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15040172 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11570 UPLAND WAY CONTRACTOR:SLINGSHOT POWER INC PERMIT NO:15040172 OWNER'S NAME: WU TIEN-YUE AND HWANG LAN-FEN TRUST 164 MAIN ST DATE ISSUED:04/23/2015 OWNER'S PHONE: 5103771278 LOS ALTOS,CA 94022 PHONE NO:(650)308-9055 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ��y� n INSTALL(N)EV OUTLET WITH DEDICATED CIRCUIT IN License Class , ) fLLiic.it '7 25 GARAGE Contractor S(r 540 /mW e j, Date y �� I hereby affirm rat 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 ofthe Labor Code,for the performance of the work for which this APN Number:36651003 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 QEPERMIT 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 F LLED 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 `L granting of this permit. Additionally,the applicant understands and will comply ed Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. l� RE-ROOFS: Signature Date ( 3_1 5-- 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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,ani 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. 1 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 Code,Sections 25505,25533,and 25P4. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: --- V Date: ( — S 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 1 IM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION k 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(akupertino.org ` CUPERTINO \ PROJECT ADDRESS ) 5,70 -7N# OWNERNAME PHONE _ E-11111,/, -3C ?- 'SG/ -51 0 � J STREET ADDRESS / /) 1 ('?o )/ -O CITY, STATE,ZIP L/ O/ 44 q'501 J FAX CONTACT NAME J (C,/pl�L PHONE EI-MAIL `� G•••K ,cC•9e.S y�-36/i-�� j�1 (�/'cG7eS�C5I�?�( S��].of wc� '�� STREET ADDRESS t/Z f /(./ ^ CITY,STATE,ZIP,S �!>�S �� [7D� F �✓� U�l �� ❑OWNER ❑ OWNER-BUILDER( ❑ OWNED RAGENT ❑ CONTRACTOR E CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME/�/_� S `O L OWC� LICENSE NUMBER 67 z C7 LICENSE LYPCB, BUS.LIC# COMPANY NAME J f( h C E-MAIL 77 b T T FAX ! 7 7 dII-ceves S).9/ -a)e STREET ADDRESS CITY,STATEIOS �L� PHONE /�6 o (� l ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF I;2' SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO ❑SOLAR PANELS 9"FLECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION Po D 1 ((> DESCRIPTION OF WORK By my signature below,I certify to each of the following: I am the property owner or authorized agent to act perty alf. I have read application and the information I have provided is correct. I have read the Description of Work and verify it is accur agre comply with al (cable local ordinances and state laws relating to buildin n. a horize representatives of Cupertino to enter the above-ide/nti ed prope spection purposes. Signature of Applicant/Agent: Date: f �� SUP LEMENTAL INFORMATION REQUIRED oz cE uPW sE oivY t.7=°. # OVER THE•COUNTER ..;: `, + E" EXPRESS x Q STAI�bARD Z ' a ❑ LARGE ' ❑, MAJOR PVApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 11570 UPLAND WAY DATE: 04/23/2015 REVIEWED BY: MELISSA APN: 366 51 003 BP#: *VALUATION: 1$1,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION SOLAR-RE USE: PERMIT TYPE: WORK INSTALL N EV OUTLET WITH DEDICATED CIRCUIT IN GARAGE SCOPE Mech. flan(:heck Phtinh Ilan Cheek Elec.flan(,'heck alech. 1'erwil Fee: Plumb. Fermi?Tee: Elec. Ferriir Fee tither Hench. Inv). Oiher Plumb Imp. 0,hei•t lec.Insp. tlech. Insp. Fee: Phinib. Insp. Fee: Elec. Insp. Fee: NOTE:This estimate does not includefees due to other Departments(i.e.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 LFee Resolution 11-053 f f. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Alternative Energy System Suppl. PC Fee: C) Reg. ® OT0.0 hrs $0.00 $109.00 ICHRGSTA EV Charging Station PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. ® OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: A61ministrative Fee: Work Without Permit? ® Yes (E) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Tru�>el I�ocurne ntrxlac�n Fees: Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $1.50 $109.00 TOL FEE: $110.50 Revised: 04/01/2015 P"ILOT PLANS Sheet Index CHECKED p I 2...Loadle, Index,and EV QV Char t Mounting Location S h<:;>t- 3 2...Load Calculations& EV Charger Circuit Schematic g S ...General Notes - +� 4...Level-2 Charger-Installation Mechanical Own Your Energy- 5...Level-2 Charger-Data, UL