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B-2016-1764
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1764 10221 STERN AVE CUPERTINO, CA 95014-3666 (375 11 069) WILLOW GLEN ELECTRIC INC SAN JOSE, CA 95155 OWNER'S NAME: LEE MENG-KUN AND LIU SHIH-YU DATE ISSUED; 04/14/2016 OWNER'S PHONE: 408-253-3385 PHONE NO: (408) 289-9725 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ELECTRICAL Lic. #591918 Contractor WILLOW GLEN ELECTRIC INC Date 04/30/2018 X BLDG X ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL NEMA VEHICLE CHARGER IN GARAGE & (N) 50 AMP I hereby affirm under penalty of perjury one of the following two declarations: SUB PANEL NEXT TO TRANSFER SWITCH BEHIND MAIN PANEL. 1. I have and will maintain a certificate of consent to self-insure for Worker's (CLEAR 20'X 20' TO BE MAINTAINED) Compensation, as provided for by Section 3700 of the Labor Code, for the of the work for which this permit is issued. jfrformance 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. Sq. Ft Floor Area: Valuation: $3290.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 375 11 069 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM L STCALJXV INSPECTION. f_ Signature Date 04/14/2016 Issued by:MEL OWNER-BUILDER DECLARATION Date: 04/14/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 04/14/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent APPLICANT CERTIFICATION Date: 04/14/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Seca 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 04/14/2016 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&uRertlr►o.oW PROJECT ADDRESS � / ^ /] �/ / / -ieAPN # -3 �t r ® /1 C, OWNERNAME - PHONE /p`�' J3, 33eSj MAII. '. ]i J STREET ADDRESS / D z/ �,,,{, CFrY, STATE',PZI,P �, C� ef � j� 1^ FAX CONTACT NAME / 1PHONE Mark Londre (4408)208)2 E-MAIL89-9725 office @willow lenelectric.corn STREET ADDRESS P. O. Box 8430 CITY, STATE, ZIP San Jose, CA 95155 1 FAX (408)289-9725 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT SeCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Mark Londre LICENSE NUMBER 591918 LICENSE TYPE C-10 BUS. LIC# 15897 CoMPANYNAME Willow Glen Electric, Inc. E-MAIL office@willowglenelectric.com FAX (408)289-9725 STREET ADDRESS P. O. Box 8430 CITY, STATE, ZIP San Jose, CA 95155 PHONE (408)289-9725 ARCHITECT/ENGINEER NAME N/A LICENSE NUMBER BUS. LIC # COMPANY NAME STREET ADDRESS E-MAIL FAX CITY, STATE, ZIP I PHONE USE OF Vj SFD Or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE:. ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No El SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HE�AJVG, ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY Z2110TOTAL VALUATION: 7 (�% DESCRIPTION OF WORK L• l Electric Vehicle Charging Circuit: (T3 3 D ( d,( -,c u4 e% Uj _�a,�,r „ ,,.� . � --5-� ��Lc�.cx�.c. Li�.ct.� c' S -3 © �1?-�/�G�Iiau►.u► . &F-1 WIN CI By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property oewrwr Tsbehalf. I have read this application and the information 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 relating to building construction. IIaauthorize � representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent:/%jLa iS /, ltYl2iK� Date: — 2 �� SUPPLEMENTAL INFORMATION REQUIRED P VApp_2 011. doc revised 03116111 Install one 240V Manual Transfer Switch behind the main electrical Mike Lee panel in the garage with a 50 Amp circuit. This manual transfer 10221 Stern Ave. switch will provide power for either an existing 240V 50AAC unit, or Cupertino, CA 95014 a new 2 -space sub panel powering an new 30 Amp NEMA 14-30 (408) 636-3671 COM(�'1e.4�ei-taclFalf&LEV1l\(3'�t�rig" ART MENT BUILDING DIVISION - CUPERTINO Noted tha" %P@la �a-fgeQvill maintain a 20' --s - : inside. This set of plans and specifications N ;ST be kept at the jab site during construction. It is unlawful to make any � - � PAINS KE® BY changes or alterations on sarne, or to deviate �� therefrom, without approval from the Building Official, , .;�� The Stamoinq of this plan and specif,, a5ons SHALL NCT�m� ��� `V - � 200A Main Panel (E) ' CO"""' w/ 50A breaker (E) 0 h F yFFIC" 240V Manual 240V Sub Panel (N) w/ 30A breaker (N) Transfer Switch (N) NEMA 14-30 (N) 3/4" EMT w/ 3 - #6 THWN conductors (N) 1 #10 THHN ground 199 EMT w/ 3 - #6 THHN conductors for Xfer switch 3/4" EMT w/ AC Unit (E) 2 - #6 THHN backfeeding AC 3 - #10 THWN conductors (N) 1 - #10 THHN -qround 1 - #10 THHN ground Residential Electrical Load Calculation - TRANSFER SWITCH POWERING EV, NOT AC Site Location: Prepared by a irD Mike Lee Willow Glen Electric, Inc. LEN 10221 Stern Ave. PO Box 8430 ® L E -C T R I C Cupertino, CA 95014 - San Jose, CA 95155®� (408) 636-3671 (408) 289-9725 - offic General Lighting and Receptacle Loads [220.12] = 3 watts perft2 x[:�r 10,707 Small -Appliance Branch Circuits [220.52(A), 210.1(0)(1)] 1,500 watts x = 3,000 Laundry Branch Circuit(s) [220.52(B), [210.11(C)(2)] 1,500 watts x = 1,500 15,207 Fastened -In -Place Appliances [220.53] Kitchen Bath(s) Outisde/Miscellaneous Refrigerator(s) = 960 Instant Hot H20(s) = Exhaust Fan(s) = Hot Tub = Dishwasher(s). = 1,200 Hood Exhaust(s) = Jacuzzi Tub(s) = 1,800 Pool Equipment = Garbage Disposal(s) = 720 Gas Range(s) = Radiant Heating = Pump House = Microwave(s) = 1,200 Gas Oven(s) = Steam shower = 9,000 H2O Pump = 3,600 Trash Compactor = Wine Fridge(s) = Sauna = 9000 Vacuum = 1,440 Steamer = _ = Garden Shed = Total fastened -in-place Appliance Load 28,920 Clothes Dryer(s) [220.54] 80% x 240 x 0. Derating Volts Amps. 5,000 OR Name Plate Rating of Clothes Dryer .Ranges, Ovens, Cooktops, and Other Household Cooking Appliances - [220.55] 80% x 240 x 100 _ Derating Volts Amps 26,400 AND / OR Name Plate Rating of Cooking Appliances Heating or Air -Conditioning System (Compare the heat and A/C, and omit the smaller.). [220.60] Air Handler/Furnace 115 x 6.0 - Volts Amps Air Conditioner 55% x 240 x 30 - 4,650 Derating Volts Amps AND/OR Name Plate Rating of Air