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10120072 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18477 EDMINTON DR CONTRACTOR: I PERMIT NO: 10120072 OWNER'S NAME: MADHAV MARATHE A-1 ec & f DATE ISSUED: 12/13/2010 OWNER'S PHONE: 4088650220 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r- BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class G-`• d Lic.# l3 {cJ�o{v MECH RESIDENTIAL COMMERCIAL Contractor --k ate kZ \3 ko b I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL 40AMP 240 VOLT(2)#8&(1)#10 GROUND (commencing with Section 7000)of Division 3 of the Business&Professions CIRCUIT FOR ELECTRICAL VEHICLE 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 Sq.Ft Floor Area: Valuation:$750 permit is issued. APPLICANT CERTIFICATION APN Number:37522068.00 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 acc - • • • City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this pe. T. Add' '. ally,the applicant 'derstands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point:.urce regulations .er the Cupertin, Municipal Code,Section ! 9.18. ,` `_'-"'•_—.. Date: 721-6; Signatu � Date> Z-(13/2•6 1-0 Issued by: - � 0 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 I,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)sh or handle hazardous material. Additionally,should I us• •.uipment or devices ich emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quail y 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 Municipa Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&SCode, ecti s 25505,25533,an. 5534. 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 Owner•. •au or' 'd _ t: forthwith comply with such provisions or this permit shall be deemed revoked. i ate: Z/f 3/ D Q CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 representatives of 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 Building Department City Of Cupertino 10300 Torre Avenue 4.. .s Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 16,4 7 7 Eov►1 t r\- -ez, h I( PERMIT# /o12..O(.77 2---- OWNER'S NAME: jyt q.Al/kav Mckr cti't PHONE# U(5 S7 3 5'5 Z-- GENERAL GENERAL CONTRACTOR: A -i E. 4, c A BUSINESS LICENSE# _ ADDRESS: isi9 ire„. ST4z5x. S'- c Pc- `i 41/ o 5 CITY/ZIPCODE: 5 cA-- 5 4 (6 1 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUP•. CY INS' ION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S ArONT'.- TORS HAVE OBTA NED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: �/ (/3 Z o / Signature Date Please check applicable subcontractors and complete the following information: V 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 ,4, /z `1/ ai U Owner/Contractor Signature / to D CITY OF CUPERTINO 5 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN • 37522068 . 00 DATE ISSUED • 12/13/2010 RECEIPT # • BS000012220 REFERENCE ID # . . . : 10120072 SITE ADDRESS • 18477 EDMINTON DR SUBDIVISION CITY • CUPERTINO IMPACT AREA OWNER • MADHAV MARATHE ADDRESS • 18477 EDMINTON CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM • ROBERT F WHITEAKER 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 1BCBSC VALUATION 750 . 00 1 .00 0 . 00 1. 00 0 . 00 1BREMMISC EACH 1 . 00 126 . 00 0 . 00 126 . 00 0 .00 1BSEISMICR VALUATION 750. 00 0 .50 0. 00 0 .50 0 . 00 lEPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0 .00 TOTAL PERMIT : 211.50 0 .00 211.50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO ti4 � FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 18477 edminton dr. DATE: 12/13/2010 REVIEWED BY: bob s. APN: BP#: *VALUATION: $2,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY i ! ,' PENTAMATION SFD or Duplex 1REAP7 USE: t,' PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Apparatus 1BREMMISC 1 # $126 TOTALS: $126.00 t, ;„=r; I Elec.Plan Check 0.0 hrs $0.00 <. Elec.Permit Fee: IEPERMIT tf,;,�; Other Elec.Insp. 17,71 hrs $42.00 NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 09-051 EY.. 7%I/10) FEE QTY/FEE MISC ITEMS Man (lhe,A /tt': /.L A PME Plan Check: $0.00 Mimi( Suppl PME Unit Fee: $126.00 PME Permit Fee: $42.00 ,,n,rrtrcri,,r 11.1 OP,/Is R Work Without Permit? 