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13100075CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10464 BREWER AVE CONTRACTOR: GREENTECH ELECTRIC PERMIT NO: 13100075 OWNER'S NAME: PROFFITT STEPHEN K AND ARNITA M 12333 SARATOGA SUNNYVALE RD DATE ISSUED: 10/10/2013 OWNER'S PHONE: 4154257560 SARATOGA, CA 95070 PHONE NO: (408) 280-1180 JOB DESCRIPTION: RESIDENTIAL COMMERCIALII LICENSED CONTRACTOR'S DECLARATION 10- License Class G-10 __� Lic. # �� INSTALL EVC STATION IN GARAGE, 6600 AMPS Contractor 1v g� I) P Q. Wf Date :10 0 1 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 Valuation: $500 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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 tJ APN Number: 32641090.00 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 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 indemnify and keep harmless the City of Cupertino.against liabilities, judgments, 180 DAY FROM LAST CALLED INSP IT ON. may accrue against said City in consequence of the Date: costs, and expenses which granting of this permit. Additionally, the applicant understands and will comply Issued by: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. `` Sign a Date .t'O 0 I� RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust 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 withwages 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: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by for this the Health & Safety Code, Sections 25505, 255 and 255P. 0 16 Section 3700 of the Labor Code, for the performance of the work which Owner or authorized age ate' 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. It after making this certificate of exemption, I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code, I must work's for which this permit is issued (Sec. 3097, Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 K 17 CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION !\� 10300 TORRE AVENUE s CUPERTINO, CA 950143255 \� (408) 717-3228 - FAX (408) 777.3333 - bulding0cupertino.om AE PRO]ECf ADIx M /t/ 4(_ 4 OWNERNAME ARA117-A PROFF-I i ' CA5) iz5' 76& "a a Ha- n ,* at oo STREEPADDRESS MY. STATE,ZW FAX cONrAcT NAME IW A N44E-1. COR V IV /4$ PHONE (4108)??*o &7"rnael reewi keh Cele STREETADDRWS CRY, STATE, ZIP FAX ❑ owr4m 17 OWNER -BUILDER ❑ oWNeRAOENr YcoNntAcroa. ❑comraA=PAOENT ❑ ARCfr = ❑ FMG'wom ❑ DEVELOPER ❑ TrxANr CONTRACTOR NAME M A NI,(E L. GR TFQ-H ELECTRIC- r LICENSE NrANBER 6ETYPE TFC-10 BUS. LIC t 3�28(P COMPANY NANM REC TECH CTR IC rrMAJ L FAX MWU ADDRESS /as 33 SA RAI -C A SUN NWAL E I aTY, srAiT z>P PHONE star M SARATOC-t Ai CA ARAT06A CA el-OU7o kX80 -1190 ARC1ff=M4Gn4 R NAME LICi M NUbl M Bus. LIC e COMPANY NAME E -MAX FAX STREET ADDRESS CITY, SPAY$ ZIP PHOM USF. OF SFD or Duplex 0 Multi -Family PROW.CT IN WB.DLAM PROTECT IN STRUCTURE: ❑ Commercial URBM W TEUACE AREA ❑ AYes ❑ No -- MO"NE ❑ Yes ❑ No ❑ SOLARPANELS BLECTSICVEWCLECHARGMSTATION D SOLARWAMRHMTM ❑ arHmL- FOR SOUR PAM S. NUMBER OF PAHU SrtINrM- KQ.OWAT M (COMDRO) Ln l AL VALUATION: �OO DESCREMON OF WORK404 140 440clo .2 40 VOL T C t RC /T 8 &� A• rZ R /Al i7YISF /NCS a -ILIN A4NE-1. FOR VEHICLE, 0-HARGINC7 DOC -I< _ - By my signatum below, 1=* to eacb of the following: I am the property owner or authorized agent to act on the property ownees behalf.- I have read this application and the information I have provided is comet. 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. I4rthoiiza re ieserhtatives of Cupertino to enter the above-ide9tfied property for inspection purposes. Signature ofApplicandAgenC _ '� .:.