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13070149 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1120 ROLLINGDELL CT CONTRACTOR:DOLLENS ELECTRIC PERMTI'NO: 13070149 CORPORATION OWNER'S NAME: BANERJEE KAUSHIK AND RESHMA TRUSTEE 3591 PINE RIDGE WAY DATE ISSUED:07/24/2013 OWNER'S PHONE: 4086790256 SAN JOSE,CA 95127 PHONE NO:(408)929-6100 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class Lic1.# 0,W? INSTALL EV CHARGING STATION IN GARAGE-6.4 KW Contractor ��� Y:(S ULwS Date 2(4 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$900 ave 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:35934015.00 Occupancy Type: permit is issued.6 0 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 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY OM LAST CALLED INSPECTION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature _Date 7LIV4113 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 e inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 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 1,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(Sec.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,Sections 25505, 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: . Date: I 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 CONSTRUCTION LENDING AGENCY 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 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPEItTINO (408)777-3228•FAX(408)777-3333•building(dcupertino.org \� [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/U ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS I n o APN# 35C3 OWNERNAME Rvstn''�''G �avlG�-� PHONE�OPj b2Slp E"MAII,! STREET ADDRESiS� f Okj, CITY,STATE,ZIP vLafi a��Y� ��o4 FAX CONTACT NAME ` PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUB.DER ❑ OwNERAGENT oNTRACToR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME1/I,L�^ ( I/1,w C LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME 'II.V`J,61 f�otv Jc, ,eVWEMAIL `^n �y �j„� n L�L,n! FAX 4d0 -/�Op-'�/_Cyd STREET ADDRESS •V, � 2/�r j-j CITY,STATE,ZIP V,�K V�(U� �1[� �1��� PHO 3,q-(, ,-U09-26 ARCHITECT/ENGINEER NAME )�J LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ` EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: ElDETACH 0 ATTACH #DWELLINGUNITS: ISASECONDUNrr ❑YES SECONDSTORY OYES ❑ BEING ADDED? NO ADDMON? ❑NO PRE APPLICATION E3 YES IF YES,PROVIDE COPY OF IS THE BLDG AN 0 YES TOT VALUATION- PLANNINGAPPL# ❑NO PLANNING APPROVAL LET`rER EICHLER HOME? 0 NO 1 (.JLC By my signature below,I certify to each of the following: I am the property owner or authorized agent 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 buil ' ons ction. I authorize representatives of Cupertino to enter the above-identifie property for inspection purposes. Signature of Applicant(Agent• Date: 7 SUPPLE TAL INFORMATION REQUIRED r, New SFD or Multifamily dwellings: Apply for demolition permit for ���� rF GVtIrVIr existing building(s). Demolition permit is required prior to issuance of buildinjr permit for new building. ' s - v ;��� � i� �•r�a P �� G k,�AI�T REXIEA� � _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. § ✓ * rf h FIREDEPTfa _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. g xr � z g't �Y �6 - � .c� � �.�<��;�� L�T!ll►1BPITA�G7HEi1ir�'��-° BldgApp 201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1120 Rollingdell ct DATE: 07/24/2013 REVIEWED BY: Mendez APN: I BP#: %VALUATION: $900 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RE USE: PERMIT TYPE: A WORK install evc station in garage, kw 6.4 SCOPE 3} ti heel. Plan Check Plumb.Plan Check F_lec.Plan Check Mech.Permil Fee: Plumb. Permit Fee: Elec.Permit Fee_ L1�1)4t'1111n, ;t9c�ch.Insp, Other Plumb Insp. El--t- 01her Elee.Insp. L�jInsp. Fee: Plumb. bisp.Fee: f lec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These Jeq are based on the prefindna information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7f1 11112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Alternative Energy System Suppl.PC Fee: (E) Reg. 0 OT0.0 hrs $0.00 $106.00 1CHRGSTA EV Charging Station PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction :Tax: Administrative.Fee: 0 Work Without Permit? 0 Yes 0 No $0.00 G) Advanced Planning Fee $0.00 Select a Non-Residential 0 Travel Documentation Fees: Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ` A $1.50 $106.00 _ xr. T _ $107.50 Revised: 07/01/2013 N Y-NT evse rs - charging dock f 40amp-240-volt zz at the Garage ..y I —I I Sub- 'lr I �� ii1jil.ii b�;i ficial. I panel C� 0 F� Ir Main Garage Door -► FbI 125q SFIA!-.L I I 100amp sub-panel �JJ �,�; on I I .i=-ru��ce ut ' to Law. I L1 N L2 G I :) V1140A 40A EV Charging Dock ` 2`i x L i Aerovironment ; ,., ,,, 3?�?a,1-4 q - -- — — — Model EVSE-RS 0 H EMT or FMC Conduit,1/2 in. 8AWG-THWN. ampacity 50A Gnd 10 ga. approx 6ft run SR# 559066 Arm Customer Reshma Banerje. OFF1("";' E COPY 1120 Rollingdell u PLOT P Cu CA 95014 �� Project Date CHECKED BY EV Charging Dock 7/23/1 CUP'ERTINO DATE 7 r L �� Prepared by 7 Building Department — J. Dollens 1 of 1 µ PLANNING JUL 2 4 2013 DATE �llens19lectr1c �I RE=VIEWEC F;;R CODE COMPLIANCE Troubleshooting • Panel Upgrades • Solar Po, Reviewed By: ,� RC. r,D . OFPT k. ,.,. 