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13090025CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10566 E ESTATES DR CONTRACTOR:B BE PERMIT NO: 13090025 D OWNER'S NAME: STEVENS JERRY W AND SHARON I T �� um Cols4xv / , DATE ISSUED: 09/05/2013 OWNER'S PHONE: 4082523028 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALU $!98 GtI 3 KITCHEN REMODEL 160 SQ FT TO INCLUDE CHANGE License Class_ Lic. # Contractor AftAeA. i.jbNG Date OUT OF WINDOW, PANEL UPGRADE 200 AMP 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. Sq. Ft Floor Area: Valuation: $33000 ftoire and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36925025.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 80 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 DA F OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expen w may accrue against said City in consequence of the , Issued by: Date: granting of thi emut. A ditionally, the applicant understands and will comply with all on- oint source a io r the Cupertino Municipal Code, Section RE- ROOFS: 9.18. 4)(5-1 t Signature Date - 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 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 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 (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. I 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 rea Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the upe ti mcipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S do 255 5, 553 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date 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 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 Iii CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 - 3228• FAX (408) 777 -3333 • buildinga- cupertino.org 0 �017 B bA [:]NEW CONSTRUCTION ❑ ADDFITON RrALTFRATION / TI ❑ REVISION / DEFERRED ORIGINAL PrERMIT # PROJECT ADDRESS 1 M S (o ce e ftT ewhws � V APN # OWNERNAME �J w�rj�J 1�►✓ PHONE ft E -,MAIL STREET ADDRESS ,� �. 4 �- E T CC� FAX CONTACT NAME PHONES► r E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUMDER ❑ OWNER AGENT ErCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER _ ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBS LICENSE TYJS BUS. LIC # COMPANY NAME AIL uTt'2N1 LS &60 !• �D FAX STREET ADDRESS I ...�M..a�i („rT' CITY, ST TE, ZIP41 0,-ro tA cts-A) V^ c PHONE V63 -3 [ jnZO ARCHITECT/ENGINEER NAME v LICENSE NUMBER BUS. LIC#,I COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK e.�nwsz (pp #wp- ?�ln • vV •� ' ruaIINv we I =- I " _ ` " I " ' USE I TYPE I OCC. I SQ.FT. I VALUATION ($) ' EXISTG NEW FLOOR - DEMO - TOTAL AREA AREA AREA NEr AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA 1,f _ JA I REMODEL AREA PORCH AREA I DECK AREA TOTAL UECK/PUXUl A" A A: LJ UG- At,n ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑N0. ADDITION? ONO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF # NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO IE -"? TOTAL VALUATION: PLANNING APPL ❑ . By my signature below, I certify to eUth Wing: I am the property owner or authorized ge to act on the property owner's behalf. I have read this application and the information I havoniol 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 i authorize representatives of Cupertino to enter the abovej enti ed property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO VIM 1 CTTM A rrnR _ RTTTI .TIINf_' DIVIRION LaiADDRESS: 10566 E ESTATES DR DATE: 09/0512013 REVIEWED BY: MENDEZ QTY/FEE APN: BP #: "VALUATION: $33,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex p Suppl. PC Fee: Q Reg. ® OT I PENTAMATION 1 R3SFDREM PERMIT TYPE: USE: $0.00 $626.001 WORK KITCHEN REMODEL 160 SQ FT TO INCLUDE CHANGE OUT OF WINDOW PANEL UPGRADE 200 SCOPE I AMP Mech. Plan Check ,L1ech. Pernnt Fee: I Other Afech. Insp. 1lech. Insp. Fee: Phuub. Plan Check Fpimb. Permit Fee: Other Plumb Insp. Plumb. hrsp. Fee: Elec. Plan Check 0.