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13110150 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1292 POPPY WAY CONTRACTOR:ROGERS ELECTRIC PERMIT NO: 13110150 OWNER'S NAME: ALLISON JEREMY AND LIN MONICA 11 AGUA VISTA CT DATE ISSUED:11/21/2013 OWNER'S PHONE: 4088724698 REDWOOD CITY,CA 94062 PHONE NO:(650)346-0981 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class C- /( Lic.# '?500 SQ— r r ��/1 Date it / i3 r MECH RESIDENTIAL COMMERCIAL Contractor I��I e/5 u I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions JOB DESCRIPTION: Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: INSTALL EV CHARGING STATION IN GARAGE 110 AMP i. 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. '2. 1 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. Sq.Ft Floor Area: Valuation:$1800 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information.is APN Number:36658002.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED posts,and expenses which may accrue against said City in consequerie:of the granting of this permit. Additional"e e applicant understands and will comply with WITHIN 0 DAYS OF PERMIT ISSUANCE OR all non-point source regulations per th Cqpertino Municipal Code,Section 9.18. 180 DAr F M LAST CALLED INSPECTION. Signature Date !'! Z�! /3 Issued by: Date:. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is installed i. I,as owner of the property,or my employees with wages as their sole without first obtaining an inspection,I agree to remove all new materials for inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: Date: 2. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: t. I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the California performance of the work for which this permit_is issued. Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 25532 a Section 3700 of the Labor Code,for the performance of the work forwhich this ( )should I store or handle hazardous material. Additionally,should I use permit is issued. equipment or devices which emit hazardous air contaminants as defined by the Bay Area s. I certify that in the performance of the work.for which this permit is issued,I shall Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety de,Sections 25505,25533,and not employ any person in any manner so as to become subject to the Worker's 25534. Compensation laws of California. If,after making this certificate of exemption,l 1112111-3 become subject to the Worker's Compensation provisions of the Labor Code,I Owner or authorized agent: Date: must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTR CTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for APPLICANT CERTIFICATION which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state'that the above information is Lender's Name oorrect.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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keepharmless the Ci of Cupertino against liabilities,judgments, posts,d expensewhich may accrue against said City in'consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with I understand my plans shall be used as public records. all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION Im COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION �� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �� CUPERTINO (408)777-3228-FAX(408)777-3333-buildinaftcupertino.ora \/0 ❑NEW CONSTRUCTION ❑� ADDITION ❑ALTERATION/TI ElREVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS '^�� �f/O \ OWNERNAME d '/ a APN# � 6-0 PHONE E-`MAII �i agm� I v Ifo 87 - u(,4 STREET ADDRESS CITCY,v STATE,� FAX o a ec �h I CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OwNER ❑ OwNER-BUIIAER ❑ Owmm AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARcHrrEcr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEr V^ LICENSE NUMBER LICENSE TYPE BUS.LIC# �C O C' COMPANY NAME 12,O e r .G E MAH. C(0�,M` \ W \ 9 �- Q `^- FAX STREET ADDRESS CTTY,S ATE, ` lA' W PH��rrrrEE 4 0�� woo 9 &5a 39C, 098 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK I �a a( e � ai ele�n�, l�, c r EXISTING USE PROPOSED USE CONSTR.TYPE I #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 DECK/PORCH AREA GARAGE AREA DETACH ❑ATTACH #DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY OYES BEINGADDED- ONO ADDITION- ONO PRE APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES =B OTAL VALUATION PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EIC M"HOME- ❑NO By my signature below,I certify to each of the following: I am the property owner or authoriz ag to act on the property owner's behalfA have read this application and the information I have provided is correct. I have a Description of Work and it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authfives of Cupertino to enter the above-identified property for inspection purposes. Sigoatureof Date: I r 1 3 SUPPLEMENTAL INF TION REQUIRED r�uv CKTYPE „' ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ovEitTHE