15100123CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7928 WOODLARK WAY I CONTRACTOR: ANTHONY LEWIS PERMIT NO: 15100123
OWNER'S NAME: LIM HEESEON AND KIM YOUNG-HOON 11070 BIRD AVE l DATE ISSUED: 10/15/2015 1
OWNER'S PHONE: 4085002942 1 SAN JOSE, CA 95125 ] PHONE NO: (408) 217-8621
7(1 LICENSED CONTRACTOR'S DEC+L--ARATION
License Class Lic. # S
Contracto>Ir l L-2)ACDate
I hereby affirm that I a 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:
1. 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.
(�Zve and will maintain Worker's Compensation Insurance, as provided for by
ltion 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all 0VointAou ere ulations per the Cupertino Municipal Code, Section 9.18.
Date 1 v -t
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued shall
not employ any person in any manner so as to become subject to the Work '
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL (N) 50 AMP ELECTRICAL CIRCUIT FOR NEMA
14-50 OUTLET WITH DISCONNECT FOR TESLA EV IN
GARAGE
Sq. Ft Floor Area: I Valuation: $1450
APN Number: 36204046.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DS FROM LAST CALLED INSPECTION.
Issued by: Z, v(itu '�449Date: 1 O k�
RE -ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Date: — O is
C NSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building o-�cupertino.orq
151
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❑ OW?NER ❑ 0\V?vtR-BUILDER ❑ OWNER AGENT /�CONFMACTOR
❑ CON7R.ACTOR AGF.NTT
❑ ARc=,-cT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME i
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LICENSE INIANIBERT,I,CENS
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ARCIETECT/ENGIINEER?NAME
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COMPANY NAME
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CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ NO
PROJECT IN
FLOOD ZONE ❑ Yes ❑ No
❑ SOLAR PANELS
�LECTRIC VEHICLE CIi4RGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: ?NUMBER OF PANELS/UNITS: KILOWATTS (COMI,IERCIAL ONLY):
TOTAL VALUATION: 1Jc
i
DESCRIPTION OF WORK -------,p _
S G CD %k oy -Io4c 4L,
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RECEIVED BY:".�` 3r r ;
P a > 4 1
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o"\pier's behalf. I have read this
application and the inform ion I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws re ting to building co tru 'on. I authorize [eprese tatives of upertino to -eater the above -identified property for inspection purposes.
Si -nature of Icant/Agent �, � 1� �, Date:
�7 �r� c
SUPPLEMENTA R\TFORMATION REQ UIRE - =
..-
PV,4pp_201 J.doc revised 03/16/11
CITY OFUPERTINO
FEE ESTIMATOR- B ILDING DIVISION 1900)@_3
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the vreliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7j,"I3)
7928 Woodlark Way
DATE: 10/15/2015
REVIEWED BY: PAUL
ImADDRESS:
APN: 362 04 046
BP#:
*VALUATION: 1$1,450
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
117�j7. l'E'(':
PENTAMATION SOLAR -RE
PERMIT TYPE:
WORK
Install N 50 Amp Electrical Circuit for Nema 14-50 outlet with disconnect for TESLA EV in Garage
SCOPE
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the vreliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7j,"I3)
FEE
QTY/FEE
MISC ITEMS
A her'n .1 Fee'Plumb.
Permit kee:
l%It'.C. YGPt?21t Fee
Other Hech. Insp.
Mica Plumb Insp.
Other E 'Ic_ Insp.
I'lt'.'.h In 1:), I`ee:iltr7r/
117�j7. l'E'(':
Elec. Insp, Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the vreliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7j,"I3)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1� #
$109.00
Alternative Energy System
ICHRGSTA7 EV Charging Station
Suppl. PC Fee: (F) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. Q OT0
0 I
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(.: cit as tt •deli on Tax.-0Work
O
Without Permit? Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
i
TrOvel 1:7oeulnenlali.on Fees:
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bld, Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$109.00
TOTAL FEE -.T
$110.50
Revised: 10/01/2015
UST I.e� 1 2
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
-d specifications MIUST be kept at the
Ar tq
j75 S lie I u Ii ,
'r' r T changes or alterations on same, or to devia!C
therefrom, withcut approval from the Building Officio"
The Stamping of tinis plan and specific.at;ons SHALL NO
be held to permit or to be an approval of the violatio:
(� 6/
3 �� of an ovisions of any City Ordinance or State Lay..