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 0.0 1 hrs $47.00 Elec. Insp. Fee: NOTE: This estimate does not include fees due to other uepartments (Le. rianning, ruouc LLJL -, U'IL District, etG ). These fiw are based on the prelimina in ormadon available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11 -053 Eff. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Lj§0 J s.f. Remodel, Kitchen (< =300 sf) Suppl. PC Fee: Q Reg. ® OT I 0.0 hrs $0.00 $626.001 IREMRESKIT PME Plan Check: $0.00F_2_00__j amps Electrical Permit Fee: $0.00 $47.00 IBELEC200 Services Suppl. Insp. Fee-0 Reg. ® OT F0.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 (.onswucaion :Tax. Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non - Residential 0 Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure Strong Motion Fee: IBSEISMICR $3.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 $143.30 $673.00 $816.30 Revised: 07/01/2013 " Sherry Stevens 10566 East Estates Drive Cupertino, CA 08 -23 -2013 Othen R4w%0 Ae k 5�W6: Remove. aysdk P.�plct ct f twt.ve amok t.cplct c& ADD DtS�w�S ,eDD 3, mew 0v-4 k-+S pwv !o 'FL-/Lrb t.-%k +s -6 1hk 4�aUC4*d'ispose02 AIDD 4 %5 AvAp Pr?phAAcc Cr,rc�i�'S "'D %) WP -�2- C AS Ir 1. L14HT6 etw►ovc r.' eta cue wt It C40 w4V •e. . PLOT PLANS KITCHEN LIGHTING TO MEET CODE. CHECKED BY a�5��3 PROVIDE SMOKE DETECTORS WITHIN EACH SLEEPING ROOM AT ALL&" AND IN HALLWAYS. It p I� (E) ° -D - CD ;=p _-x o a cn � a m 0 ,i � � n m SR cn to y> z J 0 - U_ cnej� G 1. =� T a co �-LEGTRICAL, m Q U ry w 0 z 0 U� - G D� — --- -- LL---J l DW BLDG D PTF REF FAMILY ROOM = a� —0- —X Z � KITCHEN °z o -_ __� � ° o -___ - -- GAS CUPERTINO RY wp. r OOM Quilding Department i SEEP 0 5 2013 11REVIEVVED FOR CODE COMPLIANCE Peviewed By: "J4' r , MECHANICAL, PLUMBING PLAN C�Ah�e 2yc5�s�n wooD CWV IAw-i� LIY- eFac-tav-C t�a� eieo�xtc�►i Se�vl� � 2`s° 5 . �g —I a cr o 0 a P Qo ° -D - CD ;=p _-x o a cn � a m 0 ,i � � n m SR cn to y> z J 0 - U_ cnej� G 1. =� T a co �-LEGTRICAL, m Q U ry w 0 z 0 U� - G D� — --- -- LL---J l DW BLDG D PTF REF FAMILY ROOM = a� —0- —X Z � KITCHEN °z o -_ __� � ° o -___ - -- GAS CUPERTINO RY wp. r OOM Quilding Department i SEEP 0 5 2013 11REVIEVVED FOR CODE COMPLIANCE Peviewed By: "J4' r , MECHANICAL, PLUMBING PLAN C�Ah�e 2yc5�s�n wooD CWV IAw-i� LIY- eFac-tav-C t�a� eieo�xtc�►i Se�vl� � 2`s° 5 . �g ENTRY (F Sherry Stevens 10566 East Estates Drive Cupertino, CA 8 -23 -2013 ( M 8031 KITCHEN (E) RANGE --REF-. (R 2468 i O 0 (W SOFFIT LIVING ROOM EXISTING / DEMOLITION PLAN FAMILY ROOM CUPERTINO Ruildinq Department E ; 5 2013 RE- VIEVVEf.) FOR CODE COMPLIANCE R,cmewed By: "�; y"" I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10601 N PORTAL AVE CONTRACTOR: DOLLENS ELECTRIC PERMIT NO: 13090024 CORPORATION OWNER'S NAME: JAIN ROHIT AND MADHAVI 1 3591 PINE RIDGE WAY DATE ISSUED: 09/05/2013 OWNER'S PHONE: 4089296100 A nnLICENSED CONTRACTOR'S DECLARATION License Class Ci� Lifc. # LV D —7 3 Contractor I a �v� Std C-� ►�I�Date 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. n r a:.....,.... < l �h bate ❑ 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 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. ISignature Date SAN JOSE, CA 95127 1 PHONE NO: (408)929 -6100 JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL INSTALL EVC STATION LOCATED ON SIDE OF GARAGE Sq. Ft Floor Area: I Valuation: $9060 APN Number: 31632052.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS ROM LAST CALLED INSpPEEC'TION. Issued by: Date• `U�3 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 i ipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505 5 33 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingCa)cupertino.org 3bq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS v h O APN # (.p 2? �-� • C)o %IrMAII OWNER NAME • lS �y/ rxPHONE('rO� 97-9" r o I STREET ADDRESS rt , STATE, ZIP FAX CONTACT NAME r� _ i � vl`M PHONE q vs- �S/ �� ` lX^ E -MAIL STREET PTESS ,,, CITY, STATE, ZIP 52 FAX vt ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT "❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 10 �'^ �� ` � v LICENSE NUMBER �i' /�� /� -1 n ,• LICENSE TYPE eA O BUS. LIC # 2481 LWra� 4 COMPANY NAME -",• IkMS• C tiW` ' , �V �VW S R.