NEC, NEMA ----------------------------------------------------------- P K I N G DEPT Electric V e h � Charger Additional Installation manuals, other hardware references � iD ETIo Inst, ['14' Viermit and certifications available upon request Permit 2013 California Electrical code; Underwriters Laboratory(UL) listed charging system.As Installation: ''; catickn 40 EV Chargiaw 1.EV charging system information: Level 1 or 2, EVSE system with UL listednumber or other Imarave blot tb alsm to Tyoanl of two Car approved nationally recognized testing laboratory, in compliance with UL2202, Standard for Electric Vehicle (EV)Charging System Equipment". FZe��o •� ,T'.',t='\1 T QV y EV Charger located qn, ite}side�oF� 2.Existing electrical service panel information at the residence. Include EVSE loadand circuit tT It dv the wall from the Mai.r)�e�I�� 6 - C size to determine if electric panel upgrade is required. Provide load calculations to determine if there is adequate capacity in the existing panel. (CEC220) 2013 APPR ,r,d specifications P.IUST be kep1l at the n ;truction. It i$unlawful to make any 3.Panel upgrade and electrical wiring shall be in conformance with the 2013 California l`'r ations on same, or to deviate Electrical Code. i chars i` I therefron•, ••• :�proval from the Building Official. an and specifications SHALL NOT The Stamp��; of the violation 4.Identify if a second electric meter is required to be installed because of electricutility rate be held to Pr finance or St to Law. for EV charging. of an S.Clarify EVSE locations(garage, carport, interior,exterior,etc.) E PERMIT # 6. EVSE shall be installed-in accordance with manufacturer's guideline and must be suitable pQ� for the environment(indoor/outdoor). If the EV charging equipment is located in an area subject to physical (i.e.vehicular)damage and adequate barrier shall be installed. (i.e. 3to pLiOT PLANS CHECKED BY i 4" bollard) EV DATE 7.Submit installation guideline as part of submittal. PLANNING DEPT Panel CUPERTINO p Slingshot Power, Designer slingshot.. Equipment in this Electric Vehicle Charging SystemTitle Sheet & Sheet Index Date: 29-Mar-15 Project Details: Page Number: 164 Main St., Los Altos,CA 94022 Equipment Type Manufacturers and Model Version: 1.0 Ph: 650-308-9055 Scale: None Client: Cesar Simoniak Fax: 650-887-0345 1 Level-2 Charger Tesla Universal Mobile Project: 510-377-1278 Address: 11570 Upland Way California State Lic: 6984488 Drawn: Michael Condon City: Cupertino, California 95014 Standard Method Residential Service Calulation 1.0 General Lighting: 220.:Total 2224 Sq Ft. 6672 VA .;;,; 1 y, 200 A Small Appliance: 220.52(a) M 3Jn [2f0=�0 t 200 t"4, 3 Circuits x 1500 VA 4500 VA Laundry: 220.52(b) i A t--I '""V AX Circuits x 1500 VA 1500 VA Min=r-°urn6 A%VCi Cu Wire GENERIC Applying Demand Factors:Table 220.42 Crated 75 deg Cy , 1st 3000 VA x 100% 3000 VA 10 "L `c� ~r und u t Next 3000 VA x 35% 1050 VA ��•:•r, �A%IV 1,ro Ixaxe d;-�� 6672 Remaining VA 25% 1668 VA TOTAL.................................................................. 5718 VA 2.0 Fixed Appliances: 220.53 , 3 "It shall be permissible to apply a demand factor of 75%for four appliances other than i ca eletric ranges, clothes dryers,space heating equip,air-conditioning equip.) 0 L2 YES/NO VA Dishwasher YES 900 VA Disposer YES 600 VA Microwave YES 1125'VA Compactor NO 0,VA Pool/Spa NO 0 VA Attic Fan NO 0'VA Other 0 16 VA TOTAL................................................ 1968.75 VA -- YES/NO VA FV chaf-ger 3.0 Eletric Dryer: (5000VA) 220.55,Table 220.54 Lev&i 2 5000 VA x 100% 1 NO ` VA 4.0 Cooking Equipment:Table 220.54 Oven 7200 VA x100% YESVA Range 11000 VA 100% YESt88VA �Ut'ERTINO Col C kW Other 0 t, y VA Building DePartment GEC TOTAL.. ............................................................. 