Handler & AC Units = Total Volt -Ampere Demand Load [220.83] Greater of. Air-conditioning Equipment 4,650 x 100% = 4,650 Electric Space Heating - x 100% = First 8kVA of all other loads 8,000 x 100%. = 8,000 Remainder of all other loads 67,527 x 40% = 27,011 39,661 Total Current Minimum Amperes 39,661 _ 240 = 165.3 Current MinimumI 200 Amps ' (voltage) (minimum amperes) 17 Size Service or Feeder [240.6(A)] currently Electric Vehicle [625.14] 125% x 240 x 24 - Continuous Load Volts Amps 7,200 Minimum Amperes with Added Load Divide the total 46,861 - 240 = 195.3 Minimum Size Service 20 or Feeder w/ Added 200 Amps volt-amperes by (voltage) (minimum amperes) Load [240.6(A)] with added load.. the voltage. — NOTES All References are to 2014 National Electrical Code. Building Department 14 2016 REVIEVVED OR CODE COMPLIANCE Reviewed 8 � _._ tr l a ClipperCreek, Inc. Innovative Infrastructure for Electric and Hybrid Vehicles User's Manual Model LCS LCS User's Manual PLEASE NOTE This user's manual includes the latest information at the time of printing. ClipperCreek, Inc. reserves the right to make changes to this product without further notice. Changes or modifications to this product by other than an authorized service facility may void the product warranty. If you have questions about the use of this product, contact your customer service representative. Refer to the Customer Support section located in this guide. Please visit ClipperCreek's Website @ www.clippercreek.com LCS User's Manual, Version 12, July 2015 LCS User Manual 07292015 vl2.pdf Copyright C 2015. ClipperCreek, Inc. All rights reserved. Printed in the USA. LCS User's Manual CONTENTS IMPORTANT SAFETY INSTRUCTIONS .................................... 5 ADDITIONAL SAFETY INFORMATION ................................... 7 FCCINFORMATION.................................................................... 8 OPERATION.................................................................................. 8 THE LCS FRONT PANEL............................................................. 9 INSTALLATION..........................................................................10 SERVICE CONNECTIONS...................................................10 MOUNTING PROCEDURES................................................14 This page intentionally left blank. MOUNTING THE CONNECTOR HOLSTER..................16 WIRING INSTRUCTIONS (Hardwired LCS).......................17 RECEPTACLE INSTRUCTIONS.......................................18 GROUNDING INSTRUCTIONS..........................................19 MOVING & STORAGE INSTRUCTIONS.................................19 MAINTENANCE......................................................................20 CUSTOMER SUPPORT............................................................. 20 SPECIFICATIONS....................................................................... 21 WARRANTY INFORMATION ................................................. 22 LCS User's Manual IMPORTANT SAFETY INSTRUCTIONS Carefully read these instructions and the charging instructions in your vehicle owner's handbook before charging your electric vehicle. The following symbols may be found in this manual or on labels affixed to the charge station:' NOTE This means pay particular attention. Notes contain helpful suggestions. Cela signifie accorder une attention particuliere. Les remarques contiennent des suggestions utiles. Q• CAUTION: This symbol means be careful. You are capable of doing 1 something that might result in damage to the equipment. ATTENTION: Ce symbole signifle etre prudent. Vous etes capable de faire quelque chose qui pourraitcauser des dommages a I'dquipement. ©WARNING: This symbol means danger. You are in a situation that could cause bodily injury. Before you work on any electrical equipment, be aware of the hazards involved with electrical circuitry and standard practices for preventing accidents. AVERTISSEMENT: Ce symbole signifle danger. Vous etes dans une situation qui pourrait causer des blessures corporelles. Avant de travailler sur un equipement dlectrique, etre conscient des dangers prdsent6s par les circuits electriques et les pratiques courantes de prevention des accidents. Instructions Pertaining to a Risk of Fire or Electric Shock When using the the LCS, basic electrical safety precautions should be followed: • Use this charge station to charge electric vehicles equipped with an SAE -J1772' charge port only. Consult the vehicle owner's manual to determine if the vehicle is equipped with the correct charge port. • Make certain the charge station SAE -J17721 charge cable is positioned so it will not be stepped on, tripped over, or otherwise subjected to damage or stress. • This product contains no user serviceable parts. Consult the Customer Support section in this manual for service information. Do not attempt to repair or service the charge station yourself. • Do not operate your charge station if it or the SAE -J1772'"' charge cable is physically open, cracked, frayed, or otherwise visibly damaged. Contact your Service Representative for service immediately. Consult the Customer Support section in this manual for information on the Service Representative in your area. Page 5 LCS User's Manual • Not for use in commercial garages where a COMMERCIAL GARAGE is defined as a facility (or portion thereof) used for the repair of internal combustion vehicles in which the area may be classified due to flammable vapors being present (such as from gasoline.) • Do not place fingers inside of the coupler end of the SAE -J17720' charge cable. • Do not allow children to operate this device. Adult supervision is mandatory when children are in proximity to a charge station that is in use. Ipstructions se Rapportant a un Risque d'Incendie on de Choc Electrique Lorsque Putilisation de la LCS, pr6cautions fondamentale de sdcuritd dlectrique doivent etre suivies: • Utilisez cette station de recharge pour charger les