-.— t) AUPPLE1VILNTAL WFORMA71ION REQUIRED - PYApp 201 Ldoc revised 0311,6111 enc -4%„ CITY OF CUPERTINO L1ech Plan Check Plumb. Plum Check Elec. Plan Check fe.ch. Permit Fee: Plumb. Permit Fee. Elec. Permit Fee: Other Alec•h. Insp. Other Plumb Insp. 0/Her Elee. Insp. Meek Insp, Fee: Plumb. Msp. Fee: Elec. Insp. fee: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School on (Fee Resolution 11-053 E r7ff 11113)r FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10464 brewer ave APN: BP#: DATE: 10/1012013 REVIEWED BY: Mendez `VALUATION: $500 *PERMIT TYPE: Building Permit PRIMARY, USE: SFD or Duplex PLAN CHECK TYPE: Alteration / Repair [PFENTAMATION SOLAR -RES PERMIT TYPE: WORK SCOPE install evc station in garage ppl. PC Fee: Reg. ®OT 0.0 PME Plan Check: hs $0.00 $0.00 Permit Fee: Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $0.00 $0.00 Construction :Tax: 771: Administrative .Fee: Work Without Permit? ® Yes (E) No $0.00 Advanced Planning_Fee_ $0.00 Select a Non -Residential Building or Structure E) A Travel Doc uirientation Fees: Strong Motion Fee: 1BSEISMICR $0.50 NOW L1ech Plan Check Plumb. Plum Check Elec. Plan Check fe.ch. Permit Fee: Plumb. Permit Fee. Elec. Permit Fee: Other Alec•h. Insp. Other Plumb Insp. 0/Her Elee. Insp. Meek Insp, Fee: Plumb. Msp. Fee: Elec. Insp. fee: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School on (Fee Resolution 11-053 E r7ff 11113)r "L ,FEE" »r»`QTY/FEE - MISC ITEMS FFEECITEMS an heck Fee: $0.00 1 # $106.00 Alternative Energy System ICHRGSTA EV Charging Station ppl. PC Fee: Reg. ®OT 0.0 PME Plan Check: hs $0.00 $0.00 Permit Fee: Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $0.00 $0.00 Construction :Tax: 771: Administrative .Fee: Work Without Permit? ® Yes (E) No $0.00 Advanced Planning_Fee_ $0.00 Select a Non -Residential Building or Structure E) A Travel Doc uirientation Fees: Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $1.501 $106.00 $107.50 Revised: 10/01/2013 20` FRONTOF DRIVEWAY T -2S"1 ARNITA PROFFITr 10464 BREWER AVENUE CUPERTINO, CAS5O14 Install 11) 40 amp/ 240 Volt circuit breaker in existing Utility panel, install 30 feet or less of feeder from subpanel to wail mounted charging dock. Feeder {Conduit or Romexwire) will be mounted to existing surfaces orrun through IODAMPSUSPANEt crawl Space or attic Recessed q246 �E•-VELOPMENT DEPARTMENT 12•xir 1,. rbiVISiON - CUPERTINO Weight10lbsr� ONDUIT Cord: 15 or 25 5 stall location AMPME —will Dawail mounted ao wort th"4$"Per NEC OFFICE COPY, !cT he kept at the ,,,,7� any ..::........ .. I C l c i 6i1'r4;3'l;.i?_e 01 Ea`�.,� D.k. I E _. PE;I 'AIT N0. CHECKED BY OA;n'A l a l NG DE togm s UtDG. DEpT. LOAD CALCULATION ARNITA PROFFITT PREPARED BY: ( Green Tech Electric Solutions Inc,) 0 LOAD TYPE: QUANTITY TOTAL UNIT LAUNDRY CIRCUIT: 112�� y� x.200 WATTS APPLIANCE CIRCUITS: 3 �% 1000`x® 1 d' 3000 WATTS GENERAL LIGHTING: 30 65 1950 WATTS OVEN: 1 3600 ��' 3600 WATTS MICROWAVE: 1 150 X500 WATTS DISHWASHER: 1 1000 1000 WATTS GARBAGE DISPOSAL: 1 900 900 WATTS REFRIGERATOR: 1 1500 1500 WATTS HOOE FAN: 1 300 300 WATTS DRYER 0 0 0 WATTS EVSE 1 6600 6600 WATTS AIR CONDITIONING UNIT: 100% DEMAND FACTOR 9000 WATTS 21550 DEMAND CALCULATIONS 10KVA AT 100% DEMAND FACTOR 10000 REMAINDER AT 40% DEMAND FACTOR 11550 VOLT -AMPS MULTIPLIED BY40% TOTAL 4620 AIR CONDITIONING UNIT: 100% DEMAND FACTOR. 