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13090156c/ G CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10413 MEADOW PL CONTRACTOR: GREENTECH ELECTRIC PERMIT NO: 13090156 OWNER'S NAME: DE GROOT MICHAEL AND KATJA TRUSTEE 12333 SARATOGA SUNNYVALE RD DATE ISSUED: 09/23/2013 OWNER'S PHONE: 4082537171 SARATOGA, CA 95070 PHONE NO: (408) 280-1180 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL License Class e, %0 Lic. # qbvgw UNIT A- INSTALL 40 AMP 240 VOLT EVC STATION IN �,� ` -Cfl ty,� 1- -W%13 Contractorv��G27v�C1� GG�i� Date GARAGE 6.6KW 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 Sq. Ft Floor Area: Valuation: $500 performance of the work for which this permit is issued. VI 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: 34229041.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT IBES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 0 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 LAST CALLED INSPECTIO . indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 7M 9 Issued by: Date: 12 granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. fa � . �6 Signature Date V 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 isnot 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sec ' s 255 3, and 25534. C�V lX/\ �l 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 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 CITY OF CUPERTINO Em FEE ESTIMATOR - BUILDING DIVISION mg L1ec:h. Plan Cheek PlranL Plan Check Elec. Plan Check �1ech. Permit Fee: Plumb. Permit ree: F.lec•. Permit Fee: Other ;llech. Insp. Other Plumb Insp. Usher filer. Insp. ,fech. Insp. Ir'e Plumb. Insp. Fee: flee. Insp. Fele: NOTE: This estimate does not include fees due to other Departments (Le. Planning, ruoue worsts, rtre, sanuary newer utsrncr, acnoot District, eta). Theseees are based on the relimina information available and are onlyan estimate. Contact the De t or addn'l info. ADDRESS: 10413 meadow pi DATE: 09/23/2013 REVIEWED BY: Mendez MISC ITEMS APN: BP#: *VALUATION: $500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: I PENTAMATION SOLAR -RES I PERMIT TYPE: WORK install 40 amp 240 volt evc station in ara a 6.6kw SCOPE Suppl. Insp. Fee -.0 Reg. ® OT mg L1ec:h. Plan Cheek PlranL Plan Check Elec. Plan Check �1ech. Permit Fee: Plumb. Permit ree: F.lec•. Permit Fee: Other ;llech. Insp. Other Plumb Insp. Usher filer. Insp. ,fech. Insp. Ir'e Plumb. Insp. Fee: flee. Insp. Fele: NOTE: This estimate does not include fees due to other Departments (Le. Planning, ruoue worsts, rtre, sanuary newer utsrncr, acnoot District, eta). Theseees are based on the relimina information available and are onlyan estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-1-1 # Alternative Energy System $106.00 ICHRGSTA EV Charging Station Suppl. PC Fee: (j) Reg. ® OT 0.0 hls $0.00 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: Adinlnistrative..Fee: 1 (F) Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee. $0.00 aIgo 7 ravel Z7{1ct.ttnentation Fees: a mg L1ec:h. Plan Cheek PlranL Plan Check Elec. Plan Check �1ech. Permit Fee: Plumb. Permit ree: F.lec•. Permit Fee: Other ;llech. Insp. Other Plumb Insp. Usher filer. Insp. ,fech. Insp. Ir'e Plumb. Insp. Fee: flee. Insp. Fele: NOTE: This estimate does not include fees due to other Departments (Le. Planning, ruoue worsts, rtre, sanuary newer utsrncr, acnoot District, eta). Theseees are based on the relimina information available and are onlyan estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-1-1 # Alternative Energy System $106.00 ICHRGSTA EV Charging Station Suppl. PC Fee: (j) Reg. ® OT 0.0 hls $0.00 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: Adinlnistrative..Fee: 1 (F) Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential G Building or Structure i 7 ravel Z7{1ct.ttnentation Fees: Strong Motion .Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $1.50 $106.00 $107.50 Revised: 08/01/2013 0 2011 AeroVironment, Inc. Ail rights reserved V-4 FEATURES • SAE J 1772 compliant • Auto restart in event of power outage or ground fault' • Americans with Disabilities Act (ADA) compliant in✓;tallation • Integrated cdble stowage °optional cable management • Underwriters Laboratory (UL) listed • Breakaway safety cable • Optional pedestal mourn • Wireless communication option SERVICE ANb INSTALLATION Will be supported by. • Expanding network of independent certified, trained electricians* • Convenientbome site assessments and installaoon • Electricians with depth of local code and permitting knowledge CeDI O Aerovaaranent bac. 