vdhicules,dlectriques dquip6s d'un SAE -J1772° port de recharge seulement. Consultez le manuel du propridtaire du Whicule afin de d6terminer si le Whicule est dquipd d'un correcte port de recharge. • Assurez-vous que le SAE -J1772'"' cable de recharge sur la station de recharge est positionne de telle sorte qu'il ne sera pas pidtind, accrochd plus de, ou autrement endommagd ou de subir le stress. • Ce produit ne contient aucune pidce rdparahle par 1'utilisateur. Consultez la section Support a la Client6le dans ce manuel pour obtenir des informations de service. N'essayez pas de rdparer on d'entretenir la station de recharge vous-meme. Ne faites pas fonctionner votre station on le cable de recharge si elles sont physiquement ouverte, fissurd, effiloche, on autrement visiblement endommagd. Contactez votre representant du service pour service immddiatement. Consultez la section Support a la clientele dans cc manuel pour obtenir des informations sur le representant du service dans votre rdgion. • Ne pas utiliser dans les garages commerciaux ou un garage commercial est ddfini comme une installation (ou une partie) utilise pour la reparation de Whicules a combustion interne dans lequel la zone pent etre class6e•en raison de vapeurs inflammables dtantprdsents (Tels que de P essence.) • Ne posez pas les doigts a l'int6rieur de 1'extr6mite du SAE -J17721 coupleur du cdble de recharge. • Ne pas laisser les enfants utiliser cet appareil. Supervision d'un adulte est obligatoire lorsque des enfants sont a proximit6 d'une station de recharge qui est en cours d'utilisation. Page 6 LCS User's Manual ADDITIONAL SAFETY INFORMATION QWARNING: Tum off input power to your charge station at the circuit breaker panel before servicing or cleaning the unit. AVERTISSEMENT: Couper ]'alimentation d'entrde a votre station de recharge sur le panneau de disjoncteur avant de nettoyer ou de rdparer Pappareil. NOTE VENTILATION: Some electric vehicles require an external ventilation system to prevent the accumulation of hazardous or explosive gases when charging indoors. Consult the vehicle owner's manual to determine if your vehicle requires ventilation during indoor charging. VENTILATION: Certains vdhicules diectriques ndcessitent un systdme de ventilation externe pour dviter Paccumulation de gaz explosifs ou dangereux lors de la charge a I'intdrieur. Consultez le manuel du propridtaire du vdhicule pour ddterminer si votre vdhicule ndcessite une ventilation quand le recharge en salle. NOTE Vehicles which conform to the SAEVI7721 standard for communication can inform the charge station that they require an exhaust fan. The LCS is not equipped to control ventilation fans. Do not charge the vehicle with the LCS if ventilation is required. Vdhicules qui sent conformer a la norme SAE -J1772"' de communication peuvent informer la station de recharge qu'ils ndcessitent un ventilateur d'extraction. Le LCS n'est pas dquipd pour contrBler les ventilateurs. Ne chargez pas le vdhicule avec les LCS si la ventilation est ndcessaire. A1CAUTION: DO NOT CHARGE a vehicle indoors if it requires ventilation. Contact your Service Representative for information. ATTENTION: NE PAS RECHARGER un vdhicule a l'intdrieur si it ndcessite une ventilation. Contactez votre reprdsentant de service pour plus d'informations. Save these instructions for future reference. 1 Conser®,ez ces instructions pour reference future. LCS User's Manual FCC INFORMATION This device complies with Part 15 of the FCC rules. Operation is subject to the following two conditions: (1) This device may not cause harmful interference, and (2) This device must accept any interference received, including interference that may cause undesired operation. This product has been designed to protect against Radio Frequency Interference (RFI). However, there are some instances where high powered radio signals or nearby RF -producing equipment (such as digital phones, RF communications equipment, etc.) could affect operation. If interference to your charge station is suspected, we suggest the following steps be taken before consulting your ClipperCreek Sales and Service Representative for assistance: 1. Reorient or relocate nearby electrical appliances or equipment during charging. 2. Turn off nearby electrical appliances or equipment during charging. CAUTION: Changes or modifications to this product by other than an authorized service facility may void FCC compliance. • ATTENTION: Modifications apportdes a ce produit par quiconque autre qu'un centre de service autorisd peut annuler la conformitd FCC. OPERATION The LCS Electric Vehicle Charging Station is a compact wall -mounted charging station that provides the Plug-in Hybrid or Battery Electric Vehicle (together Plug -In Electric Vehicles, or "PEV") user with a safe and manageable link be- tween the power grid and the PEV. Both hardwired (LCS) and NEMA plug - equipped (LCS-P) versions are available. The LCS is very easy to use. Just unwrap the SAE -J1772- charge cable and plug the charge coupler firmly into the vehicle's charge port. Normally, the vehicle will immediately request a charge using a special commu- nication line in the cable. Within a few seconds the green "Charging" light on the face of the LCS will tum on and the charging cycle will begin. After an av- erage driving day the vehicle battery pack will require several hours to recharge completely. Charging overnight is the most convenient way to maintain healthy batteries and ensure the vehicle's full range will be available for the next day. When the vehicle has stopped charging the green "Charging" light on the LCS will tum off. To remove the charge coupler once a charge cycle has completed (or to interrupt a charge in progress) press and hold down the latch release lever on the charge coupler handle then unplug the charge coupler from the vehicle charge port. Page 7 Page 8 LCS User's Manual THE LCS FRONT PANEL Amber The front panel on the LCS has four indicator