cool rER Dn�Ic PLAN ItEv>Ew existing building(s). Demolition permit is required prior to issuance of buil permit for new building. ❑ ExpREss ❑ c PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0" sTANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ t mE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. El IKAaoR El SANITARY sEwt DISTRICT ❑ ENVIRoNMENTALHEALTH BldgApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ` ADDRESS: 1292 poppy way DATE: 11/21/2013 REVIEWED BY: MENDEZ APN: BP#: `VALUATION: 1$1,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RES USE: p PERMIT TYPE: WORK install ev charging station in garage SCOPE ALlech.Plan Check Phrrrrb,Plan Check Elec..Plan Check F-111-1/1,Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: C�zher Alech.Insp. Other Plumb Insp. Other Elec.Insp. Li tterh.Insp.Fire: Plumb. trrsp.Fee: I:Iec.lnsp.l°ee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc). Theseees are based on the prefinmdina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check.Fee: $0.00 0 # Alternative Energy System Suppl.PC Fee: (E) Reg. 0 OT r 0.0 hrs $0.00 $106.00 I CHRGSTA EV Charging Station PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.FeeQ Reg. Q OT : p0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction :Tax: Administrative.Fee Work Without Permit? 0 Yes Q No $0.00 0 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 $1.50 $106.00 $107:50 Revised: 10/01/2013 s � ' f - Till® partment NOV 2 `u"!FVVED FOR C,:'•C `: ; .. p,�r LiANCE Reviewed By. +0 4p fav Ah • 1 1 ©2011 AeroVironment, Inc. All rights reserved j V-4 i 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 Electri;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 11772 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. Numberof -• Flz Voltage AC CurrentOperating Phases Amps Temp C Power Disconnect switch Charging Dock distribution (if applicable) panel Wall stud v. t EA tZ ■ t 1 . Choose wire entry location HOLE IN REAR OF HOLE ON UNDERSIDE OF CHARGING DOCK CHARGING DOCK nif ` J Bottom View 1 Rear View 2. Attach the mounting plate Mounting plate a G 0 Large hole for conduit utility wires o small holes for Charging Dock mounting holes mounting plate to"rte stud O Flat washer Lag bolt O O 00--- ------------------La------- Wallstud O C)00- 0 0s----- ----------------Q------- � 48- O Wall stud ig 11, AW . � a 3, Attach the Charging Dock to the mounting plate a. Torque the screw to 40 in/Ib. Upper mounting hole Flat washer Socket head screw .-- -- -------{}o ----------- _ o —J 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 i Ground Wire Two power wires \ _ J I a 5. Install the front cover #10 Torx screws—Torque 12in/Ib 1 ti f j Removing the trim ring AMWAS a Aacrss rale Ower ring 6. Complete the installation 1 % r O o a OP a t t ' `< � FRONT PANEL COMPONENTS DOWER PRESENT The_harping do:-kis receiving Ai r,_r;er. START READY TO CHARGE Press tc begin a charge.The T e charting deck is ready to PQ4MeR�IT o O P`— ER.PRESENT and READY charie�r charging is paused. READYTOr o S RT TO HARGE lights mus'be:.n Oil COMECTED' o Vain--owtom o OST P TRotSL--O VEHICLE CONNECTED STOP The tonne yr is properly Press to manually stcp charging. eannect=d tv the rchide port The device Will step automatically cr the charge is complete. when it reaches full hang-2. VEHICLE CHARGING he vehicle is bring charged. TROUBLE There is an error. Try removing the-cnne--tcr and inserting back �ntc the vehicle.If Trouble Indicatcr is still illuminated call Custpme;Servir_e at! $77t NO _AS EV or 1 i$7T i ob i-2738-or v is;t Customer'Service on the L RELEASE BUTTON -b at v:,vv.nis<_anusa.com.+leaf. Press to release rhe Cc nn=ctcr from the the chide pert. CHARGING THE VEHICLE 1-� Press the button on the Unwrap the,able hom connecter to rcdeasa it atc=und the,-. le harn}r from the charging dcc c VBi1CLE CONNECTED* ,. � ncwn►.�enr• Insr_rtconnectorflrmlyinto the �rua+u 0 *TAPW Chargingwill begin whtcle charge port. When automatically.When fully inserted.the VEHICLE .harginq brgrns,tha CONNECTED haht.;n the °Iow"° VEHICLE CHARGING light charging dock will illuminate. ,411 begin to blink.There rs no nead tc Press START. YEmcLE cHARGtNG s OfrNa Chargtnq-will step automatically When the'rEHICLE ^-• �� when complete. You ran manually CFWRGING fight stops stop charging bypresstng STOP. bfiokmq-n the.har-qer, When the READY TO CHARGE press the button on the light blinks,remove the conne-:tor conn ctor to release, fr,m the rahicle charge port.If F'uil to remi�.e fr'.;m ysu have.prossad STOP,you can ,-hi,_r, harqi�puri. press START to resume charging. ' - .tr`�X",air c�� � 4�•. �.S�.h^�3 �N��"`��M�qi"�. � ., • t � \ C, vc— V S ky cp kirrIV6 WWI cc,,s 3 Ll CUPI�TINO a 9uildinQ eoartment NOV 2 12013 l REVIEWED FOR CODE CO PLIANCE CUA�� S7a Reviewed By: � 2U y �D cr. O O V S ( Zo to c�4�-� mac. caar m c3 a CLOD et,crt PLAT\J L��nTu�D V�-(.sN�CtF!'rL. Copt CHECKED BY oA kNNJW-D!2E!P�T.l3 PL DATA - 'c��\ lly,I)G. DEPT. �rJ