0 Yes 0 No $0.00 Planning Travel Documentation Fee: 1TRAVDOC $42.00 4 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 12/07/2010 Electric Vehicle Supply Equipment Model RS Installation and Service Manual Charging Dock Specifications Line input power: 208 -240V AC single-phase, 60 Hz Output power: 30A at 240V, approximately 7200 Watts Circuit breaker rating:40 Amp DO NOT use a Class A circuit breaker with the EVSE-RS Charging Dock. Power draw at idle: < 5 watts Weight (with 15 ft.cable): 10.1 lbs (4.7 kg) Weight (with 25 ft cable): 13.1 lbs (5.94 kg) Operating Temperature Range: -30C to+50C Storage &Transportation Temperature Range:-40C to+ 60C Environmental rating: NEMA 3, IP56 APPF>(,','G IN ACCT ORI)ANCI ... .,u CITY C / 4 , c, 6 I IN i i'. �../ SIGN r.!, This set of plan -ml : ifica ms MUST I--ptont / i• a tin •'� and itis is rniawt ti hi, an hinges or •ns }c ,,,un with•ut written permission from the Nodding Department, City of Cupertino The=s',ump!ng of this plan and specifications ,,,n:; NO1 PP held to aermit or to be a, approval of trio S,,C,I >n ` '',v provisions C" , ©2010 AeroVironment,Inc. AV Proprietary.Use,duplication or disclosure of data contained on this page is subject to the restrictions which appear opposite the title page of this manual. Page 63 17314-76_2 FWA.E336193 -Electric Vehicle Supply Equipment http://database.ul.com/cgi-bin/XYV/template/LISEXT/1FRAME/showpag... (Ta ONLINE CERTIFICATIONS DIRECTORY FFWA.E336193 Electric Vehicle Supply Equipment page Bottom Electric Vehicle Supply Equipment See General Information for Electric Vehicle Supply Equipment E336193 AEROVIRONMENT INC 1610 S MAGNOLIA MONROVIA,CA 91016 USA EV charging station,Model EVSE-RS. Last Undated on 2010-09-07 Questions? Print this page Notice of Disclaimer Page Too Copyright n 2010 Underwriters Laboratories Inc® The appearance of a company's name or product in this database does not in itself assure that products so identified have been manufactured under UL's Follow-Up Service.Only those products bearing the UL Mark should be considered to be Listed and covered under UL's Follow-Up Service.Always look for the Mark on the product. UL permits the reproduction of the material contained in the Online Certification Directory subject to the following conditions: 1.The Guide Information,Designs and/or Listings(files) must be presented In their entirety and in a non-misleading manner,without any manipulation of the data (or drawings).2.The statement"Reprinted from the Online Certifications Directory with permission from mnoUndice n wri rita slow rs oratomat ries c. must appear adjacent to the extracted material.In addition,the reprinted material must include a copyright 2010 Underwriters Laboratories Inc.®" An independent organization working for a safer world with integrity. precision and knowledge. 10/26/2010 12:05 PM 1ofl AeroVironmentTM Municipality Primer Why AeroVironment? AeroVironment(AV)has been charging industrial vehicles for over a decade. We have the experience. We have the products. And we have a trained and certified support network to service your project. The Product:Home Charging Dock EVSE-RS-Our EVSE safely delivers AC power to electric vehicles and includes several important safety and performance features. • Underwriters Laboratory(UL)listed • NEC 2008—Article 625 Compliant • Breakaway safety cable • Built in Ground Fault Interruption • Convenient cable stowage • Auto shut off in the event of a power surge • SAE J1772 compliant connector(North American standard) Service Tool-We developed a service tool that allows only our certified installers to test our charging stations without having an electric vehicle present. The service tool simulates connectivity with the EV onboard battery charger.The installer has the ability to test the EVSE so we can confirm all charging stations have been field-tested and safe to use. Limited Warranty—With AV's Installation Services • Simulate EV by drawing full load • Tests faults to insure unit is functioning as designed • Performs diagnostics to determine fault sources ,.. Service Our expanding network of certified installers is