lights: Red Red LCS Modele POWER (yellow), indicates that power is available riO�POWER �CHARGING to the LCS. I�lPOW[P rPULr CHARGING (green), indicates that the vehicle ��SSGWAPG> G Frv�T is requesting a charge and AC power is currently LED applied to the vehicle. Fault LED POWER FAULT (red), indicates that the LCS is C13 not wired correctly. The problem can be due to 0 improper grounding or a missing Earth Ground. CLP R ECK The wiring should be examined by a qualified No power to EVSE. Check circuit .. electrician. ,.. CI ECTRIE VEHICLE CMGRGE STATION CHARGING FAULT (red), indicates that the LCS Hicw PGWER is unable to communicate with the vehicle correctly, Breaker. or a safety fault condition has been detected by the Figure 1- Front Panel unit, ort Table i - Front Panel LED Information Page 9 LCS User's Manual INSTALLATION: SERVICE CONNECTIONS CAUTION: To reduce the risk of fire, connect only, to a circuit provided with the appropriate maximum branch circuit overcurrent protection in accordance with the National Electrical Code, ANSI/NFPA 70 (US) or the Canadian Electric Code C22.2 NO. 280-13 (Canada). ATTENTION: Pour rdduire le risque d'incendie, de se connecter uniquement a un circuit fourni avec le approprid circuit,de derivation protection maximale contre les surintensitds, en conformite avec le Code National diectriqueANSI/NFPA 70 (US).ou Code Canadien de_I'dlectricitd C22.2 NO. 280-13 (Canada). Amber Green Red Red LCS Modele # Power Charging Power Charging Fault Condition. 15A LED LED Fault LED Fault LED LCS-20P+NEMA L6 -30P 1 off orf off oft No power to EVSE. Check circuit 50A NEMA6-50R LCS-20P+NEMA 14 -SOP 50A - NEMA 14-50R Breaker. 2 ON off ort Off Not Plugged into the EV or the EV 30A NEMA 14-30R LCS-25P + NEMA 6-50P 50A NEMA 6-50R I is not ready to charge. 3 ON ON ort at Charging, enabled, power is applied to the vehicle 4 ON Off ON- not °g Improper grounding or ground is blinking not present. 5 ON off Off ON -not Problem with EV communications. blinking I Disconnect and restart'. 6 ON Off off blinking EV ground fault trop. Check vehicle connection. 7TON off bikiking (clinking Internal EVSE fault. Cal for service. Table i - Front Panel LED Information Page 9 LCS User's Manual INSTALLATION: SERVICE CONNECTIONS CAUTION: To reduce the risk of fire, connect only, to a circuit provided with the appropriate maximum branch circuit overcurrent protection in accordance with the National Electrical Code, ANSI/NFPA 70 (US) or the Canadian Electric Code C22.2 NO. 280-13 (Canada). ATTENTION: Pour rdduire le risque d'incendie, de se connecter uniquement a un circuit fourni avec le approprid circuit,de derivation protection maximale contre les surintensitds, en conformite avec le Code National diectriqueANSI/NFPA 70 (US).ou Code Canadien de_I'dlectricitd C22.2 NO. 280-13 (Canada). LCS Model Circuit Breaker Rating Receptacle. Type LCS Modele Calibre de Qisjoncteur Prise Electrique LCS-10 (Hardwired) 10A n/a LCS-15 (Hardwired) 15A n/a LCS-20 (Hardwired) .,. 20A n/a LCS-20P+NEMA L6 -30P 30A NEMA L6 -30R LCS-20P+NEMA 14-30P 30A NEMA 14-30R LCS-20P + NEMA 6-50P 50A NEMA6-50R LCS-20P+NEMA 14 -SOP 50A - NEMA 14-50R LCS-25 (Hardwired) 25A., - n/a LCS-25P + NEMA L6 -30P BOA NEMA. 1.6-3011 LCS-25P+ NEMA 14-30P 30A NEMA 14-30R LCS-25P + NEMA 6-50P 50A NEMA 6-50R LCS-25P+NEMA 14-50P 50A NEMA 14-50R CAUTION: This is a single-phase device Do not connect all three phases of a 3-phase feed !ll You may use any two phases of a three- phase wye-transformer feed. The center-pointofthe three phases (usually used as Neutral) must be grounded somewhere in the system. A Neutral connection is not required by the LCS. Only Line 1, Line 2, and Ground are required, as shown in Figure 3. ATTENTION: II s'agit d'un anpareil monophase. Ne pas relier toes les trois phases d'une alimentation triphasee!!! Vous pouvez utiliser les deux phases d'un triphasd en dtoile transformateur alimentation. Le point central des triphasd (gdndralement utilise comme Neutre) doit etre mis a la terre quelque part dans le systdme. Une connexion Neutre n'est pas exigde par la LCS. Seulement ligne 1, ligne 2, et Mise 6 la Terre sont ndcessaires, comme le montre la Figure 3. Q1 CAUTION: The two phases used must each measure 120V to Neutral. Earth Ground must be connected to Neutral at only one point, usually at the service entry breaker panel. ATTENTION: Les deux phases utilisdes doivent mesurer chaque 120V 6 Neutre. Mise a la terre doit etre connectd an Neutre en un seul point, generalement A Fentrde panneau de disjoncteurs de service. Page 10 LCS User's Manual A1CAUTION: If a 240V 3-phase feed is from a Delta -connected secondary, the leg used must have a center tap. That tap must be Grounded. Only the two phases either side of the center -tapped leg can be used. See Figure 4 below. ATTENTION: Si une alimentation a triphas€ 240V provient d'un triangle connectd secondaire, la homes utilisde doit avoir un centre - tap. Que la tap doit etre Mise a la Terre. Seuls les deux phases l'une ou I'autre cdte du centre tapped brancher peut etre utilisd. Voir la Figure 4 ci-dessous. ACAUTION: Warranty is void if this unit is not wired properly ATTENTION: La garantie est annul& si cette unite n'est pas correctement cable WARNING: Only a qualified electrician should perform the installation. The installation must be performed in accordance with all local electrical codes and ordinances. AVERTISSEMENT: Seul un electricien qualifie doit effectuer P installation. U installation doit etre effectude conformement a tous les codes electriques locaux et des ordonnances. Only 3 wires are connected, but care must be taken that the service transformer secondary connection is definitely known, and the 3 wires from the main circuit breaker panel are connected and labeled correctly. Figures 2, 3, and 4 below show the most common service transformer secondary wiring formats. Notice that Ll, L2, & Ground are labeled on each diagram. Those transformer