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15070201CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19759 LA MAR DR CONTRACTOR: WILLOW GLEN PERMIT NO: 15070201 ELECTRIC INC OWNER'S NAME: RICHARD LI 1085 WARREN AVE DATE ISSUED: 07/28/2015 OWNER'S PHONE: 4082181765 SAN JOSE, CA 95125 PHONE NO: (408)289-9725 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ �— q INSTALL (N) 50 AMP DEDICATED EV CHARGING License Class �'� Li.. # 1 �� STATION. W ��� &Q V (ol1XkDate " / f UPGRADE (E) PANEL TO (N) 200 AMP PANEL. Contractor 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 Sq. Ft Floor Area: Valuation: $5290 performance of the work for which this permit is issued. 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 APN Number: 36910024.00 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 YS FROM LAST CALLED INSP TI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, /1R costs, and expenses which may accrue against said City in consequence of the �('S%%,/ / �II >) �M"V V �VNV I(7'V l Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source reg ati s per the Cupertino Municipal Code, Section 9.18. f J .L8 ^ RE -ROOFS: Signature Date 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. ❑ DECLARATION VOER-BUILDER Signature of Applicant: Date: I hereby affirm 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) 1, 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 C pert! o Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 50 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 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 CONSTR TION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 l5©=t� I ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1�1 I (408) 777-3228 • FAX (408) 777-3333 • buildingtatcupertino.org CUPERTINO PROJECT ADDRESS z dc, % /� �,j APN # J3bj 10 00 OWNERNAME i L A C� PH ,1� / /�P E MML eW STREET ADDRESS 9 �. /✓lam r Dr ; ✓{.- CITY, STATE, ZIP + {. -terC'�9 FAX CONTACT NAME Matt Londre PHONEE-MAB. 7 - STREET ADDRESS P.O. Box 8430 CITY, STATE, ZIP San Jose CA 951551 FAX (408)289-9725 ❑ OWNER ❑ OWNER-13UILDFR ❑ OWNER AGENT 0 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ark Londre LICENSE NUMBER 591918 LICENSE TYPE C 1 0 BUS. LIC # 15897 COMPANY NAMEWi1low Glen Electric E-MAIL mark@willowglenelectr1&.com ""'P.O. Box 8430 CITY, STATE,ZIPSan Jose, CA 95155 PHONE (408)289-972. ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ■ SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes 0 NO PROJECT IN FLOOD ZONE [I Yes ❑ No ❑ SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING Gln 2001} t� J J IN OTHER: Gi h e I ✓' FORSOLAR PANELS. NUMBER OF PANELSIUMTS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION$ 5 ,( ^ q 6— DESCRIPTION OF WORK I o J� l 1 - �1 ; eaJ4- H.A 14 -5n b(� erVi[« RECEIVED B By my signature below, I certify to each of the following: t am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I have pro ed is c rrect 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 b ' g do I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLA4ENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER a ❑ EXPRESS x w � ❑ STANDARD V Z ❑ LARGE 4 ❑ MAJOR PVApp 2011.doc revised 03/16/11 . con ��,�,���� CITY OF CUPERTINO J CA5� li '��I FFF ESTIMATOR - BUILDING DIVISION im,ADDRESS: 19759 LA MAR DR. DATE: 07/28/2015 REVIEWED BY: PAUL APN: 369 10 024 BP#: `VALUATION: 1$5,290 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex Suppl. PC Fee: ie) Reg. OT PENTAMATION PERMIT TYPE: SOLAR -RE WORK Install (N) 50 Amp Dedicated EV Charging Station. Upgrade Epanel to N 200 Amp Panel. SCOPE u Elec. Plan Check 1 0.0 1 hrs $0.001 Elec. Permit Fee: IEPERMIT Other Elec. Insp.0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Tlictrirf ot, 1 Thoco foot aro hacod nn tho nroliminnni infnrmatinn availahlo and aro nnly an octimato_ Cnntaet tho Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff' 771.,13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $109.00 Alternative Energy System 1CHRGSTA EV Charging Station / Suppl. PC Fee: ie) Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 200 1 amps $48.00 Electrical IBELEC200 Services/ Permit Fee: $0.00 Suppl. Insp. Feelo Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.69 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $142.69 $157.00 TOTAL FEE: $299.69 Revised: 07/02/2015 M Kglact fiv�c Favu.I i,,;t'ti G PO vud - Sv, mtr 1 i (+xA,,) C01MMUNITY DEVEL �P-J 1 ART BUILDING DIVI SUtN 2 5 OA t APPROVED tO `Z c CA 4-%C I WI o t -et GCI�e C 6i 3 uy r (zThis set of plans and specifications C1UST be kept at the jcb site during construction. It is unlawfiul to make any changes or alterations on same, or to deviate therefrom, without