�JL�I/ F ' STREET ADDRESS r r1 + „, „ ��J2�j c� �(,J� �.7� V CITY, STATE ZIP �SZ � C�'"�� % (, / ( PHONE �O� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � � G Jam_ { �� /�,� /�1 /► A L � ��n w L = � � (/1 I _� A I _ �. V� !�•(W� VVx C'� LA EXISTING USE PROPOSED USE CONSM TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) E)USTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I ❑ ATTACH # DWELLING UNITS: IS A SECOND uN r []YES SECOND STORY []YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL# 0 N PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLERHOME? I'.f`z1 J" -. ` '" 4g..�.z' c TO UATION: ❑NO :s , s,. 6jo(au By my signature below, I certify to each of the following: I am the property owner or authorized ag nt 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: S rt. SUPPLEMENTWL NVOMAATION REQUIREDpy _ New SFD or Multifamily dwellings: Apply for demolition permit for existin building(s). Demolition permit is required prior to issuance of building g Pe q P g t BxDZI`trrtAN, permit for new building. �pµ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ ruB�tc wolu�s _ form if any Hazardous Materials are being used as part of this project. x z _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. B1dgApp_2011.doc revised 06121111 ��,�� CITY OF CUPERTINO 1#�* ^Yi/�I FTTi' 1PQT11%4ATnR — RITTT.DING DIVISION Xfcch. Plan Check ;Lii>ch. Permit Fee: Other• Alech. Rap. Hech, Insp. Fee: Plumb. Plan ('heck Plumb. Permit Fee: Other Plumb Insp. Plumb. Insp. Fee:: Elec:..Plan {.;heck tiles. Permit Fee: Other Elcc. Insp. u �_ Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. riammng, ruouc works, r1re, ounefury newer �warou, .cievvi District, etc.). These ees are based on the relimina in ormation available and are onl an estimate. Contact the Dept or addn7 in o. ADDRESS: 10601 N PORTAL AVE DATE: 09/05/2013 REVIEWED BY: MENDEZ MISC ITEMS APN: BP #: *VALUATION: 1$9,060 —� *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p PME Plan Check: PENTAMATION SOLAR -RES PERMIT TYPE: WORK Permit Fee: SCOPE Suppl. Insp. Fee-0 Reg. Q OT Xfcch. Plan Check ;Lii>ch. Permit Fee: Other• Alech. Rap. Hech, Insp. Fee: Plumb. Plan ('heck Plumb. Permit Fee: Other Plumb Insp. Plumb. Insp. Fee:: Elec:..Plan {.;heck tiles. Permit Fee: Other Elcc. Insp. u �_ Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. riammng, ruouc works, r1re, ounefury newer �warou, .cievvi District, etc.). These ees are based on the relimina in ormation available and are onl an estimate. Contact the Dept or addn7 in o. FEE ITEMS (Fee Resolution 11 -053 Eff. 7111121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Alternative Energy System $106.00 ICHRGSTA EV Charging Station Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction ..Tax: A.clrninistrative Tee: E) Work Without Permit? ® Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential G Building or Structure i Travcrl Documentation Fees: Strong Motion Fee: 1BSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $1.91 $106.00 '. = $107.91 Revised: 07/01/2013 EV Charging Dock Aez Aerovironment Model EVSE -RS 10 GFP 23' r 100amp sub -panel 21' Garage CUPERTINO� De artment Building P OFF t Sp052013 1_ i k 1 P)40A � 1 REVIEWED FOR CODE COMPLIANCE 1 Reviewed B� o� 1 I � II40A j COMMUNITY DEVELOPMENT DEP?ARTM APPROVED V This set of plans and specifications �bekeptattlhe job site during construction. It ' nlawful to make any changes or alter at on same, or to deviate herefrom, without oval from the Building Official. Thus & of this plan and specifications SHALL NOT bcQ1 -�p4pRrmit or to be an approval of the violation ofaWpgavlslons of any City Ordinance or State Law. BY approx 35ft DATE - 5 /3 PERMIT