outputs correspond to the same inputs on the LCS. Also, each of the two 3-phase diagrams shows an L3 output, which is not used. Do not connect all three Phases of 3-phase secondary to the LCS This is a single-phase device. The Neutral at the service panel must be connected to Earth Ground somewhere in the system on gm of the three connection arrangements. Ground -fault protection is not possible unless the Neutral (center -tap on the service transformer) is connected to an Earth Ground. If no Ground is provided by the electrical service, a grounding stake must be driven into the ground nearby, following local electrical codes. The grounding stake must be connected to the ground bar in the main breaker panel, and Neutral connected to Ground at that point. AWARNING: Local electrical codes must always be followed when installing the grounding stake. AVERTISSEMENT: Les codes electriques locaux doivent toujours etre respectees lots de ('installation du piquet de mise a la terre. Page 11 LCS User's Manual The following diagrams illustrate the three service transformer secondary connections most common in North America. GROUND Figure 2 - 220124OV Single Phase L3 (NOT USED) 20 V NEUTRAL (NOT USED) GROUND Figure 3 -208V3 -Phase, Wye -Connected NOTE With a wye-connected secondary, any two of the legs can be used to provide 208V to the LCS. For example, Ll & L2, or Ll & L3, or L2 & L3. Leave the unused leg open. Do not connect it to a Neutral bar, or to Ground. Be sure the center point is Earth Ground somewhere in the system. Avec un transformateur etoile-connectd secondaire, deux des lignes peut etre utilise pour fournir 208V a la LCS. Par exemple , Ll & L2, on Ll & L3, ou L2 & L3. Laissez la borne inutilisde ouverte. Ne le connectez pas $ un bar Neutre, ou a la Mise a la Terre. Assurez-vous que le point central est Mis a la Terre quelque part dans le systeme. Page 12 LCS User's Manual L2 GROUND Figure 4 - 240V 3 -Phase, Delta -Connected, with center -tap on one leg CAUTION: With the delta connection, one leg must be center -tapped. Only the two phases on either side of the center tap can be used. The two phases must both measure 120V to Neutral. The third line (L3) of the delta is 208V, with respect to Neutral, and is sometimes referred to as a "stinger". Do not use this third line! Consult the transformer manufacturer's literature to be sure the single leg can supply the required power. ATTENTION: Avec la connexion triangle, une borne doit etre centre - tapped, et seulement les deux phases d'un cotd ou de Fautre du centre tap peut etre utilisd., Les deux phases doivent mesurer 1.20V u Neutre. Ta troisi6me ligne (L3) du delta est 208V, par rapport a la position Neutre, et it est parfois ddsignd comme un "stinger". Ne pas utiliser ce troisiPme li2nel' Consultez la documentation du transformateur fabricant pour etre sOr du home unique pent foumir la puissance requise. Page 13 LCS User's Manual CAUTION: A 37phase delta -connected transformer secondary without a center -tap on one leg cannot be used with the LCS: No "Neutral" point is available to be connected to ground for ground -fault protection. The LCS will not allow the contactor to close if it does not sense the presence of a Ground wire connected to a "Neutral' point on the transformer secondary. ATTENTION: Un triphasd triangle-connectd transformateur secondaire sans centre -tap sur le terminal ne pent pas etre milisd avec la LCS. Aucun point "Neutre" est disponible pour etre connectd u Mise a la Terre pour protection de ddfaut a la terre. Le LCS ne permettra pas le contacteur de fenner si elle ne ddtecte pas la prdsence d'un fil de Masse connectd a un point "Neutre" sur le secondaire.du transformateur. , MOUNTING PROCEDURES Locate the wall mounting position of the EVSE: • On the hardwired LCS, the three service conductors are shielded by three feet of flexible conduit. The LCS must be positioned such that this conduit can reach a nearby service panel or junction box. • On the plug-in LCS-P, the NEMA plug head is connected by nearly one foot of cable to the top side of the LCS-P. The LCS-P must be positioned such that this plug can safely be inserted into a wall -mounted NEMA socket. • Position the bottom of the charge station at a comfortable height and at least 18 inches above the ground. Ensure that the LEDs on the front panel of the EVSE can clearly be seen by anyone who will be operating the device. • The LCS has four mounting holes spaced in a 2" wide by 10" tall rectangular pattern. Use a template to mark hole locations on the wall. QWARNING: For safety, always turn off input power to the charge station at the circuit breaker panel prior to plugging it in or wiring it to the service lines. Likewise, turn off the circuit breaker prior to unplugging it or disconnecting the unit from the service lines. AVERTISSEMENT: Pour sdcuritd, toujours desactiver le courant d'entrde de la station de recharge an niveau du disjoncteur du panneau avant de le brancher on de cdblage a les lignes de service. De meme, coupez le disjoncteur avant de le ddbrancher on ddconnecter l'unitd a partir des lignes de services. Page 14 LCS User's Manual For Hollow -Wall Construction: • Place the unit such that at least two (but preferably all four) mounting holes can take advantage of solid structural framing inside of the wall or a strong wall surface such as plywood. • For any remaining mounting holes which do not have a solid mounting structure (such as drywall without a solid backing) it will be necessary to use proper anchoring hardware such as drywall toggles or molly bolts. Figure 5 - Mounting the LCS to a hollow wall For Solid -Wall Construction: • To secure the unit in concrete, pre -drill appropriately sized holes and use multi -set or wedge anchor hardware at all four mounting points. • To secure the unit in brick or stone, pre -drill appropriately sized holes and use multi -set or wedge anchor hardware at all four mounting points. Machine