different from that to which the receiver is
connected.
• Consult the dealer or an experienced radio/TV technician for help.
This device complies with Part 15 of the FCC Rules. Operation is subject to the following
conditions:
1. This device may not cause harmful interference, and
2. This device must accept any interference received, including interference that may cause
undesired operation.
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Guidelines and specifications
bink
This Installation Manual describes how to properly install Blink Model WE-30C/K and WE-48C/K
Electric Vehicle Supply Equipment (EVSE), referred to as the "charger" throughout this document.
Applicable codes and standards
The installer or contractor is responsible for obtaining and becoming familiar with the following
publications. Installer or contractor work and materials shall comply with the local municipality's
currently adopted versions of:
• National Electric Code
• Municipal, county and state building codes and standards
• Occupational Safety and Health Administration (OSHA)
• Uniform Building Code
• Other relevant codes and standards that apply to the installation of structural components
and electrical equipment
Installer/contractor notes
The installer or contractor selected to install the blink Model WE-30C/K and WE-48C/K
chargers, including electrical connections, shall conform to the following general notes:
• Installation shall be performed as described in the electrical plans and approved
drawings.
• All work shall comply with the latest adopted edition of the National Electric Code and
Building Code.
• Labor and materials not specifically described, which are incidental to installations and
without which a satisfactory job cannot reasonably be completed, are a part of this
installation work.
• All materials used in the installation shall be new and UL listed and labeled where
required.
• The installation of AC power circuits and circuit disconnects are not included in this work.
Such work must be performed by a certified electrical contractor.
• It shall be the installer's or contractor's responsibility to carefully read this entire guide and
associated drawings and sketches to determine his/her responsibilities. Failure to do so
shall not release the installer or contractor from doing the work in complete accordance
with this document.
IM0001 L2 R WMv1.1 6
Intelligent EV solutions
• During performance of the work and after all requirements of this installation manual and
associated details are fully completed, ECOtality NA and/or the customer shall have the
option to inspect the work.
• The installer or contractor shall not modify or otherwise alter charging equipment other
than specifically authorized by these installation instructions. Unauthorized modification to
the charging equipment will void the manufacturer's warranty.
Customer responsibility
The customer is responsible for contracting with a certified electrical contractor to perform all
electrical work, including connections at the charger, supply circuit and main service panel.
Tools required for installation
Meters
• Current Clamp Meter (with 600 A MAX AC/DC) (Recommend: Fluke° 336)
• Digital Multimeter (1000V MAX DC/AC) (Recommend: Fluke° 87V)
Hand tools
• Drill bit, 3/16 inch
• Hammer
• Pencil/marker
• Slotted and TORX°-head screwdrivers
• Wrench, 10 mm
• Torque wrench (reference)
Installer -supplied items
• Service wiring to charger
• Conduit and fittings (1 -inch trade size), except for cord -connected units
Charger features and specifications
Features
• Charge circuit interruption device (CCID20)
• Ground monitoring circuit
• Nuisance -tripping avoidance and auto re -closure
• Cold load pickup (randomized auto -restart following power outage)
• Certified energy and demand metering
IM0001 L2 R WMv 1.1 7
Intelligent EV solutions
• Wireless IEEE 802.11 g
• LAN capable
• Web -based bi-directional data flow
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• Cord management system
• Power cord for connection to NEMA 6-50R receptacle (WE -30K and WE -48K only)
Specifications
Model
WE-30C/K
I - WE-48C/K
Input Voltage
208-240 VAC +/-10% (120 VAC to GND)
Input Phase
Single (3 -wire)
Frequency
60 Hz
Input Current
30 Amps (maximum);
configurable to 12A, 16A, or 24A
48 Amps (maximum);
configurable to 12A, 16A, 24A, or 30A
Breaker Size
40 Amps; Available settings:
15A, 20A, 30A, or 40A
48 Amps; Available settings:
15A, 20A, 30A, 40A, or 60A
Output Voltage
208-240 VAC +/-10%
Output Phase
Single
Pilot
SAEJ1772TMcom liant
Connector/Cable
SAE J1772TM compliant; UL -rated at 30A maximum
Cord Length (output)
18 feet (approximate)
Cord Length (input)
1 foot (WE -30K and WE -48K only)
Exterior Dimensions
Charger assembly: 18" wide x 22" high x 5-9/16" deep
Cord reel: 18" diameter
Temperature Rating
-22 °F (-30 °C) to +122 °F (+50 °C)
Enclosure
NEMA type 31Z sun- and heat -resistant
Mounting
Wall mount
IM0001 L2 R WMv 1.1 8
Intelligent EV solutions
Charger layout
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The charger assembly should be mounted on the wall in close proximity to the vehicle stall and at
a location where the 18 -foot charger cord can be easily connected to the vehicle charging port
without the cord stretching taut or presenting a trip hazard.
