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13120132 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23005 STANDING OAK CT CONTRACTOR:ROGERS ELECTRIC PERMIT NO: 13120132 OWNER'S NAME: GOLAN AVRAHAM AND OSNAT 11 AGUA VISTA CT DATE ISSUED:12/17/2013 OWNER'S PHONE: 6505800824 REDWOOD CITY,CA 94062 PHONE NO:(650)346-0981 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL 11 License Class �'�'� Lic.# 9 INSTALL EVC STATION LOCATED OUTSIDE OF SFDWL /2 �� Contractor Date / AMTS I hereb that I am licensed under the provisions of Chapter 9 (co ncing 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 tie performance of the work for which this APN Number:34250013.00 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 FROMLAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the �7 granting of this pe ition , e ant un ands and will comply Issued by: Date: with all non-po. source ion Cu unicipal Code,Section 918. RE-ROOFS: Signature Date 1Z al 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(x)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 Section3700 of thetabor 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 Cupertin cipal Code, ter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5 , 553 ,a 5 Section 3700 of the Labor Code,for the performance of the work for which this 12-111? Owner or authorized agent: ate: /,,Jpermit 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 12 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 . O&�v CUPERTINO (408) 777-3228• FAX(408)777-3333•buildingecupertino.orq PROJECT ADDRESS •� r- lir j APN# 1 OWNERNAME PHONE C-S&IA E-MAIL STREET ADDRESS'j7V7 (7A,0a, OAK C, CITY, STATE,ZIP C 15014 FAX CONTACT NAME D J PHONE LE-MAIL l D .3 VG 1��18► % iz a ,�GY r¢J/z c• f•s w� STREET ADDRESS ( CITY, ATE.ZIP FAX IUJA A* vej 711 ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 91111-"TRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME f Le LICENSE NUMBER LICENSE TYPE /_l BUS.LIC# COMPANY NAME (` e,Yyy/d} FAX yLtzC-7� � 4 � STREET ADDRESS CITY,STATE/ZIP �(y � C,1 J/ 6 PHONES Q l3y6,0-%C,1 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# 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 NO FLOOD ZONE ❑ Yes E NO ❑ SOLAR PANELS U ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANEL S.- NUMBER OF PANELS/UNITS: #KILOWATTS: TOTAL VALUATION: /6:) DESCRIPTION OF WORK 1 N a C AN C)n L 6- (cL C Xi2 il_ /`! /C5C�7rL _RECEIVED BY:' By my signature below,I certify to each of the followii m the pr o r or or ed a ct on the property owner's behalf. I have read this application and the information I have provided' Correct. a ad the scrip ' of d ify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu'Id' onstructi authori rese tives upe o to enter the above-identi ed pr perry for inspection purposes. Signature of ApplicanUAgent: Date: SUPP NTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER a F ❑ EXPRESS U ❑ STANDARD. U C ❑` LARGE MAJOR`. PYApp_2012.doc revised 06/20/12 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION FIAADDRESS: DATE: 12/17/2013 REVIEWED BY: Mendez APN: BP#: "VALUATION: $500 PERMIT TYPE: Building Permit: PLAN CHECK TYPE: Alteration/Repair PRIMARY PENTAMATION USE: SFD or.Duplex PERMIT TYPE: SOLAR-RES WORK install evc station located outside of sfdwl SCOPE E 7 fl IIII a� sad. , _ .I3 h13 1333I IU3I lyllff 1 '�' ;�- ,''- nh t Fee: ?'ltt z.l:..''£ra;azt Fee r:... .,,,';#:i.F ': Lioth£:#'Nun?;lj?sp. NOTE:This estimate does not include fees due to other Departments(Le Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These ees are based on the preffinina information available and are oidy an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Alternative Energy System Suppl.PC Fee: (F) Reg: 0 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. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes (E);No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential T uvel Doc:rgrne�,,,'iution fi'ec�:y: Building or Structure 0 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ,mu3w' � �Ts, TO $1.50 $106.00 TALFEE:= $107.50 Revised: 10/01/2013 4 i f� i f f ,. Ab I I }I 1 ©2011 AeroVironment, Inc. All rights reserved V-4 i� j 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. 1 , 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 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. i 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 I Place. No exposed live parts • 625.14 Rating: 30 amp output rating. Continuous load I 625.15 Markings: I — (A) For Electric Vehicle Use Only(Denoted on EVSE-RS Label) i — (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 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. j 625.25 Loss of Primary Source:Contactor opens upon loss of power. i I 3 I i i L INSTALLING THE EVSE-RS Specifications: I ■ 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. PhasesNumber of Freq Hz Voltage AC Current Operating Amps Temp 101 WRIN i� Power Disconnect switch Charging Clock i I distribution (if applicable) el wall stud ow 1 t i ---------------- 1 . Choose wire entry location HOLE IN REAR OF BOLE ON UNDERSIDE OF CHARGING DOCK CHARGING DOCK G It ` /� Sottorn View Rear V- 2. Attach the mounting plate I Mounting plate Large hole for conduit utility wires—1--�— 10 i o Small holes for Charging Dock mounting holes -Q mounting plate to wall stud O Flat washer Lag bolt j Wall stud �O tIo 0*----- ---------------- ------- I !1 O aE- i Wall stud 1 3. Attach the Charging Dock to the mounting plate a. Torque the screw to 40 in/Ib. Upper mounting hole Fiat washer Socket head screw i { t •-- - -------{o ------------gip 1 � i / w o _ J i 4. Wire the Charging Dock { a. Torques the,terminal block screws to 20 in/lb. { b. Torque the Grounding Strip screws to 20 in/Ib. i Terminal Block r 1 Ground Strip o Ground Wire i Two power wires r I i i i 5. Install the front cover 1 #10 Torx screws—Torque 12in/Ib f 4M # t Removing the trim ring Z 6. Complete the installation I � ------------ f j 7 $ I � 0 0 j t i s 3 1 3 t t FRONT PANEL COMPONENTS p Mm PmSiNT ,"E :harwnq ic"A is receiving START TO CHARGE POWERPRESENI'.IS ready tC 0 . �jin '.qlrg is paus ed READY TO CKMIDWE G 08 RT "�R H ;gn'�—j�- vem=oomm 0 os p L VG4K3.E COW*CUD STOP Rfcss t-.tn�-,�ak,;to-- n- prDperly 'hc v&.Icic GO nz fine, -'�'Azhe� f4 Ali of 7E r`COt:i�letE. %%KW CHAROM 71 c hi;vehicle is being hatgod. TROUBLE W: ry I Try emoving and inser-ung back m7,ttc o?'nilric H Trouble ifluminatedcafi -at 1(67!;ND 3 (877,664-2-,38:tr L RRIM BUTTON ,u-�.Dme,Josvic*on the fn�rr'he i F"a%;-c CHARGINGTHE VEHICLE C E i i ( t i T- I f r � k 3 i i veacu amozcna! o insbe' t-:to�;inrb arae.tn.- 9e+o+mo..as o �� l:rrrnnq wdl baa, n n+84e+� 1aa*: c et4rr ux eauaesm .�,. ,K�S,ntaScMk 'aNh ri e.! i, t...t L: vttti fat tii r Y { it x a S—,APT { VB*CLE CHARGWG t _ omw ='Or^ ChP 9,. a h C er I �V 12 ft I-1��'y1 �csc,,gTj a.ax ar COMMUNITY DEVEL PMENT DEPARTMENT BUILDING DM ION -CUPERTINO 2_„0sw APP OVED This set of pians and ifications MUST be kept at the 15�! job site during constructs n. It is unlawful to make any changes or alteratio is on same, or to deviate therefrom, without apprcval from the Building Official. The Stamping of this plan and specifications Si-W" l�,�T be held to permit or to I a an approvEl of cf any provisionsof any City Orth ,a FY t RATE I':1EWr'T I' 131201 .� CUPERrilVO 3: `Y uildin9 nPD rtM a enf a F 17 2013 REVIEWL, D FC UR CODE E CGMPLIANCE PIAT PLANS CHECKED BY 7;LWNIN (Z �7 13 EPT. OFFIL& DATE