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13120133 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10704 STEVENS CANYON RD CONTRACTOR:ROGERS ELECTRIC PERMIT NO:13120133 OWNER'S NAME: REDWOOD CITY,CA 94062 PHONE NO:(650)346-0981 El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.# �C� INSTALL EVC STATION LOCATED IN GARAGE 40 AMPS Contractor ate fZ IP /� I her rum that I am licensed under the provisions of Chapter 9 (co mencing 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 whichthis 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 66 performance of the work for which this APN Number:35603059.00 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 180 DA LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City' onsequence of the granting of this permit d' on ,th cant rstands and will comply Issued by: Date: Z with all non-point urce r s r th o Municipal Code,Section 9.18. /2 �� RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature ate /j 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 1,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 whichthis permit is issued. will maintain compliance with the unicipal C , hapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti s 2 33, 3 Section 3700 of the Labor Code,for die performance of the work for which this permit is issued. Owner or authorized agent: Date: Z/� 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 918. Signature Date ALTERNATIVE ENERGY PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDINGDIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 e oD CUPERTINO (408)777-3228• FAX(408)777-3333• buildingcupertino.org 1 7 PROJECT ADDRESS APN35( OWNER NAMEH,,.,,,,, _T STREET ADDRESS CITY,STAT,Z P FAX )D `j Ill tl/u�c o�7v,•� Ccs f Crf CONTACT NAME PHONE E-MAIL 4�- STREET ADDRESS r CITY STATE. ZIP FAX O��JI•1 li'i i C!� HCl ac ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �) ? LICENSE NUMBERq C` LLICENSETYPEBUS.LICk COMPANY NAME E-MAIL �/ / � ' FAX STREET ADDRESS( rs�� e CITY�ST^TE�ZI��IJi�cP�f' C PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial / URBAN INTERFACE AREA ❑ Yes X10 FLOOD ZONE ❑ Yes NO ❑ SOLAR PANELS L`7 ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: A FOR SOLAR PANELS: NUMBER OF PANELSIUNITS: N KILOWATTS: TOTAL VALUATION: � (/-D DESCRIPTION OF WORK J�-� /CNS C, ..RECEIVED BY:'. - By my signature below,I certify to each of the I am the pe wrier o uthorized age on the prop e calf. I have read this application and the information I have pro ed is c�in k I re Descri Ion f Worl erify it is accurate. [agree to comply with all applicable local ordinances and state laws relating to b ing co recti au ze repres rtino to enter the above-identifi prope for inspection purposes. Signature of Applicant/Agent: P EMENTAL INFORMATION REQUIRED OFFICE USE ONLY rI ❑ OVER-THE-COUNTER G r `' ❑ EXPRESS s U ❑ STANDARD. J z. a,:, ❑ LARGE MAJOR P VApp_2012.doc revised 06120112 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: 12/17/2013 REVIEWED BY: Mendez APN: BP#: "VALUATION: $500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY PENTAMATION SFD or Duplex SOLAR-RES USE: PERMIT TYPE: WORK install evc station located in garage SCOPE .. ("'heck pi�dtsl%),Plan(,ti£'£-�. Elec, P;. C?i,'€�iI'IrsF,";7s:s/;. Li J�°f:FI 7,t.ar3. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These ees are based on therelinin information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS flee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Alternative Energy System Suppl.PC Fee: Reg. ® QT;' 0:.0 hrs $0.00 $106.00 1CHRGSTA 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: $0.