13040191 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10111 CRESCENT CT CONTRACTOR:SOLARCITY PERMIT NO:13040191
OWNER'S NAME: YAN MA 3055 CLEARVIEW WAY DATE ISSUED:04/29/2013
OWNER'S PHONE: 4082427635 SAN MATEO,CA 94402 PHONE NO:(650)638-1028
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALEI
License Class li.� Lic.# 1 q INSTALL(N)EV CHARGING STATION IN GARAGE
Contractor Date TYi 1�l
I hereby affirm that I am licens d 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.' Sq.Ft Floor Area: Valuation:$750
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 APN Number:32617058.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter rlS�TALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save 180
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of Date-
granting
"f Z
granting of this permit. Additionally,the applicant understands and will c ply y'
with all non-point source regulati s per the Cupertino Municipal Code,Section
9.18. .
RE-ROOFS:
Signatu e Date Lq . 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.
❑ OWNER-BUILDER DECLARATION Date:
Signature of Applicant:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(See.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit.hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect* 25505,25533, d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date• I Rp
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 CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all cityand 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �\
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building a(lcupertino.Org
PROJECT ADDRESS /.
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OWNER NAME E-MAIL
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STREET ADt S 1 J CI�YvSTATE, I /� A( /� 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 NAMEpw lI v 4 LICENSE NUMBER i e� LICENSE TYPE BUS.LIC#Z 6�Q
COMPANY NAME So/�r /,• E MAI 1w /acv. , / FAX D O
STR,AtDD SS (�`. ' �w C ,SSTT(TE,ZIP ( � �n NE6 - 09 I
ARCHITECT/ENGINEER NAME LICENSE NUMBER `7 V BUS.LIC N
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO
❑SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR,SOfAR PANE/S: NUMBER OF PANELS/UNITS: k KILOWATTS: TOTAL VALUATION. . 00
DESCRIPTION OF WORK
100A_
0 C
By my signature below,I certify to each of the following: I am the property owner or authorized agent t on the property owner's alf. I have read this
application and the information I have pr ided is correct I have re he Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b I i g construction. I a representatives of Cupertino to enter the above-iiddeentifieeddpproperty for inspection purposes.
Signature of ApplicanUAgent: Date: 7l - 4i 1L 13
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
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PVApp_2012.doc revised 06/20/12
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10111 CRESCENT CT DATE: 04/29/2013 REVIEWED BY: MELISSA
APN: 326 17 058 BP#: *VALUATION: $750
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION SOLAR-RES
USE: SFD or Duplex PERMIT TYPE: A
WORK INSTALL N EV CHARGING STATION IN GARAGE
SCOPE
TX
ARAI
tech.flan Check Phstzrb.Plan Check Elec.Plan(,,heck
Fled, Perirrit Fee: Plumb.Permit Fee: Elec, Permit Fee:
OXher Alech.Irish. Other Plumb Insp. Ocher Elec.Insp,
Alech.Imp,Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
EiLl
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These ees are based on the relimina information available and are onl an estimate. Contact the Dept or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 L J # Alternative Energy System
Suppl.PC Fee: � Reg. ® OT 0.0 �S $0.00 $102.00 1CHRGSTA EV Charging Station
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Feer Reg. Q OT [0-01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tex:
Adininistrative.Fe€:: ®
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$1.501 $102.00 $103.50
Revised: 04/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: j�// GY2 ert ur�I' PERMIT#
OWNER'S NAME: PHONE# 9Ai/t9 650: 678 - l$RS
GENERAL CONTRACTOR: p BUSINESS LICENSE
ADDRESS: CITY/ZIPCODE- b
*Our municipal code requires al businesses working in the city to have a City of-Cupertino busi ess license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS. HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
V9`t�
Signature Date
Please check applicable subcontractors and complete the following information:
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
Owner/Contractor Signature Date
'7niT
DFPARTM ENT N
CUPE-R-1 iNO
hi-
7 aind NAIUST be kept at the W E
n. is,u n 1 a to i -0 any
Fr1e; or 110 devia.
or Oil e
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Wi'l;ou"
'j-,"S P!�Iil F,ild S (.—ificadons SHALL NOT
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of I&I'a vida'Jon
Of ariy rr, nanceor Staito Law.