comprised of licensed,independent electrical contractors and quality assurance professionals who make your installation and ongoing NI,„ > support their first priority. • Installation Network is managed by Licensed Electricians • Local contractors with local code&permitting knowledge • Trained and certified to install our equipment k • Trained and certified to use our service tool • Fast response time to your requests using our proprietary CRM system Installation Network „� 4=1� • Hardware and installation coverage • 3 year limited warranty on parts and labor • Replacement units(if required) • Call Center support • Committed to deliver service within one business day • First Time On-site resolution No other charging station manufacturer can offer AV's combination of advanced product, extensive installation and service network, and complete customer care. AeroVironment,Inc. 181 W. Huntington Dr.,Suite 202,Monrovia,CA 91016 AU'p)626 357 9980 1)626.358.1691 ronrnenf '02010 AeroVironment,Inc AeroVironment'" EV Solutions'" ELECTRIC VEHICLE HOME CHARGING DOCK TURNING HOME GARAGES INTO FILLING STATIONS OF THE FUTURE MODEL EVSE-RS AV The EVSE-RS Home Charging Dock charges all SAE J1772-compliant i vehicles-including both electric FEATURES vehicle(EV)and plug-in hybrid ',( PHEV)models-in the convenience • SAE J1772 compliant of the home garage,workplace, • Auto restart`in event~_of polder ot,rtage or condominium,apartment,or retail ground fault parking structure.The Home Charging • Arrtericanswith prsablllties. et OD i Dock safely and reliably delivers compliant instal)atio k . AC power to the vehicle's on board • Integrated cable stowage,optional- ., charger and features a weather- cable management_: resistant NEMA 4 enclosure for indoor • Underwriters Laboratory(L14 listed and outdoor installations. Pre-production image shown. • Breakaway safety cable '' Production model may vary. • • Optional pedestattr O,Ptit '1 w:- • The Home Charging Dock is installed by one of our independent certified • Wireless cor munication o tLl ftI^ 1 licensed electricians who also facilitate necessary permitting and inspection, and provide information about EVSE-RS use to the customer.An optional SERVICE AND INSTALLATION- module is used to enable WiFi,Zigbee,or cellular communication. Will be supported by • Expanding network of independent ,i certified,trainedelecti'ician5* INTUITIVE USER INTERFACE - r. :s;.aN r ;-• GREEN=utility voltage connected • Convenient home site assessments' A . GREEN=ready to operate and installation; ,.:_,u:r TO C'.i:17GE • s • GREEN BUNKING="off*state due to a manual STOP • Electricians with depth of local code and::- - .E1.IcaE ca'11, T`EL GREEN=connected to vehicle permittingknowledger cu, ,;, • GREEN=vehicle is charging(fast blinking=high charge when battery is low,slow blinking=charge near complete) tin,,1,L F ` • REO=error has occurred;blinking pattern based on fault type 'Installation services available in certain areas;contact AV for additional information. a,,r��Vu r in n1 CV Lulu'iu• 181 W I lun•r-1to^Di,Sure:O2,M_,n' i..i,CA ViV16 �� ©2010AeroVimnmen1,Inc . F 5°N. li3.'118 f 6.'63�176:�5 �;�virr nmi�e' ,i'iv�-s +i^• ci� 1010_10147 EVSE-RS SPECIFICATION EVSE-RS Connector SAE J1772 Voltage 208VAC to 240VAC Frequency 50Hz/60Hz Current 30A max Operating Temperature -30°C to 50°C Storage/Transit Temperature -40°C to 60°C Humidity Up to 95%non-condensing Dimensions 12"x 12" x 8" (approximate) Weight 10 lbs.(excl.cable) Cord Length Up to 25'available Enclosure NEMA 4 Regulatory Compliance UL listed,CSA and CE pending Information and speoficanons subject to change a :Vr- n, n� �✓ :Iiti 1'd1 / Iluriu �' G n'ci(I7 flr ii (�A`)101( �� 02010 AeroV ironment.Inc 1010_10147 irillUilir EVSE- RS Installationr Gulu„,,,,,,,,,,,,,...„,,,,,,,,,,„:„,„,,,,,„1 '="114,37.1114tilf°,1irli,4')-51,,1.1:::1,i.,.,1,,,,,., and U .,,...,,,,,..„,,,,,,, ,. ...gym' QAvY © 2010 AeroVironment, Inc. All rights reserved INSTALLING THE EVSE-RS Basic Specifications: ■For use with Electric Vehicles ■Ventilation not required ■Rain tight Number of Freq Hz Voltage AC Current Operating Phases Amps Temp C 'ititt4Z4v 0-t +50 Power Disconnect switch Charging Dock distribution (if applicable) panel Wall stud iT 40 ,/ rM 1 a3 tg 1 . Choose wire entry location HOLE IN REAR OF CHARGING DOCK HOLE ON UNDERSIDE OF CHARGING DOCK 1 7.1.1.:477:40-!'