1oso_)osa7 The EVSE RS Home Charging Dock charges all SAE .11772 -compliant vehicles — including both electric vehicle (EV) and plug-in hybrid (PHEV) models — in the convenience of the home garage, workplace, condominium, apartment, or retail parking structure_ The Horne Charging Dods safely and reliably delivers AC power to the vehicle`s on -board charger and features a weather - resistant NEMA 4 enclosure for indoor and outdoor installations. The Home Charging Dock is installed by one of our independent certified licensed electricians who also facilitate necessary pernfatrng and inspection, and provide information about EVSE-RS use to the customer. An optional module is used to enable MR. 2'igbee, or cellular communication_ MTUMVE USER IIMITERFACE 'bion services aw7abk.n certain anew conractnvioraddioaur GREEN =tri t V011agecomected ?` GREEN=readytooperate GREEN BLINKING="ofPstate dueto a manual STOP GREEN= camecuedtr, VdWO GREEN=Veiideischarin(fatbtinking=high charge when bMq is IOW, 5Mw b = cMW n8ar c0MP1ebe) RED =error has occurred; bkddng pattem based on fauRtype 'bion services aw7abk.n certain anew conractnvioraddioaur This guide is a reference for Municipalities inquiring about the use, installation and compliance of the Aerd�Aronment EVSE RS with the National Electric Code and Local Codes. m t. Inc. Model EVSE-M The EVSE-RS is a device which offers simple and safe way o providing electricity to the on -boar! charger in an Electric Veh • 625.2 Definitions. • Pirsonnel Protection System A system of personnel p on devices and cclnstructional features that wh n used together prov! protection against electric shock ol personnel. • S Listed or Labeled: UL d 2594 • 65.9 EkCWk Vehide Coupler: 1772 coupler SAE N American standard • 615.13 gkXdric Veldde Supply Permanent y connected and fastened in • 131�ce. No exposed live parts • 625.14 Rating: 30 amp output • 6iS.15-MMlc : ng. Continuous load (A) For Electric Vehicle U Only (Denoted on Ev. E46 Label) r (B) Ventilation not require (Denoted on EVSE Label) • 6 5.16 Meana of €oupUW Con uctive !1772 connecti ir and EVT rated cable • 615.17 Cable: EVT rated cable heavy usage • 625.18 InterhWc Proximity de -energizes when plugged • *-"AukwWk of Cable: Cable k away feature. • 62S21 Over current P *ectlon Shall be sized for co uous duty 12S % - 40A Circuit Breaker • 625.22 Personnel Protection Trouble annunciation light for Prrwdmity swit+r , Its and NEMA 3 in GR protection, Breakaway cable, enclosure. • 61,5.23 Disconnecting Means: A r electric vehicle sup • equipment rated more than 60 peres or more than 0 • volts to ground, the disconnect! gmeans shall be pro " ed • a0d installed in a readdy accessl le location. • 625.25 Loss of Primary Source: a a i t i i ctor opens upon of power_ INSTALLING THE EVSE-RS cations: ■ 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-R� Charging Dock. 3. MOO the Charging Dock to the mounting plate a. Torque the Mew to 40 infib- UPW OlOw" We Pat w&4w Sodet hud wrm - - -------- ------------ emu W, rj WMI "M 4. Wiro the Charging Dock a. T4que the terminal block screws to 20 inAb. b. To,rque the Grounding Strip screws to .20 !nAb. Terminal Block 'Ground Strip ;Ground Wire Tw¢ power wires c 5. lns�all the front cover #10 Tom screws— Torque 1 ZffAb A *3 ing nplete the installation I= CMGAetvVkm w*.Iar- 1010 10147 ENSE•-RS SAE J1772 208VAC to 240VAC 50Hz/60Hz 30A max 30'C to SWC A1C to 6M Up to 95% non -condensing 12" x 12' x 8" (approximate) 10 lbs. (excl. cable) Up to 25' available NEMA 4 UL listed, CSA and CE pending 40AMPI INSTALL 3- CAR GARAGE SPACE MIKE DE GROOT 10413 Meadow Place Cupertino, CA 45014 COMMUNITY DEVELOPM.CNT BUILDING DIVI; ::C dd - GUPFRTINO G DRIVEWAY This set of plans and Job thio during Constrcr:-,-t-al 16 chano-vs or aitarat;I r G, oiic, ,_... therefrom, without appruvail trorn L e 3 The stam;aing of this plan a cl I .. be held W pert iii or to bean Of any, provisl ns of any City O diniance Or C ,.,L ., By �0 DATE PERMIT NO. 30 0 1�� agp",::, pr St, GARAGE DOOR SCOPE OF WORK. install {1) 40 AMP/240 V circuit breaker In existing utility panel. Install feeder from utility panel to wall mounted charging dock. Feeder (conduit or romex wire) will be mounted to existing surfaces or run through crawl space or attic. Charging Dock will be installed on the far left hand side wail located in the detached garage. EVSE•RS SPECS: Wx1T'x 8" 50 AMP.SUBPAREL RECESSED PLOT PLANS CHECKED BY DATE e -2Z L3 _ PLANNING EPT. (MATE Ri,T1G. DEPT CUPERTINO Building Department SEP 2 3 2013 REVIEWED FOR CODE COMPLIANCE Reviewed By: I/ "