9000 TOTAL DEMAND FOR OTHER LOADS 23;620 EXISTING SERVICE SIZE AT 240V SINGLE PHASE SERVICE 98.4667 REQUIRED 100 a 'd � � i FEATURES • SAE J1772 compliant • Auto restart in event of power outage or ground fault • Americans with Disabilities Act (ADA) compliant installation • Integrated cable stowage, optional cable management • Underwriters laboratory (UL) listed • Breakaway safety cable • Optional pedestal mount • Wireless communication option SERVICE AND INSTALLATION Will be supported by: • Expanding network of independent certified, trained electricians* • Convenient home site assessments and installation • Electricians with depth of local code and permitting knowledge 02010 AeroVironment. Inc. 1010-10147 Pre -production image shown. Production model may vary. The EVSE-RS Home Charging Dock charges all SAE J1772 -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 Home Charging Dock 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 permitting and inspection, and provide information about EVSE-RS use to the customer. An optional module is used to enable WiFi, Zigbee, or cellular communication. IMMMVEUSER INTERFACE GREEN= utigtyvoltage connected GREEN = ready to operate GREEN BLINKING = "off' state due to a manual STOP GREEN = connected to vehicle GREEN =vehicle is charging {fast blinking = high charge when battery is low, slow blinking = charge near complete) RED = error has occurred; blinking pattern based on fault type *Installation services available in certain areas; contact AYforadditional information. This guide is a reference for Municipalities inquiring about the use, installation and compliance of the AeroVironment MEAS with the National Electric Code and Local Codes. AeroVironment, Inc. Model EVSE-RS Product and inion Oversew The EVSE simple RS is a device which offers a and safe way of providing electricity to the on -board charger in an Electric Vehicle. NEC 625 Compliance • 625.2 Definitions. • Personnel ProteWon System: A system of personnel protection devices and constructional features that when used together provide protection against electric shock of personnel. • 6255 Listed or Labeled: UL Listed 2594 • 625.9 Electric Vehide Coupler. J1772 coupler SAE North American standard • 625.13 Electric Vehide Supply Equipment: Permanently connected and fastened in • Place. No exposed live parts • 625.14 Rating: 30 amp output rating. Continuous load • 625.15 Marl Ings: — (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 Interiodc Proximity switch de -energizes when unplugged • 625.19 Automatic De -Enron of Cable: Cable break away feature. • 625.21 Over current Protection: Shalt be sized for continuous duty 125 %- 40A Circuit Breaker • 625.22 Persornmt Protection Syston . Proximity switch, GH 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_ 9 1. Choose vAre entry localion HOLE ON UNDERSIDE OF CHARGING DOCK sotwMvM 1 2. Attach the mounting plate I.qphob HoMMoF CHAMfdrx P=Vim f I Attach the Charging Dock to the mounting plate a. Torque the screw to 40 innb. upper mounting ho% Flat washer Socket head screw -4 ------------ 4. Wire the Charging Dock a. Torque the terminal block screws to 20 in/lb. b. Torque the Grounding Strip screws to 20 inAb. Terminal Block Ground Strip Ground Wire Two power wires If SPECIFICATION Connector Voltage Frequency Current Operating Temperature Storage/Transit Temperature Humidity Dimensions Weight Cord Length Enclosure Regulatory Compliance Information and specifications subject to change 02010 Aerovironment, Inc. 1010_10147 f a EVSE-RS SAE J1772 208VAC to 240VAC 50Hz/60Hz 30A max -30°C to 50°C -40°C to 60'C 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