408-929-6100 • fixmypower.cc J� y`"�' 4 jbw COP ©2011 AeroVironment, Inc. All rights reserved V-4 This guide is a reference for Municipalities inquiring about the use, installation and compliance of the AeroVironment EVSE-RS with the National Electric Code and Local Codes. AeroVironment, Inc. Model EVSE-RS Product and Installation Overview The EVSE-RS is a device which offers a simple and safe way of providing electricity to the on-board charger in an Electric Vehicle. NEC 625 Compliance • 625.2 Definitions. • Personnel Protection System:A system of personnel protection devices and constructional features that when used together provide protection against electric shock of personnel. • 625.5 Listed or Labeled: UL Listed 2594 • 625.9 Electric Vehicle Coupler: J1772 coupler SAE North American standard • 625.13 Electric Vehicle Supply Equipment: Permanently connected and fastened in • Place. No exposed live parts • 625.14 Rating: 30 amp output rating. Continuous load • 625.15 Markings: — (A) For Electric Vehicle Use Only(Denoted on EVSE-RS Label) — (B)Ventilation not required (Denoted on EVSE-RS Label) • 625.16 Means of Coupling: Conductive J1772 connector and EVT rated cable • 625.17 Cable: EVT rated cable extra heavy usage • 625.18 Interlock: Proximity switch de-energizes when unplugged • 625.19 Automatic De-Energization of Cable: Cable break away feature. • 625.21 Over current Protection: Shall be sized for continuous duty 125 %-40A Circuit Breaker • 625.22 Personnel Protection System: Proximity switch, GFI protection, Breakaway cable, Trouble annunciation light for faults and NEMA 3 Rain Tight enclosure. • 625.23 Disconnecting Means: For electric vehicle supply • equipment rated more than 60 amperes or more than 150 • volts to ground,the disconnecting means shall be provided • and installed in a readily accessible location. • 625.25 Loss of Primary Source: Contactor opens upon loss of power. INSTALLING THE EVSE-RS Specifications: ■ For use with Electric Vehicles ■ Ventilation not required ■ NEMA Type 3 Rain Tight enclosure ■40 Amp. circuit breaker rating. Do NOT use a Class A circuit breaker with the EVSE-RS Charging Dock. Power Disconnect switch Charging Dock distribution (if applicable) panel Wall stud r,� 1 . Choose wire entry location HOLE IN REAR OF HOLE ON UNDERSIDE OF CHARGING DOCK CHARGING DOCK t� O 4 o 11 O O Bottom View Rear View 2. Attach the mounting plate Mounting plate a 0 Large hole for conduit utility wires o Small holes for Charging Dock mounting holes mounting plate eto.wallstud O Fiat washer Lag bolt Wall ah,a O O 0- --Ag)------- 0 0.----- ----------------0------- W Wall stud 3. Attach the Charging Dock to the mounting plate a. Torque the screw to 40 in/Ib. Upper mounting hole Flatwasher Socket head screw t - - - -- ------------ 0 - --------- 4. Wire the Charging Dock a. Torque the terminal block screws to 20 in/Ib. b. Torque the Grounding Strip screws to 20 in/Ib. r„ =, Terminal Block Ground Strip r Ground Wire Two power wires -� o A A 5. Install the front cover #10 Torx screws—Torque 12in/Ib ti Removing the trim ring Jyffiwa ao Access hde Ouw ring. 6. Complete the installation 1 tir O O O O 1 ° � i � Q � FRONT PANEL COMPONENTS POWER PRESENT The charging dock is recelvirttj AC pourer. START READTTO CHARGE Press to begin a charge.The The charging dock is ready to PanerPRESEW op POWER PRESENT and READY charge or charging is paused. FEADY10CHARGE O 011 RT TO CHARGE lights must be on. 'VEHICLE CONNECTED 0 VBIQE C 0 3T P VEHICLE CONNECTED STOP The connector is properly Press to manually stop charging. connected to the vehide;port The device will stop automatically or the chargeP is complete. x ' when it reaches full charge. ��� VEHKLE CHARGMIG : The vehicle is being charged ' Y TROUBLE There,is an error. Try removing the connector and inserting back into the vehicle.If Trouble Indicator is still illuminated call Customer Service at 1 W7)NO - GAS EV or 1(877)654-2738 or visit Customer Service on the L RE! E BUTTON web at www.nissanusa.comAeaf. Press to release the Connector from the charging dock or the vehicle port. s in 1 CHARGING THE VEHICLE Ptase the button on the Unwrap the cable from connector to r>atems It around the cable hanger. from the dinging dock VEmcLE Commm v Ineartconnectorfmy Into the ammToa"=a �+ Charging will begin vakb charge port When vaowacrar+semo � autornattcafty.When Uy Inserted,the VEHICLE vx++e crwea o o charging bosuns,the =WECTM light on the ° VEHICLE CHARGING fight charging dock will Affmata. will begin to blink There is no need to press START. VEHICLE CHARGING OST Ob"ng will stop automatically When the VEHICLE tlolr` when complete. You can manually CHARGING light stops stop charging byprassing STOP, blinking on the charger. When the READY TO CHARGE press Hto button on the k of blinks,remove the connector connector to release. from the veNda dharge port.If Pull to remove from you have pressed STOP,you can vehicle charge port. Prose START to resume charging. •