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14040093 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21001 HAZELBROOK DR CONTRACTOR: j �j�Gy PERMIT NO: 14040093 / �►-�t OWNER'S NAME: PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL INSTALL(N)EV CHARGING STATION IN GARAGE AREA. License Class Li/c.## � UNIT WILL NOT ENCROACH INTO CLEAR 20' X 20' Contractor Date 7 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1800 Wnave 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:32628095 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 DAYS FROM L LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of thef( granting of this permit. Additionally,the applicant understands and will comply Y _ Date: with all k•! All roofs shall be inspected prior to y 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 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 MIRNATIVE ENER GYPERMITAPPUCATION aws-VAX 18diocAm ori 42 FST Si li,�'FTt�DORFS: CIT1',STT SY FA3c rRACTOii bo arr crox x r a csixr r.a [ :ri v�o r :.n:r n f7FRA{TO j3R3E W �C•r�v� �i!+�' �i 37CEvaE4S13LA L1t T`SETI*E _ LSI S L14..= /+ oS�F�td 4 NA RE E-A@ FYI P S� Aj 3 56. Gid t �.� T? AbMtSbZ Sl 'ErIT U Z5 MPAN NAI STREET: £ilZESS f� r,szAiE7P. Ptdo E ©. W6 Family momcTl %I,D AMD::: r Thr e o C>Car..v�� oTJ2I' Yt1al 11gSAN: x F9 FAL fS G' r G� TC �.SOLARRAN FT.S �E�fiiRF�1�Y17{il ckT4RCiJNfizS[A�It�2v::: 3� SOI�Ft1��FERI�EA3�iCr. L� C?7FIEK. rZ3iz: nt-0I 1414:1 5 .: z i33P i sI S/[ ss X&OW I SC01; CERA.ON' TOT v��.ut11TES OFAVORK 8y:try s� naitare trelc�s�;l: eraif ftp:eaeh:pf#lre lcil l is g:.:l: tx Ih lsr tty owner.( ��i2}rors�ed a�n��+act on the pm�x`sty owner._bell �:•'I have react z3��. pplit§gin-aiid tix :iiifeizuihon T:llxveniC3 a oorrc T'l�agxeadtlie i3spticn 6f§�roantixerlfy ss a urate agrt to saiisl. {�fh:ali agl�hatTlt 1 mil tjrdirian and tate laws dating lz7 buy a.coxsst�ueit t aulfiori .rssttlatic rTi 1 tpertmE toritr fl�L ab)V/xtxrc�i I�x for a iiozl� ces. AE ST�Tsatureol� 71i�aaTG±A enf.. / Irl. bate `�"/� f7 Sl oI'€�1t Lt AL IN�L3R lr�I(�T:ItEt,>UIRE}- m � i>ised L��tIl CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21001 HAZELBROOK DATE: 04/16/2014 REVIEWED BY: MELISSA APN: 326 28 095 BP#: *VALUATION: 1$1,800 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RES USE: p PERMIT TYPE: i WORK INSTALL N EV CHARGING STATION IN GARAGE AREA. UNIT WILL NOT ENCROACH INTO SCOPE CLEAR 20'X 20' E._ UE 11(:ind).Pleur C'hecn' 11`&c.1'lan t i? ck I>c1r. Por-nrlt F'e, Plrwlb. Permit I"ee: Ff<:( Pt'r ;1 e, 1;tas, 1I< Ta.yrs°>. Other I':u'mb Insp. C1ii7�r l tcc-Lnsp. Plsimb, hasp. 7'ee, f ce NOTE:This estimate does not includefees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 I J # Alternative Energy System Suppl. PC Fee: (j) Reg. 0 OTFO.01 hr's $0.00 $106.00 ICHRGSTA EV Charging Station PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. ® OT Q,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C.YC1PzSlr"1%{'t 111,7 /C':t".` r:LII 7r<rl.SfifllJiL 'E:'1:'. 0 Work Without Permit? 0 Yes No $0.00 Advanced Plannin&Fee: $0.00 Select a Non-Residential Building or Structure list .'