` ,• 4,c-f--1:;,,:4_i'71--.:--;,;:,;.,1: l'.0 �� It �\ \, a s I f / -)s- }i�� �`\ i s V 1 ill .'. 4, . `'1'• / .�1 i�/ , 4 1 i Bottom View Rear View 2. Attach the mounting plate Mounting plate ,,,,, 0 o O• Large hole for conduit utility wires ' a •• Small holes for Charging Dock mounting holes mounting plate to wan stud Wall stud Q Flat washer Lag bolt O0(:I:f)• 48' © i 0 Wall stud V ,N� 4 ' A d 3. Attach the Charging Dock to the mounting plate Upper mounting hole Flat washer Socket head screw C1 -------. 0 amp Iht, ., ,...... o O Al IO 4. Wire the Charging Dock a.. / .t k�. Terminal Block Ground Strip Ground Wiref0�\ / � Two power wires a a i 0! 2", rrrw :s1 I, 5 5. Install the front cover #10 Torx screws- Torque 1 2in/lb 1 1 , ', 11 ( ' ......„,,..„,,,,. ........_ _____ Removing the trim ring t.t: ...,... .....,. . ft , , . . . .. , Amottai hokt au.,op 6. Complete the installation (----„, re li ‘ . . ,..,.. ,, , ( p 11 , 4... , .... , I t.,_,V::;;:i-Jii..) 4 FRONT PANEL COMPONENTS POWER PRESENT _ / ,, The charging dDA i<_receiving 7 AC pcvrer. _ START \\\\ Prays to begin a charge.The READY TO CHARGE PCWERPRESEN7 o O S ' RT POWER PRESENT and READY The charging dock is ready to 1 r TO CHARGE lights must be charge or charging is paused. I REI�DY7DCStA1ME 0 VEHICLE CONNECTED 0 i I 1 , O VEHICLE o ST* P I TROUBLE 0 L STOP The nC for Ic ro OI - Press is manually stop charging. The connector is properlyi The devices will stop autarnati:allp o nn6cc�d to the vehicle port then it reaches full charge. or the charge is camFl,te VEHICLE CHARGING Tha vehide is being charged. TROUBLE --- There is an error. Try removing the corwador and inserting back into the.vehicle.If Trouble Indicator is still illuminated call \ Customer Service at 1(877)NO �— GASEV or 1 (877)664-2738 or RELEASE BUTTON visit'..Customer Service on the — Pra�ssleoreleasetheC nn=ctc>r ,web at r:a.v;.nissarrusa.corn!leat. from the.charging dock or the ,,chide port. 1111.114 yr CHARGING THE VEHICLE r� i 0., ¶::::; Ilir ! i :*: • 0, . ,_.,, „� ' Vii : ,1 1 VEHICLE CONNECTED•• w cseur• •eimr 111,.. '''''' In crtcor.nec1otfrrrrdyu;tothb rrwrroawenro Charging dlt:egin '. ,,..: charge Fort. Lrt}iNn .eae rum«Kna . • autr mat;r tlty.When POI.I jNui hilly inserturd.Ow VEHICLE vergaecr aero 0 charging begins,the �� CONNECTED light on the moms° VEHICLE CHAPGINC;light chargingdo‹,k will illuminate. �l _ 7/ will begin t:,blink Nene in no need to press START. III VEHICLE CHARGING i ' '344,:.,,,,,, lap ,.........• _• O.TMIT Charming will Fiop automani1lly When the VEHICLE • when carrrpl ts, You can manually r ���! CHARGING light stop, stop charging by pressing STOP. ,...„9„ ���'� blinking un thH h �r. When the READY TO CHARGE tt,� f rets the biiitcai .n the light blinks,r rn de ft c�,inne,forihmil�� uttrrt<.t r b n_lr se. from the, hid charge port,If Pull to rerncr:e fr,-rn you have pressed STOP,y_u can ,. hvJo charge}girt. press START to rcYrurno rhargtng. CITY OF CITY OF CUPERTINO 4vSs' �, 9s GENERAL BUILDING CUPERTINO PERMIT APPLICATION FORM APN# z2 �, Date: iZ 1 ( z.c) Building Address: 1 3 '- 77 FYt11 %'\ b ( Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No ifr HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA If Residential is house an Eichler? Yes ❑ No 2111.yes, needs planning approval. Owner's Name: ``, Phone #: 04 �Jl VV"V OA o L}a` -- 0, - o Z Z Ci Contractor: Phone: f\ 4. 1 Fax: Contractor License#: 3.A s 6 G - fo Cupertino Business License#: Contact: Phone: Fax/e-mail: Residential Commercial ❑ Job Description: 1 N 110 A w-f 2 Li-0 (z-) C Ak1a lo04\, cJ Lke_LvcT eFE irk Building Permit Info: Bldg 0 Elect Plumb 0 Mech 0 Type of Construction(Usage Class): Occupancy T e: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Valuation: at „� U o_ Square Footage: �SoU 14- Project Size: Counter 2Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.org Revised 12/06/10