NO. evse rs - charging dock 40amp- 240 -volt tI ANS GiC� BY. TIE q SR# Customer Ma have Jaine 10601 North Portal Av Cum CA 95014 Project Date EV Charging Dock 9/3/13 Prepared by J. Dollens 10 1 Main Garage Door anensIllechic 11Lalrp 491, Troubleshooting - Panel Upgrades - Solar Power ,.. „„ 408- 929 -6100 • fixmypower.com FWA.E336193 - Electric Vehicle Supply Equipment bttp:Hdatabase.W.comlcgi- bin /XYV/ template /USEXT /1FRAMFJshowpa&.. FFWA.E336193 Electric Vehicle Supply Equipment Electric Vehicle Supply Equipment AEROVIRONMENT INC 1610 S MAGNOLIA MONROVIA, CA 91016 USA EV charging station, Model EVSE -RS. E336193 Last Ugdated on 2010 -09 -07 Questions? Print this page Notice of Disclaimer Page To 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 Folow -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 Underwriters Laboratories Inc." must appear adjacent to the extracted material. In addition, the reprinted material must include a copyright notice in the following format: "Copyright 2010 Underwriters Laboratories Inc. ®" An independent organization working for a safer world with integrity, precision and knowledge. Jim iEi ghwir ;0 M ^,� N M m 7! 4 m C7 CL o x cr, r°i C-) a O C3 o r I O CO j C `v vM ~ a a x � y 0 Z M O I of 1 10/26/2010 12:05 PM 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. • 625.254o imary Source: Contactor opens upon loss of power. M M CD CD Q -n n 0 o ° M L71 CU 0 .. _p a C_ -Q v vM r Z 0 1. Choose wire entry location MOLE ON UNDERSIDE OF CHARGING DOCK Bottum View 2. Attach the mounting plate HOLE IN REAR OF CHARGING DOCK Rear View O Flat �was;her Lag bolt 0 0 0* --- ----- ------------ o p - -- ------------ - Q - - - - -- Wall stud X co C' CD CL UO 3. Attach the Charging Dock to the mounting plate a. Torque the screw to 40 in /lb. 4. Wire the Charging Dock a. Torque the terminal block screws to 20 in /lb. b. Torque the Grounding Strip screws to 20 in /lb. Terminal Block Ground Strip ound Wire -11-1 � k wer wires. GI3 cm —t� er CCU C7 o '? C v (O 5. Install the front cover #10 Torx screws Torque 12in /Ib gt �i ,+ W+uk't+kL�y dI9P1Y60 )ems. ''X'� 'Y✓�K'tK �N9�Mi i � 4� v NpT$RN Removing the trim ring FRONT PANEL COMPONENTS The charging dock is r lv" AC power. START RMYTO CHARGE Prays #u begin a charcie. The The charging dock isreadyta r rr rr p RT P ER P tSENT and READY T GNARGE lights must be on. charge or charging is paused. axe ressctorrt t3 ST R VEHICLE CONNECTEQ STOP The tonr€ t€nr is proPee{Y Press to manually step charging, connected to the vefide port The device-will stop automatically or the charge is ccsmplew. when t reaches full barge. VENKIECHARSM { Y The vehice is being char d; TROUBLE Them is an error. Try renscvrng the connecior and Inserting hack into the vehicle. if Troub Indicator is still Illuminated ca Cusiomrvr Service at 10" + +l NO GAS EVor i OR 664-2M or L visit Customer Services an the RELEASE BUTTON web at tww.nissanusa,Eom/feaf. Press to release the Connector from the charging deck or the vehida port. ;a M CD „e.y. cn' M a 0 W %0 —0 OO o `r X00 M o T CD Z C Q0 CD M FIR ! /' j5 �,li• Aq 1 - • �r • 1 u „__ Building Department City Of Cupertino 3 10,300 Torre Avenue / a'l Cupertino, CA 95014 -3255 Telepbone: 408- 777 -3228 C O P E RT I N O Fax: 408 -777 -3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: a5' E -TE �' PF,RMIT # OO OWNER'S NAME: Sl ��v 'r ,�� _ PHONE # o - GENERAL CONTRACTOR: � 1Q. S ISINESS LICENSE # qgj ADDRESS: SJ LSw E I CITY /ZTPCODE: '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: Signature Date Please check applicable subcontractors and complete the following information. Owner I Contractor Sigas L00 /L00A 8LEL# Date E9 :00 OLOZ /L0 190 SUBCONTRACTOR'. = BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork c Cement Finishing ! ('t Electrical y;�L WP0 ,0DO ' Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Shcct Rock Tile 1 Owner I Contractor Sigas L00 /L00A 8LEL# Date E9 :00 OLOZ /L0 190