15200 8.0 ,t 5.0 Heating or A/C:220.60(non-coicident loads) VA APR AC t dad Center. Heating unit 1500 VA x 100% NO VA ELECTRICAL LOAD TOTAL It CGGE�O�p�IANCE 1-2 P�sle 50 Amp A/C Unit 6000 VA 100% YES vi VA Service Total VA= 38486.75 REviEyVEG �R Ctrcnit Breaker' S y Heating Pump 1500 VA 100% NO 0<VA VA/240= 160.36 Amps Reviewed By, (loads)............................Take Largest Load 660 6.0 Largest Motor 220.14(c)=430.24&440.6 0 VA 0 VA x 25% Xu��`-� j� 7.0 EV Charger Level 2 9600)VA YES 9600`VA Slingshot Power, Designer Equipment in this Electric Vehicle Charging System slingshotload Calculations & EV Charger Circuit Schematic Date: 2 - 11: Dat 29-Mar-15 Project Details: Page Number: 164 Main St., Los Altos,CA 94022 Equipment Type Manufacturers and Model Version: 1.0 Ph: 650-308-9055 Scale: None Client: Cesar Simoniak Fax:650-887-0345 1 Level-2 Charger Tesla Universal Mobile Project: 510-377-1278 Address: 11570 Upland Way -, California State Lic: 6984488 Drawn: Michael Condon City: Cupertino,California 95014 UNGROUNDED PANEL ❑ LEGEND POSITIVE GROUNDED PANEL ❑ NEGATIVE GROUNDED PANEL ❑ ABBREVIATIONS E)Utility Meter& MICROINVERTERS ❑ A...........Ampere Warning Label AC........Alternating Current BLDG.. Building Structure + Inverter W/Integrated CONC...Concrete. THIS PROJECT SHALL COMPLY WITH: DC.........Direct Current DC DISCONNECT THE: EGC.......Equipment Grounding Conductor 2013 CA BUILDING CODE (E)..........Existing DC DISCONNECT& 2013 CA PLUMBING VODE EMT.......Electrical Metal Tubing WARNING LABELS 2013 CA RESIDENTIAL CODE GALV....Galvanized 2013 CA ENERGY CODE GEC.......Grounding Electrode Conductor 2013 MECHANICAL CODE GND.......Ground AC DISCONNECT& 2013 CA CITY/COUNTY FIRE CODE HDG.......Hot Dipped Galvanized WARNING LABELS I..............Current California Code of Regulations Imp.........Current At Maximum Power Title 24, Par 3 Isc...........Short Circuit Current JUNCTION BOX kVA........Kilovolt Ampere Cralifornia Building Standards Commission kW..........Kilowatt LBW.......Load Bearing Wall Based on 2011 NabGnai Efeetheal Code DC COMBINER BOX& Neutral MIN........ uWARNING LABELS (N).......... tral NEUT.....Neutral NTS........Not To Scale DISTRIBUTION PANEL OC..........On Center O &WARNING LABELS PL...........Property Line " POI.........Point of Intersection PV..........Photo Voltaic LOAD CENTER& SCH........Schedule WARNING LABELS EFFECTWe SS...........Stainless Steel J�k,UAW 11 *414 STC........Standard Testing Conditions tFo► ► r�� ;.� ua+�pt +l TYP........Typical DEDICATED PV 2Pole......Grounding System(N) &GNDRTINO UPS........Uninterruptible Power Supply SYSTEM METER �U�� ent UFER......Grounding system to foundation Build i(1C1 De acfim V.............volt Vmp........Voltage at Maximum Power CONDUIT RUN ON EXTERIORF F► Voc.........Voltage at Open Circuit PLIANCE W............Watt # ; CODE C REVIEWED tOl"c OM 3R...........NEMA 3R,Raintight - CONDUIT RUN Reviewed By: f� Slingshot Power,Designer Equipment in this Electric Vehicle slingshot Charging System General Notes Date: 29-Mar-15 Protect Details: Page Number: 164 Main St., Los Altos,CA 94022 Equipment Type Manufacturers and Model Version: 1.0 Ph: 650-308-9055 Scale: None Client: Cesar Simoniak Fax:650-887-0345 1 Level-2 Charger Tesla Universal Mobile Project: 510-377-1278 Address: 11570 Upland Way 3 California State Lic: 8984488 Drawn: Michael Condon City: Cupertino,California 95014 CHARGING RATE OF 32 MILES RANGE PER HOUR AT MAX POWER The Universal Mobile Connector is ideal for road trips or as an alternative to the High Power Wall Connector. The Universal Mobile Connector is highly flexible -it includes a NEMA 14-50 adapter and 10 new dryez-s additional adapters are available for purchase.The Universal Mobile Connector enables a complete NEMA 14-30 30 10 recharge in 6 hours or less. Store the Universal Mobile Connector in the trunk for road trips,and enjoy the freedorn of plugging your Roadster into nearly any outlet, an ere. TECHNICAL SPECIFICATIONS 0 MaximumCurrent:40A NENU Ll 4-30 generators 30 to 0 Voltage: 120-240V & Maximum Power:9.6 kW -a a Cord Length.- 18 ft I-OW UNIVERSAL CONNECTOR CHARGE TIMES 0i'd dryers Charge times vary by outlet type and adapter. NENU 10-30 30 10 Breaker Charge Adapter Outlet Rating(Amps) Time-(Hours) motel AC units NEMA 6-20 20 14-5 NE 4A 14-50 RVs (hwkuted) 50 6 AC units CUPERTINO NEMA 6-15 15 19 Building Department EA, APR 2 2 2015 electrical vuelden REVIEWED FOR CODE COMPLIANCE NEMA 6-50 50 6 standard3-pron& Reviewed By: ■ hiAff Current NEMA 5-20 20 37 AC units, connnerew equipment stwuhrd 3 prong 17 NEMA 6-30 30 10 NEN4A 5-15 15 48 / Slingshot Power,Designer Equipment in this Electric Vehicle Level-2 Charger Datasheet & Information ingshc;>t Charging ystern Date: 29-Mar-15 Project Details: Page Number: 164 Main St., Los Altos,CA 94022 Equipment Type Manufacturers and Model Version: 1.0 Ph:650-308-9055 Scale: None Client: Cesar Simoniak Fax: 650-887-0345 1 Level-2 Charger Tesla Universal Mobile Project: 510-377-1278 Address: 11570 Upland Way 5 California State Lic: 6984488 Drawn: Michael Condon City: Cupertino, California 95014