screw size 410 hardware is recommended for mounting the LCS. Screw shafts of at least 2" are recommended. The LCS mounting holes are 3/16" in diameter, so ensure that the screw heads do not exceed this size. Place appropriately sized washers between the screw heads and the LCS enclosure mounting flanges. Page 15 LCS User's Manual MOUNTING THE SAE-J1772TM CONNECTOR HOLSTER The SAE-J1772TM connector holster comes standard to provide a convenient, protective housing for the SAE-J1772TM connector head when it is not in use. • The SAE-J1772TM connector holster should be placed so that users have easy and safe access to the SAE-J1772TM connector. • For indoor installation, mount the SAE-J1772Tm connector holster between 18 and 48 inches above the ground or grade. • For outdoor installation, mount the SAE-J1772TM connector holster between 24 and 48 inches above the ground or grade. • The SAE -J1 772"m connector holster has two vertically aligned mounting holes spaced 5.45" apart, one each on the enclosure top and bottom. Use a ruler or template to mark hole locations on the mounting surface. • The vertical alignment of the LCS and SAE-J1772TM connector holster mounting holes allows for the convenient mounting of both components onto the same post or wall structure. For example, the holster may be mounted directly above the LCS. • Place the SAE-J1772TM connector holster such that both mounting holes can take advantage of solid structural framing inside of the wall or a strong wall surface such as plywood. • A set of exterior wood screws and stainless steel washers are included for the purposes of mounting the SAE -J 1772TM connector holster to a wooden surface. • For mounting to a solid surface such as concrete, brick, or stone, alternate hardware may need to be procured. Examples of solid -wall mounting hardware include multi -sets, wedge anchors and sleeve anchors. Use the type of mounting hardware most appropriate for the supporting structure. To �o Figure 6 - Mounting the holster using the exterior wood screws and washers Page 16 to LCS User's Manual WIRING INSTRUCTIONS (Hardwired LCS) Route the LCS conduit to a nearby service panel or junction box. Use the included 114" trade size watertight fitting to provide a moisture -resistant seal with the service panel or junction box. If necessary, drill a 1/2" diameter hole to accommodate the liquid -tight fitting or use the included 1/4" NPT to 1/2" NPT thread reducer kit. Z NOTE Before connecting the LCS service conductors, please carefully read the section of this manual titled Service Connections on page 6. If you are unsure of the type of power provided at the service panel, please consult with your local utility or call your Service Representative for assistance. Figure 7- Wiring the LCS Vert: Mise a la Terre in a junction box Noir: Ligne 1 (120VAC a Mise a la Terre) Rouge: Ligne 2 (120VAC u Mise a la Terre) Page 17 LCS User's Manual RECEPTACLE INSTRUCTIONS (Plug -In LCS-P) The LCS-P is fitted with one of the following NEMA plugs: NEMA L6 -30P NEMA 14-30P NEMA 6-50P NEMA 14-50P The plug extends from the top of the LCS enclosure. Regulations limit this plug to a maximum of12 inches in length. For this reason, the LCS-P must be mounted below the NEMA receptacle and must also be located within 12 inches of it. The NEMA 14 -50P,14 -30P, and 6-50P configurations, the ground pin is located at the top position of the plug. With this in mind, it is recommended that a NEMA 14-50R 14-30R, or 6-50R receptacle be oriented accordingly, such that the ground socket is at the highest point. Figure 8 - Preferred orientation of the NEMA receptacles above the LCS-P NEMA L6 -30R ty Grotenl UMGround O q O NEMA 14-30R Page 18 Grotutd NEMA 06-SOR Grol®md O NEMA 14-SOR NOTE The three LCS service conductors use stranded 12AWG, 75oC copper wire. The insulation of each conductor is color coded for standard 240VAC installation: Green: Ground Black: Line 1 (120VAC to Ground) Red: Line 2 (120VAC to Ground) Les trois conducteurs service la LCS utiliser multibrins 12 AWG; 751C fil de cuivre. U isolation de chaque conducteur est un code couleur pour une installation standard de 240 V CA: Figure 7- Wiring the LCS Vert: Mise a la Terre in a junction box Noir: Ligne 1 (120VAC a Mise a la Terre) Rouge: Ligne 2 (120VAC u Mise a la Terre) Page 17 LCS User's Manual RECEPTACLE INSTRUCTIONS (Plug -In LCS-P) The LCS-P is fitted with one of the following NEMA plugs: NEMA L6 -30P NEMA 14-30P NEMA 6-50P NEMA 14-50P The plug extends from the top of the LCS enclosure. Regulations limit this plug to a maximum of12 inches in length. For this reason, the LCS-P must be mounted below the NEMA receptacle and must also be located within 12 inches of it. The NEMA 14 -50P,14 -30P, and 6-50P configurations, the ground pin is located at the top position of the plug. With this in mind, it is recommended that a NEMA 14-50R 14-30R, or 6-50R receptacle be oriented accordingly, such that the ground socket is at the highest point. Figure 8 - Preferred orientation of the NEMA receptacles above the LCS-P NEMA L6 -30R ty Grotenl UMGround O q O NEMA 14-30R Page 18 Grotutd NEMA 06-SOR Grol®md O NEMA 14-SOR LCS User's Manual GROUNDING INSTRUCTIONS This product must be grounded. If this product should malfunction or break down, grounding provides a path of least resistance for electric current to reduce the risk of electric shock. For the hardwired LCS: The hardwired LCS is equipped with three service conductors shielded by three feet of flexible conduit. This product must be connected to a grounded, metal, permanent wiring system, or an equipment -grounding conductor must be run with the circuit conductors and connected to the ground lead on the product. For the plug-in LCS-P: The plug-in LCS-P is equipped with a cord having an equipment grounding conductor and a grounding plug. The plug must be plugged into an appropriate outlet that is properly installed and grounded in accordance with all local