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning_Fee: $0.00 Select a Non-Residential G Building or Structure 0 Strong Motion Fee: IBSEISMICx $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ill ��1 W (?TMI.i TOTAL FEE: $107.50 �; $1.50 $106.00 . ; Revised: 10/01/2013 SSC= ✓.��s C-af��'�'�.� ►7`� N�N�t'Z �s+� 2 pFVELOPMENT DEPART�Et`T COMMUN" �r BUILDING DIVISION C� APP This set of plans and specifications MUST be kept at the construction. It is unlawful to make any in late e during o dee lob site or t changes or alterations frommhe Building U1;�r,al. therefrom, without app The Stamping of this plan and spec`f c io¢ L'� L k6��31 be held to permit or to be an app F.� � � ro��isiuns a any Citi Ordiz`anea yr Ci ars, p _ V 1 i L&moi 2tc-A AP tlz)?5 11 � i s a,.A-XE r> >-- L�[Sisk FFICE Comfty 0 C,,,TT � C/I CUPERTINO rte; 11iidding Depar7nent T 2013 2c) REVIEWED FOR GORE COMPLIANCE PLOT PLANS Reviewed By; CHECKED BY PLArrNr DEP . DATE dASr yid 02011 AeroVironment, reserved { { 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. i 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. i 3 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: 11772 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: i (A) For Electric Vehicle Use Only(Denoted on EVSE-RS Label) { — (B)Ventilation not required (Denoted on EVSE-RS Label) i 625.16 Means of Coupling:Conductive 11772 connector and EVT rated cable 625.17 Cable: EVT rated cable extra heavy usage j 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 I 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. i f s i I i i r f i 4 !3 { f INSTALLING THE EVSE-RS I Specifications: j ■ For use with Electric Vehicles • Ventilation not required ■ NEMA Type 3 Rain Tight enclosure I. ■40 Amp. circuit breaker rating. Do NOT use a Class A circuit breaker with the EVSE-RS Charging Dock. Number of Fr eq Hz Voltage AC Current Operating Phases Rower Disconnect switch Charging Bock distribution (if applicable) panel Wali stud S 3 .-4 `I 1 i 3 t I l f i --------------- 1 . Choose wire entry location HOLE IN REAR OF HOLE ON UNDERSIDE OF CHARGING DOCK CHARGING DOCK AWL Bottoms.View ► ' Rear V- 2. Attach the mounting plate Mounting plate �I �o Large hole for condutl uhlq wires--}---I— 1 Small holes for Chargmg Dock mounting holes mounting plate to wall stud O Flat washer Lag bolt I o o •--- --------------- fl —Wall stud O �--- i0 ' 00----- --- p_-____- - ae' O I I Wall stud i i 3. Attach the Charging Dock to the mounting plate i a. Torque the screw to 40 in/Ib. Upper mounting hole flat washer Socket head screw I •-- ----- ------------ Comoff i _ k I Q TJ i I f 4. Wire the Charging Dock a. Torque the terminal block screws to 20 in/Ib. b. Torque the Grounding Strip screws to 20 in/lb. Terminal Block �. s Ground Strip Ground Wire j J Two power wires '; 1 { 1 1 y i i 5. Install the front cover #10 Torx screws—Torque 12in/Ib # i 1 t Removing the trim ring {� Access hole Outer nW ! f 3 6. Complete the installation i � 1 1 � s j O O O, 1 i 4 _ a FRONT PANEL COMPONENTS POW0 PmWT STAR[ MWY TO CHARDS P—MIEF.PR E SE'q-a R E A: r1p -i,n:�-'Dcl.is read,Ic Ell POVARPRESEN'0 CHARGE t,:ihaz mus',tD;.-n T 0 RT i:ic paused IWADY TO CKVtM 0 S VEPG=COMB=0 IN 0 os P ilt MRCUR--0 vwmcow*m STOP cress tc manualk zto,,:cn�- ar"-:To�tc property r, The deur fill t0- acs'Ji&KVehidC Dort "'azhe��u"!narq� -hr zr'��Tat;is'ompietc, �ihBr it VEHM CHAROM T1w vehide is being charged. TROUM iF arerror Try removing --nr'-to,and insem ing back ,n.1,rhe�'�Ndc If Trouble nP 1fluminatad call at 1(877NO f877 664-2738 or ROAM BUTTON or,the. 10r. "Issanusa comiieaf. Pies-tc'61e a.e the i-crnpmr t,,Drr,the a-j,,:3--jeck IhG CHARGING THE VEHICLE ji 'm. anrw VEHICLE ,_0 VEPKLE—HX'GINC li,jht 4S,AP VEJMCLE CHMGV#G SlW, !dmkip to J:x,1'-- PEZ, P.3 E ai