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13090184 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8061 HYANNISPORT DR CONTRACTOR ME PERMIT NO:13090184 OWNER'S NAME: YOSHI KOICHI AND YUKO L DATE ISSUED:09/24/2013 OWNER'S PHONE: 4084841959 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL❑ License Class CLi,.#_0% _V 2 INSTALL AN ELECTRICAL VEHICLE CHARGING 2` / STATION Contractor Date INSIDE THE GARAGE OFF OF A 200 AMP PANEL I here mhat 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:$500 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:35611008.00 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 00 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 DAYM LAST CALLED INSP CTION. 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 so egulations the Cupertin Municipal Code,Section 9.18. 7 RE-ROOFS: Signature . Date 3 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 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 2550 �and 55 Section 3700 of the Labor Code,for the performance of the work for which this Z Owner or authorized ag 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 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333•buildinga-cupertino.org PROJECT ADDRESS 80V1 _ ���� N 1 �,�� `�`� APN At OWNER NAME SUA.�► \ V��-i�>rg PHONE LI�11•tG� E-MAIL STREET ADDRESS 8o is 1 g f0RT O CITY,G�/STATE,�V`�1`�� C -` �h FAX CONTACT NAME H PHONE EE--MAIL - ti 6%:—e.> -J`l 6.OSI 81 (L*A4R P'%N(/'9j k'G- Cd STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT C CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �'� ` LICENSE NUMBER LICENSE TYPE BUS.LIC N /�mk �yli 0t 57o e, C-1 COMPANY NAME EMAIL FAX 1L C6 Ga It! lFGT c I�i�-�^���R',te e• ti lf STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD Or Duplex ❑ Multi-Family PROJECT IN WILDLAND _ {/ PROJECT IN STRUCTURE: ElEl , Commercial URBAN INTERFACE AREA Yes o 0 FLOOD ZONE ❑ Yes E-,IqO ❑SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANEL S: NUMBER OF PANELS/UNITS: #KILOWATTS: TOTAL VALUATION: DESCRIPTION OF WORK IJV lAJS-tA,tL1,#J cA'ci i L V&AlfCG C6c1� RECEIVEI7BY:'` _ By my signature below,I certify to each of the following: I am the property owner or autho ' ed agent to act on the property owner's behalf. [have read this application and the information I have provide rrect have read the Descripti and verify it is accurate. I a ree to comply with all applicable local ordinances and state laws relating to buildi stru on. I au th epre I pertino to enter the above-ide ified pro rty for inspection purposes. Signature of Applicant/Agent: Date: el Z C� UPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY w OVER-THE-COUNTER a } F' ❑ EXPRESS :E U x ❑ STANDARD U J ❑' LARGE' Q MAJOR PVApp_2012.doc revised 06/20/12 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 8061 hyannisport dr. DATE: 09/24/2013 REVIEWED BY: bobs. APN: BP#: "VALUATION: $500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RES USE: PERMIT TYPE: WORK install ev station at garage local. SCOPE 4 G x t�'x k <s :L1ech. Plan Check Phunb.Plan Check Elec.flan{.`heck 61e"'A Permit Fee: Plumb. Permit Fee: Elec. Permit 1°ce: FWc, Alech.Imp. Other Phimb Insp, 0 Ocher Elec.Imp,.Insp.Fce: Plurub. htsp. fee:: Elec.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 fiW are based on the prefindna information available and are only an estimate Contact the Dept-for addn'1 info. FEE ITEMS(Fee Resolution 11-053 E, . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F1 # Alternative Energy System Suppl.PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 $106.00 ICHRGSTA 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: _T_T7 $0.00 Construction Tax: Aoministrivive Fee: Work Without Permit? ® Yes (E) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential 0 71ui�c�l l�octrrrtentution Fees: Building or Structure I Strong Motion.Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 1 $1.00 ��;�- " � TAS � � 107.50 $1.50 $106.00172 . : �� $ Revised: 08/01/2013 EVSE - RS Installation and User Guide ©2011 AeroVironment, Inc. All rights reserved V-4 This guide is a reference for Municipalities inquiring about the use, installation and compliance of tha Aarn\Jirnnment F\JSE_RC�A;iti the Nati^ al 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 i • 625.18 Interlock: Proximity switch de-energizes when unplugged • 625.19 Automatic De-Energization of Cable: Cable break away feature. a • 625.21 Over current Protection:Shall be sized for continuous duty 125%-40A Circuit I Breaker i • 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 :'`'1ean`s sh?ll b- pr�yeu�d and installed in a readily accessible location. • 625.25 Loss of Primary Source: Contactor opens upon loss of power. ( i � I i 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. Number of Freq Hz Voltage AC Current Operating Phases Amps Temp Power Disconnect switch Charging Dock distribution (if applicable) panel wall stud x OW 1MEMMM 1 . Choose wire entry location HOLE IN REAR OF ROLE ON UNDERSIDE OF CHARGING DOCK CHARGING Docx Bottom View Rea Vew i 2. Attach the mounting plate IMounting ptate � La.a-hc4e!t--conduit ut*-,aweso c C f I i Small holes far _ fI C.oar�mg Dods mo� ig h:c;E; mounting prate ' l to wit smat O Fiat washer Lag bolt j IE O ,s--- ---------- -- - -- - I t I f , I a 4,----- ----------------<D() ------- 4T yAlaI eud I � 1 `Fl 1 t 3. Attach the Charging Dock to the mounting plate a. Torque the screw to 40 in/Ib. tipper-mounting-tole Flat washer Socket head screw - -- ------- -----------Emu 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. Terminal Block Ground Strip t ;f Ground Wire Two power wires .. t �" t 5. install the front cover #10 Torx screws—Torque 12in/Ib i 1 ,t On 40 C::511 t ; Removing the trim ring Access We Outer ring 6. Complete the installation ins ------------ ----------- 1 r 4 { i L FRONT PANEL COMPONENTS POWER PRE59T The charging dock is receiving AC power. 5TARr READYTO CHARGE Press to begin a charge.The The charging dock is ready to PSR in and READY charge or charging is paused. 1MWTOc waw a T TO CHARGE lights must be on. 6 QSTv o le®3t=e VO4KU CONNECIM STOP The connector is properly Press to manually stop charging. connected to the vehicle port The,vice will stop auto matically or the charge is conrpk&e when it reaches full charge. VEHKIE CHARG M xw The vehicle is being charged. = =sem 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 07)NO GAS EV or 1 gM 664-2736 or visit Customer SerWm on the REBASE BUTTON web at www.nissanusa.cmrnlleaf. Press to rdeas=the Connecter from the charging dock or the chide port. M' CHARGING THE VEHICLE =UW4:tcrtoMW� -It aecundthacalve;raga Wm the chargh3 dock i VEHKME siuxt rormzctarfinr in .°.e r s +x a �'� - AIS ±' g 9=rt�f begin sehda--Nm port When UVAMOmra�s. ac:t maucally.When fut,Kt .the 11BICL= waseeuYtana 4 h ns•the r 0-M&C-TED l t w.dh8 ' a VESICLE 7 CLE Chit RG-M.UgH, charging dock will glaminatp_ ' n to bkrrtk llxw* is rte need W press STAFF. 1 VB#CLE CHARG�IG ovum c-M ql.N mil " •t su-af y `l h-thn 11'FNIC'J F ii _.3C .. ....�5 britt-3___.1 .-..__ •fOF when-zomolete. You can rttanuatly CFARGNG itght stcP€ _ P 24rTp8 by pT-- sing. OP- - f bwaiuttg on tho chafx er, - - —_ _ Whan the READY TO CWGE pts the button an he kryht Winks,remo a Nta�-mnet--tor ,atnect ar to release. €fom the v-hic'le charga piort it Pug f�rqm,-e Fom you hart pressed STOP,you can --hicbe charge port_ pra,--START to resr„ms charring. 1 I sm I lAarAe. 0-11-S%Z. Scst�-�1 �c5b►��� 0" �� : E C Q _ �fiPfie.�co CA oGfD��I COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTiNO APPROVE® - j 71hi; set of plans and specifications MUST be kept at the �j Jot site during construction. It is unlawful to make any changes or alterations on same,or to deviate (� th refrom,without approval from the Building Official. Tho �ampinq of this plan cnd Slf?Cif;ca+3OnS SI ja�l i,i`�T cy'/Z�cAL �yvTRAcjt. 2 bo �z-lo to c ..`i(;Ji` ) c{S� -r 't of ii�, r M�T �C-& j BT 'l)�p:-"�` i`✓i' l�tGil a� a �,r....,.d�.: ..i :� 4 t _ �G�I1:.�.5 GI C. B G AGvA Ut)rA Ci �1=flr�cwD C,t-ko' Z- r , C CI�IU6Z iP wk 65 PLOT PLANS CHECKED AY -� CUPERTINO BuildingDepartment partment SEP 2 4 2013 REVIEWED FOR CODE COMPLIANCE Reviewed By: -�.