codes and ordinances. ©WARNING: Improper connection of the equipment -grounding conductor may result in a risk of electric shock. Check with a qualified electrician if doubt exists as to whether the product is properly grounded. Do not modify the plug provided with the product — if it will not fit the outlet, have a proper outlet installed by a qualified electrician. AVERTISSEMENT: Une mauvaise connexion du conducteurde terre peut entramer un risque de choc electrique. Vdrifier avec un dlectricien qualifid si it existe un doute quant a savoir si le produit est correctement mis A la terre. Ne pas modifier ]a fiche foumie avec le produit — si elle n'entre pas dans la prise, faites installer one prise addquate par un dlectricien qualifi6. MOVING & STORAGE INSTRUCTIONS Note that both the hardwired LCS and the plug-in LCS-P are intended for fixed installations. For mounting requirements, consult the Mounting Procedures section of the Installation Instructions in this manual. Aways turn off input power to the charge station at the circuit breaker panel prior to hard -wiring an LCS to or disconnecting an LCS from the service lines. Likewise, always turn oft' input power to the charge station at the circuit breaker panel prior to plugging an LCS-P into or unplugging an LCS-P from a NEMA socket. When transporting the charge station, do not lift or carry the entire unit by the SAE -J] 7721 charge cord. Likewise, do not lift or carry the entire unit by the flexible conduit and input conductors (LCS) or the NEMA plug (LCS-P). The charge station has a non -operational storage temperature range of -40°C to +80-C (-40°F to +176°F). Page 19 LCS User's Manual MAINTENANCE The LCS requires no periodic maintenance other than occasional cleaning. QWARNING: To reduce the risk of electrical shock or equipment damage, exercise caution while cleaning the unit and the EV charge connector cable. 1. Turn off the charge station at the circuit breaker before cleaning. 2. Clean the charge station using a soft cloth lightly moistened with mild detergent solution. Never use any type of abrasive pad, scouring powder, or flammable solvents such as alcohol or benzene. AAVERTISSEMENT: Pour rdduire le risque de choc dlectrique ou des dommages dquipement, user de prudence lots du nettoyage de 1 appareil et le cable du connecteur de charge EV. 1., Eteignez la equipement au disjoncteur avant de le nettoyer. 2. Nettoyez 1'6quipement a 1'aide d'un chiffon doux ldg6rement humidifid avec une solution de ddtergent doux. Ne jamais utiliser de tampons abrasifs, de poudre a rdcurer ou de solvants inflammables tels que 1'alcool ou le benzene. CUSTOMER SUPPORT Call your ClipperCreek, Inc. Service Representative at any time, 24 hours a day, at the number below. PLEASE HAVE THE MODEL NUMBER AND SERIAL NUMBER AVAILABLE WHEN YOU CALL. This information is printed on the label on the side of the LCS enclosure. If your call is made after business hours or on weekends, please leave your name, telephone number, the unit serial number, and a brief description of the problem. A Service Representative will call back at the earliest opportunity. Distributor Service Number Here To contact ClipperCreek, Inc. directly for service, call (530) 887-1674 between 8:00 AM and 5:00 PM Pacific Standard Time. Page 20 s „ 4 LCS User's Manual SPECIFICATIONS Line Input Power 240V AC single-phase - Ll, L2, and Safety Ground. Dimensions: Voltage & Wiring: 208V AC 3-phase wye-connected -Any 2 phases and Safety Ground. 240V AC 3-phase, delta -connected. With center -tap on one leg, must use only the two phases on either side of the center -tap. The Weight: two phases must both measure 120V AC to ground. Do not use the third leg (208V "Stinger"). Supplied Service Ll, L2 and Ground use 12AWG, 75'C copper wire LCS-25P weighs approx. 2.9 kg (6.31bs) with SAE -J] 772"" connector and 25' length of cable Conductors: Operating Temperature: -301C to +50'C -22'F to +122'F Voltage Range: 185V AC to 264V AC Frequency: 60 Hz CCID: I Includes CCID with automatic reset. Trips at 20mA. ETL Listed (LCS, all LCS-P), cUL Listed, UL Listed (LCS-P with NEMA L6 -30P, NEMA 14-30P), FCC Part 15 Class B, cUL Listed. Current & Output Power (at 240VAC) LCS Model Circuit Maximum Output Cable LCS Modele Breaker Current Power Length LCS-10 (Hardwired). 10A 08A 1.9 KW 22ft(6.7M) LCS-15 (Hardwired) 15A 12A 2.9 KW 22ft (6.7M) LCS-20 (Hardwired) 20A 15A 3.6 KW 22ft (6.7M) LCS-20P+NEMA 1.6-30P 30A 15A 3.6 KW 22ft (6.7M) LCS-20P+NEMA 14-30P 30A 15A 3.6 KW 22ft (6.7M) LCS-20P+NEMA 6-50P 50A 15A 3.6 KW 22ft (6.7M) LCS-20P+NEMA 14 -SOP 50A 15A 3.6 KW 22ft (6.7M) LCS-25 (Hardwired) 25A 20A 4.8 KW 25 ft (7.6M) LCS-25P+NEMA L6 -30P 30A 20A 4.8 KW 25 ft (7.6M) LCS-25P+NEMA 14-30P 30A 20A 4.8 KW 25ft (7.6M) LCS-25P+NEMA 6-50P 50A 20A 4.8 KW 25ft (7.6M) LCS-25P + NEMA 14 -SOP 50A 20A 4.8 KW 25ft (7.6M) Note that the maximum current for.thevelucle is set. by the duty cycle or the Pilot waveform. Output power is variable depending upon the LCS model and vehicle demand. Plugs: Attached NEMA L6 -30P, NEMA 14-30P, NEMA 6-50P and NEMA 14-50P plugs are available for the LCS-20P and LCS-25P Dimensions: Dimensions are for the enclosure only: Height 280 mm (11 in) Width 100 mm (4 in) Depth 180 mm (3 in) Weight: LCS-20 weighs approx. 2.2 kg (5 lbs) with SAE -J1772"" connector and 22' length of cable LCS-25 weighs approx. 2.7 kg (6 lbs) with SAE -J1772111 connector and 25' length of cable LCS-20P weighs approx. 2.4 kg (5.3 lbs) with SAE -J17721 connector and 22' length of cable LCS-25P weighs approx. 