The charger assembly must be mounted at a height (minimum 18 inches [460 mm] above floor)
where the panel display can be easily seen and monitored by the operator. A height of 60 inches
(152 cm) to the center of the display is suggested. The cord reel can be mounted below or in
another location near the charger assembly that best accommodates the user's preferences and
comfort. The charger assembly and cord reel may be installed on adjacent walls (corner
mounted). For cord -connected chargers (models WE -30K and WE -48K), there must be sufficient
space allowed between the charger assembly and mounting of the cord reel for installation of the
6-50R receptacle.
® WARNING: RISK OF FIRE
This equipment has arcing or sparking parts that must not be exposed to flammable
vapors. This equipment must be located at least 18 inches (460 mm) above the floor.
Figure 1 — Charger installations/ iypicai
IM0001 _L2_R_WMv 1.1 9
Intelligent EV solutions
Installation
bink
® WARNING: RISK OF FIRE
To reduce the risk of fire, install charger on a wall constructed of a material resistant to
combustion such as plasterboard (drywall) over studs, 16 inches on center.
The charger kit supports installation of the charger assembly over a wood -framed wall (studs on
16 -inch centers) with or without plasterboard (drywall) covering. If the assembly is to be installed
on a brick or concrete wall, anchors (not supplied) of an appropriate size suitable for the 1/4 -
inch lag screws and wall material must be used.
WARNING: Suitable wall anchors (not supplied) for brick or concrete walls must
withstand a pull-out force of 80 lb (36 kg) per anchor, without damaging the wall
mounting.
Shipping box contents
1. Cord reel 4. Charger housing assembly (with 18 -foot
2. Cord reel cover charger cord)
3. Cord reel cleat 5. Hardware packet
Figure 2 — Shipping Box Contents
IM0001 L2 R WMv 1.1 10
Intelligent EV solutions
Charger housing assembly and cord reel
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Figure 4 — Charger Housing Assembly and Cord Reel
Item #
Part Number
Description
CRY
1
11-357-0277
Torx-head screw (T30)
2
2
20-030-0001
Bezel
1
3
11-356-0273
M6 x 20 hex -head bolt
8
4
20-180-0001
Charger housing cover
1
5
11-031-0564
1/4 -inch lag screw
8
6
11-452-0163
1/4 -inch washer
8
7
20-180-0001
Charger unit and base
1
IM0001 L2 R WMv 1.1 12
Intelligent EV solutions
1 1
1.4 WALL STUDS— 0
1 I
I
- -----
--
f-J
- - - - - -
--
MARK
HOLES
(4 LOCATIONS)
22"
a
a
64" TO FLOOR
RECOMMENDED
i
I
I
NEMA 6-50R
I
I
I
MOUNTED INA
1
5S DEEP BOX
1
(METAL ONLY),
I
CENTERED ON
I
I
STUD
Figure 5 — Charger Assembly Installation
6. Using the housing assembly as a template, mark the centers of the four mounting holes and
remove the housing assembly from the wall.
IM0001 L2 R WMv1.1 14
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: /0760 044 Y
PERMIT # S
OWNER'S NAME: ay Rowe_
PHONE #
GENERAL CONTRACTOR: Zreremi Yee
BUSINESS LICENSE #
ADDRESS: Z S
CITY/ZIPCODE: czh TD SI
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
gnature Date
Please check applicable subcontractors and complete the following information:
Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Contractor Signature
Date