�{�(17ri tC'Y11tT17t3(7 bees: � Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bida_ Stds Commission Fee: IBCBSC $1.00 r ' a $1.50 $106.00 TOTAL FEE: $107.50 Revised: 04/01/2014 OQ��NG�e�P�\Np �r0 p �c�C�,pN � <� � , E INSTALLATION SITE PLAN aid$ \G.\0(\•°�c�7 5rJ \O CIRCUIT CONDUCTORS ARE#8 AWG THWN-2 AND EQUIPMENT UND TO °,� Q�a� c° o�a too a��� ec\f\o��o yO ���a3J• GROTINACC RD NCE WITH N-2 BUILT IN ACCORDANCE WITH CEC ART.625 REQUIREMENTS. v3Coa° o � a�a aP . aye °� ` Vj\'fir \a� CEC 625.15(A)EQUIPMENT SHALL G d(C\+ �r\5� (b BE MARKED FOR USE WITH ELECTRIC .1\61 �t 60 O�Cn\ p(a VEHICLES. u CEC 62 5.2 5 UPON LOSS OF PRIMARY SOURCE @h (� OF POWER VEHICLE SHALL NOT BE ABLE TO KFEED SERVICE UNLESS COMPLYING WITH 705. �p. 21001 HAZELBROOK DRIVE A DD EDICDIC ATED 40 P/T H I1V X1004 partrne,,7 GARAGE PROPOSED EVSE LOCATION IN GARAGE r;VIEW�f) r oR N.STELLING ROAD Co)E COMPLIA MAIN SERVICE PANEL Reviewed By. NCE LOCATION ELECTRICAL PANELS NOT DRAWN TO SCALE PURPOSE OF ILLUSTRATION IS TO SHOW PROPOSED LOCATIONS OF EQUIPMENT MOUNTING. w��y�I�$ DRIVEWAY 1��H./ �i t APR 16 2014 HAZELBROOK DRIVE #;'' CUSTOMEROFFICE CO •R •N ELECTRICAL CONTRACTOR Customer Name: EC Name: W3 SOLAR ELECTRIC Address: 21001 HAZELBROOK DRIVE 3 Address: 3090 ELEANOR WAY Address: Address: City: CUPERTINO State: CA Zip: 95014 City: SANTA CRUZ 1 State: CA Zip:95065 Phone 1: 408-873-7640 Phone 2: Phone 1: 831-818-0312 License Number:955351 EVSE Installation - Single Line.Diagram volts: 240 Raceway Type: NM OR EMT Amps: 125AI WlreType: J HHN/THWN-2 Phase: —SINGLE X Line 1 Wire Size: # 8 AWG^� Space: Line 2 Wire Size: # 8 AWG^� Type: -�� Ground Wire Size: # 10 AWG` Style: 400 Electrical 4� VSE-RS Panel EVSE-RS (GFI) A product of AeroVironment 25 Linear FtU #5rtui1drn P'//VO APR I �'arie hrEp r � B comp CUSTOMER INFORMATION ELECTRICAL .- Customer Name:RAMESH JAGANATHAN EC Name: W3 SOLAR ELECTRIC Address:21001 HAZELBROOK DRIVE Address: 3090 ELEANOR WAY Address: Address: City: CUPERTINO T state: CA zip: 95014 city: SANTA CRUZ state: CA zip: 95065 Phone 1: 408-873-9640 Phone 2: Phone 1: 831-818-0312 License Number: 955351 mm The EVSE-RS Home Charging Dock charges all SAE J1772-compliant including both electric vehicle(EV) d plug-in hybrid � vehi 1 an convenience (PHEV)models—in the c i of the home garage,workplace, • AutQ"restart in even*czf" civ r a"...``. e - ndominium;apartment,or retail 0 ground fault parking structure.The Home Charging • Americans with Qrsabtli#res Aye f�Cl?A Dock safety and reliably delivers compliant tnstalla#�orr AC pourer to the vehicle's on-board • Integrates}cabke stavua: e p rota# charger and features a weather- nage resistant NEMA4 enclosure for indoor • Underwnters LaboratctLy jUL�lfstecF and outdoor installations. Pre-produerkm image shown. Production made!may vary: •,©ptianal pedestafi mount • Wrieless eommunrttaxt trat3 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.i n optional AN€1"IN � � module is used to enable WiFi,Zigbee; or cellular communication. Will be.suppartecl by` • ;Expanclmg network of7rrdepe dent _ certified,trarnecl eletricra�s* !ii' • Convei isn##�o),M. srte as sn a fs. >:=' `•` REfi r iEi y�,haga ccsr, edea and�nstallatron ��flE�N re�d�taupera4e iftd BE 1NKdNC nN =sate dtte#o a maruat STGP • =Electricians with dep F}a##ora#code and t# t r tt etez Edd to e tacle per mltEing.knowled e' REfM1t ve�ice�scira grngi#a tE}I;eking=7rgticttagewhert ��ttenfr�3�'ra s1o�n"�7nkrng, eharge tear c�roplete# r .er r3r lfasttrsed ,nkirig ptera based au faErit ty(xe *installation services available in car min areas:contactAV ror ad itlona! n WWW AeroVironment.Inc. S•�1 707 i7 SPECIFICATION EVSE-RS . Connector SAE il772 Voltage 208VAC to 240VAC . cEequency 50Hz/60Hz Current 30A max Operating Temperature -301C to 50°C Storage/Transit Temperature -40°C to 60°C Humidity Up to 95%non-condensing .... _ Dimensions 12"x 12"x 8"(approximate) Weight 10 lbs.(excl.cable) Cod Length Up to 25 available _. Enclosure NEMA 4 Regulatory Compliance JL listed,CSA and CE pending Lnformat c n an d s_ fica`.rcs sul:,iec='c charge Maximum overcurrent protection 40 amps Ventilation not required The AeroVironment EVSE meets SAE and UUcUL standards. The pilot signal is a communication link between the EVSE and the-Electric vehicle. During the initial communication signal or handshake between the car and the EVSE it is determined that the car has batteries that do not require ventilation. If it is determined that the car needed ventilation, then the EVSE would not continue and close the circuit. It is stated in the 2008 NEC Art 625.15 (B)and (A) and (B) are clearly marked on our UL label. If you have any questions Please call me Martin Young RME 626 357-9980 x 574 r t= Ventilation not required ARTICLE 625 Electric Vehicle Charging System 625.15 Markings.The electric vehicle sapply equipment shall comply with 625.15(A)through(C). (A)GeneraL All electric vehicle supply equipment shall be marked by the manufacturer as follows. FOR USE WITH ELECTRIC VEHICLES ;;tom= e [4iroi��Ya�e._ ,�` 1 be clea�Ty�arkedb�tYi���� ,�au�.. - �= _r y�� tvr Theinarking s"halliec�fe� ��i �����: (C)Ventilation Requhv&Where marking is req�ired by 625.29(D),the electric vehicle supply equipment shall be clearly marked by the maanfacturer,"Ventilation Required." The marking shall be located so as to be clearly visible after installation. NATIONAL ELEC UCAL CODE 2008 Edition SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CU06014 0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildino cDcupertino.ora Permit No. J 4 V 4 D'U `�3 Address 2_/0 Oj 12e4.41-0 d<<- P., #of Alarms Smoke: Carbon Monoxide: PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORM-ATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds $1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply:In dwelling units with no commercial power supply,alarm(s)may be solely battery operated. In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with e manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. l have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: 1AM E511 signature........................ .. .............................................Date: ................... Contlactpr Name: S Signature. 4A. �K .."........Lic.#.. .............r`.............Date: ............ .. Smoke and COform.doc revised 03118/14