2.9 kg (6.31bs) with SAE -J] 772"" connector and 25' length of cable Environment: Operating Temperature: -301C to +50'C -22'F to +122'F Storage Temperature: -400C to +80'C -40'F to +176'F Enclosure Rating: I NEMA 4 - watertight Agency Approvals: ETL Listed (LCS, all LCS-P), cUL Listed, UL Listed (LCS-P with NEMA L6 -30P, NEMA 14-30P), FCC Part 15 Class B, cUL Listed. Page 21 LCS User's Manual WARRANTY INFORMATION LIMITED WARRANTY - ELECTRIC VEHICLE SUPPLY EQUIPMENT and ACCESSORIES ClipperCreek, Inc. 11850 Kemper Road Auburn, California 95603 Phone: 530-887-1674 Email; information@clippercreek.net ClipperCreek shall provide the following warranty with respect to the Products to Representative, its Sub -Representatives and their customers: Product 3 -year parts, 3 -year factory labor: ClipperCreek, Inc. warrants this product to be free from defects in materialand workmanship. The warranty period shall commence on the date of installation date (firstuse). The product installation date must be evidenced and communicated to ClipperCreek by way of the warranty registration card (or its equivalent): The warranty registration card must be filled out completely and accurately, and returned to ClipperCreek within 30 days after installation, and the product. installation date shall be within 6 months after the purchase date. If a Product installation. date is not communicated to ClipperCreek as described above, the product purchase date shall serve as the warranty commencement date. If this product is defective in materials or workmanship during the warranty period, ClipperCreek will, at its option, repair or replace the product. Repair parts and/or replacement products may be either new or reconditioned at ClipperCreek's discretion. This limited warranty does not cover service or parts to repair damage due to improper installation or use, including but not limited to improper connections with peripherals, external electrical. faults, accident, disaster, misuse, abuse or modifications to the product not approved in writing by ClipperCreek. Any service repair outside the scope of this limited warranty shall be at applicable rates and terms then in effect. This warranty covers factory parts and factory labor only; it does not cover field service or removal and replacement of the product or any other costs. All other express and implied warranties for this product including the warranties of merchantability and fitness for a particular purpose are hereby disclaimed. Some states do not allow the exclusion of implied warranties or limitations on how long an implied warranty lasts; so the above limitation may not apply to you. If this product is not as warranted above, your sole and exclusive remedy shall be repair or replacement as provided above. In no event will ClipperCreek, any of its authorized sales and service representatives, or its parent company be liable to customer or any third party for any damages in excess of the purchase price of the product. This limitation applies to damages of any kind including any direct or indirect damages, lost profits, lost saving or other special, incidental, exemplary or consequential damages whether for breach of contract, tort or otherwise or whether arising out ofthe use of or inability to use the product, even if ClipperCreek or an authorized ClipperCreek representative or dealer has been advised of the possibility of such damages or of any claim by any other party. Some states do not allow the exclusion or limitation of incidental damages for some products; so the above limitation or exclusion may not apply to you. This warranty gives you specific legal rights, and you may also have other rights which may vary from state to state, To obtain warranty service: Call your nearest authorized Service Representative or ClipperCreek at the above number. You will receive information as to how service for the product will be provided. Ifyou mail or ship the product in for service, you must insure the product, prepay all shipping charges, and properly pack it for shipment in its original shipping container or its equivalent. You are responsible for all loss or damage that may occur in transit. You must provide proof of purchase of the product and the purchase date before any warranty service can be performed. Page 22 This page was intentionally left blank. CLIPPERCREEK, INC. 1 1 B50 KEMPER RD., SUITE E AUBURN, CA 95603 WWW. CLIPPERCREEK.COM SMOKE / CARBON MONOXIDE ALARMS FILE OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION CUPERTMO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org `' ate' PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section 8314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access .for inspections are required. GENERAL INFORMATION 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 bedroom(s) X X 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-buming 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 8314 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 wiririg. As owner of the above -referenced property„ I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the C'ali.forrua Buldiulg and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. WATER -CONSERVING PLUMBING FIXTURES FILE 19 OWNER CERTIFICATE OF COMPLIANCE7-1 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE - CUPERTINO, GA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aAcupertino.org > Owner Name {. (��. I (i %— T (A Permit N o% Address fy' i{ i'!'� t . ��ti_pA+YtU 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. [A No Go to Question 2; 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. E8 No Go to Question 4. Li 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. j 'E] Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: LJ R My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. " On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether propertyundergoes alterations or improvements). • My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant. plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements)'. I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's. installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: r i Date: ! 4 2.1 Upon completing and signing this Certificate, please return -if to the Building Division in order to final your building permit. SB40 7 2015.doc revised 08/26/15