approval from the Building Official. The Stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation OFFI of any is; -)ns of any Citydin nce or State Law. CE COPT( BY DATE P ER i� 1i T ' _ __-- ,00 A(A;v,P Use l W RECEIVED JUL 2 S 2015 sY snt REVIEWED FOR CODE COMPLIANCE Reviewed By: T4n�vW rf" C Le- (A) Residential Electrical Load Calculation Site Location: Prepared by Richard U I L L O W Willow Glen Electric, Inc. L E N 19759 La Mar Drive PO Box 8430 L E C T R I C Cupertino, CA 95014 San lose, CA 95155 A I (408) 218-1765 (408) 289-9725 - off -ice General Lighting and Receptacle Loads [220.12[ 3 watts per ft" x 1,374 = 4,122 Small -Appliance Branch Circuits (220.52(A), 210.1(C)(1)] 1,Soo watts x 2 = 3,000 Laundry Branch Circuit(s) [220.52(8), [210.11(()(2)] 1,500 watts x 1 = 1,500 8,622 Fastened -In -Place Appliances Kitchen Bath(s) Outisde Miscellaneous [220.53] Refrigerator(s) = 720 Instant Hot H20(s) = Exhaust Fan(s) = Hot Tub = Dishwasher(s) = 1,200 Hood Exhaust(s) = Jacuzzi Tub(s) = Pool Equipment = Garbage Disposal(s) = 600 Gas Range(s) = 1,200 Radiant Heating = Steam Room = Microwave(s) = 1,200 Gas Oven(s) = = Central Vacuum = Trash Compactor = 480 Wine Fridge(s) = = Water Pumps = _ = 40A Circuit = Total Fastened4n-place Appliance Load 5,4470 Clothes Dryer(s) [220.54) 80% x 240 x Derating Volts Amps OR Name Plate Rating of Clothes Dryer = 780 Ranges, Ovens, Cooktops, and Other Household Cooking Appliances [220.55) 80% x 240 x = 1100 Derating Volts Amps AND/OR Name Plate Rating of Cooking Appliances = 3,600 Heating or Air -Conditioning System (Compare the heat and A/C, and omit the smaller.) [220.60] Air Handler/Furnace 115 x 5.0 - Volts Amps Air Conditioning Unit 1 55% x 240 x = Derating Volts Amps AND/OR Name Plate Rating of Air Handler & AC Units = 3,956 Total Volt -Ampere Demand Load [220.831 Greater of. Air-conditioning Equipment 4,531 x 100% = 4,531 Electric Space Heating - x 10D% = First8kVA of all other loads 8,000 x 100% = 8,000 Remainder of all other loads 10,402 x 40% = 4,161 16,692 Total Current Minimum Amperes b,i,92 - 240 - 69 ` 100 Amps (voltage) (minimum amperes) 17 Size Set ice orMinimum Size Service or Feeder [240.6(A)] currently Electric Vehicle [625.14] 125% x 240 x 40 - Derating Volts Amps Minimum Amperes with Added Load Minimum size Divide the total 78,592 r 240 119.5 Service or Feeder 200 Amps volt-amperes by (voltage) (minimum amperes) 20 w/ Added Load with added load the voltage. [240.6(A)) NOTES All References are to 2014 National Electrical Code. j[ �UPERTINO I wilding Department 4>sr if 2 8 2015 REVIEWED FOR CODE COMPLIANCE Reviewed By: Tkvlo wl w Need help finding a qualified electrician, or have questions about home charging installation? Contact Tesla at: Charging Installation@teslamotors.com or 1-877-798-3752 CUPERTINO Building Department INSTALLING YOUR 240 VOLT OUTLET! .IUL 8 2015 Every Model S includes the Mobile Connector, which is a 20 -foot long cable with RL't,/IEWED FOR CODE COMPLIANCE of adapters for standard electrical outlets. The NEMA 14-50 adapter ensures the best charging experience with the Mobile Connector. Reviewed BY! Ow Tesla recommends installing a 240 Volt outlet with a NEMA 14-50 receptacle where you plan to park your vehicle. This is a common outlet, often used for home appliances, and the electrician you hire for the installation will provide all necessary materials. You can OC charge your Model S from this outlet at a rate of 29 miles per hour. ris Below you will find all relevant information required for an electrician to complete the installation. Note: municipal building departments frequently require a permit and inspection for any electrical modifications in your home. Any licensed electrician will be able to take care of this paperwork and provide a copy for your records. DETAILS Voltage: Single phase, 208-250 Volt AC supply, 60 Hertz Current: 50 Amp circuit breaker / 40 Amp continuous current Wiring Recommendation: 6 American Wire Gauge, copper conductors only Ground Fault Circuit Interrupter: Not required • Service Disconnect: Not required Receptacle Recommendation: High quality, industrial grade receptacle Location: Install near vehicle charge port, maximum 15 feet away. Minimum 18 inches above ground. • Electric Code Compliance: Installing electrician will source permit and inspection as required by local municipal building department RECOMMENDED OUTLET LOCATIONS ONE OR TWO VEHICLE GARAGE a n ..... .......................... CHARGE PORT 1 ............................... OUTLETS O............................... T=—SLR FOR YOUR RECORDS ELECTRICAL COMPANY PHONE NUMBER EMAIL ADDRESS PERMIT NUMBER INSTALLATION DATE 3500 Deer Creek, Palo Alto, CA 94304 1 Nov. 2014 1 Version 1.0