N) Tesla HPWC
D'
PERMIT NO. For Electric Vehicle Charging
Height Between
No Ventilation Required
PLOT PLANS
CMCKW 13Y
E) 200A Main Panel
MC� O
NG DV :3
NG DEPT. F I
kTE
2) #3 AWG THHN-2
rF (1 ) #8 AWG THHN-2
CUPERFINO 1" EMT-31
Buildingrtnent
' OFFICE ("'h;OPI RBCET %7Fy
ArK 2 9 2013 APR 2 9 2013
REVIEWED FOR CODE COMPLIANCE Cupertino 13Y:-,---
Reviewed By:
CONI'IDENIAL-THE IWORMA71ON HMEINAR PROME ONM 111.01
CONTAINED WALL NOT BE USED FOR M JB-9501399 Cupertino Yan Ma 2
BENEFIT OF ANYONE EXCEPT SOLARCITY INC.. yAplEg MAIN PANEL SOW RAM
NOR WILL IT BE DISCLOSED IN WE OR IN 10111 Crescent Court SolarCit
PMT TO OHM W1W.THE RECIPIENTS a EV Charger 200 Cupertino,Ca,95014 y
ORGANIZATION,EXCEPT IN CONNECTION%MTH PICT 1"AGIR MW VOLTAGE/AMPERAGE:
THE SALE AND USE OF THE RESPECTIVE Colin Fl 240V 100A (408)242-7635 3055 Clearview Way
SOLARCITY EQUIPMENT.WITHOUT THE WRITTEN ORMIR.: Gmm: San Mateo,CA,94402
PMSSION OF SOLARCITY INC. I Hadi Rismonchi HPWC 100A jma@translucence.com (888)-SOL-CrrY V65-2489) wwwsolarcity.cm
NEC 220.83 -Adding a Circuit to an Existing Dwelling Unit
Square Feet: 4.000 Panel Breaker Rating: 200 A LVL2 240 Vac
NEC 220.83(A)(1) "General lighting and general use receptacles ... @ 3 volt/amperes per square foot as
determined by 220.12"
4,000 square feet x 3w/sq ft 12,000 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 9.600 VA
Microwave 1.760 VA
11,360 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 1.760 VA
m VA
ti m �! Washer 1.760 VA
`D
< (, �`r f � Dryer 5.760 VA
�.,,. ..W�;
* 0 VA
a TJ VA
X VA
n VA
O ^' 0 VA
0 - VA
0 c= VA
p M EVSE 1: 0 VA
D AJ EVSE 2: HPWC 100A 19,200 VA
32,320 total VA
r Total of non air-conditioning loads: 61,680 total VA
First 8kVA of load at 100% 8,000 VA
Remainder of load at 40% 21,472 VA
Adjusted total of non air-conditioning load 29,472 VA
NEC 220.83(8) "Where additional air-conditioning equipment or electric space-heating equipment is to be
installed..."
A/C Equipment Unit#1 and 2 13.440 VA
A/C Equipment Unit#3 VA
Total of A/C Loads and All Other Loads: 42,912 total VA
Total Proposed Calculated Load: 178.80 Amps
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JB - Ma Yanpool
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O copyright SolarCity 2008
SolarCity.
SPECIFICATIONS
•
The maximum rating for the High Power Wall Connector is 20 kW or 80 amps at 240 volts.Your vehicle will charge from 200 to 240 volts.
LLJ
120V ABOVE GROUND(common in North America) 230V ABOVE GROUND(common in Europe,Asia,and Australia)
•
240V AC single-phase:L1,L2,and safety ground 230V AC single-phase:LINE,NEUTRAL,and EARTH.
Voltage and Wiring 208V AC 3-phase,wye-connected:Any 2 phases,and safety ground.
240V AC 3-phase,delta-connected:With center tap on one leg,use only the
two phases on either side of the center tap.The two phases must both measure
L 120V AC to ground.Do not use the third leg(208V"stinger").
LLJ
Maximum 100A Circuit Breaker. Maximum 100A Circuit Breaker.
• Current The maximum current for charging the vehicle is 80A or 20 kW. The maximum current for charging the vehicle is 80A or 20 kW.
At 240V,this will be 19 kW maximum. At 230V,this will be 18 kW maximum.
Frequency 60 Hz 50-60 Hz
Cable Length Approximately 25'(76 m)
Height:15"(382 mm)
Bracket Dimensions Width:6.22"(158.2 mm)
Depth:3.7"(96 mm)
Weight(including bracket) 20 lbs(9 kg)
QperatingTemperature -22°F to 113°F
-30°C to 45°C
•
-5
Storage Temperature
� -500°' to 185°F
C to 85°C
Enclosure Rating Type 3R IP 44
i Agency Approvals UL,FCC Part 15 EN,IEC
I
CUP ERrirva
l ;tJ %3uilding QPI,a
.,�. . rtmem t
APR 2 9 2013
�EVIEWED FOR CODE COMPLIANCE
Reviewed By