BY LLI WN
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DATE r -- - -
PERMIT m
(;Up� �rtmen�
Building Dei
OCT 15 2015
ED FOR CODE COMPLIANCE
REVIEW
Reviewed BY.
PLANS EV .
DATE L;
PLANNING DEPf-T
CUPERTINO
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Awhony Lewis Inca
Building and Electrical
RESIDENTIAL ELECTRICAL LOAD CALCULATION SHEET
Load Calculation for Existing Dwelling Unit 220.83
1. GENERAL LIGHTING: Table 220.12
�Sq. ft. x 3 VA = -----------_ `�qs� VA
Small Appliances: 210.11 (C) (1) and (C) (2)
Q_ VA x CSU circuits = ----- VA
Laundry: 220.52 (B)
VA x 1 circuit = ------------ t�S 00 VA
Total: -1—�C 6- V A
2. FIXED APPLIANCES: 220.83 The name plate rating of the following:
A. All appliances that are fastened in place, permanently connected, or located to be on a specific circuit.
Dishwasher =
aSC) (1500) VA
Disposer =
���~l (800) VA
Compactor =
(99) VA
Microwave
(1300) VA
Spa/Pool Motor
= (12,000) VA
Attic Fan -
(1600) VA
"T'ota1:2-AV0 VA
B. COOKING EQUIPMENT: Table 220.55; Notes
CUpE
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. r Buildir7g De
�----.�� OCT
152015 parent
� ViE 5 2015
WIZ D r C�k coo,
F�eV1ev'ed C��,PUA�VCE
Col A
VA x
%=
VA
Col B
VA x
%=
VA
Col C
VA x
%=
VA
Total --------------------------- VA
C. DRYER: 220.54; Table 220.54 C
q- �OQ VAx UO %= l 60 VA
D. WATER HEATER:
VA
Total --------------------------- VA
1
Anthony Lewis Inc.
Building and Electrical
3. APPLYING DEMAND FACTORS: Table 220.83 (A) or (E3)
1" 8000 VA x 100% _--------------- Oov VA
Remaining VA x 40`%� _�__ �u VA
Total------------------------�-- VA
A/C UNIT 1 - �Oo__VA x 100% =�f, Oy VA
A/C UNIT 2 = VA x 100% -= VA
EVSE _ __ t6()U-_VA x 100% _�� VA
Total-------------------------�, A
Total of A/C [,Dads and All Other Loads: l VA
4. ELECTRICAL SERVICE:
Total VA
VA/240 volts --
Minimum Conductor size
a -
J q93 VA
Amps
Y copper
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Need help finding a qualified =have questions about �thome charging installation?
Contact Tesl binstallationCr'Ptestrir?+AloriZR br1 798-3752
wilding Depatnent
7Z 1
4.y i
MWw"t?"' OCT 15 2015
INSTALLING YOUR 240 VOLT OUTLET
REVIEWED FOR CODE COMPLIANCE
Reviewed By: G
Every Model S includes the Mobile Connector, which is a 20 -foot long cable with a set
of adapters for standard electrical outlets. The NEMA 14-50 adapter ensures the best
charging experience with the Mobile Connector.
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
charge your Model S from this outlet at a rate of 29 miles per hour.
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.
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DETAILS
I
• Voltage: Single phase, 208-250 Volt AC supply, 60 Hertz
• Current: 50 Amp circuit breaker / 40 Arnp 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
I
i
1 � I
CHARGE PORT
-- -� OUTLETS
FOR YOUR RECORDS
ELECTRICAL COMPANY
PHONE NUMBER
EMAIL ADDRESS
PERMIT NUMBER
INSTALLATION DATE
T _ rS. L, n 3500 Deer Creek, Palo Alto, CA 94304 1 Nov. 2014 1 Version 1.0