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B-2016-3177CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMI r NO: B-2016-3177 10518 S BLANEY AVE CUPERTINO, CA 95014 (369 11 062) REPUBLIC ELECTRIC MANTECA, CA 95337 OWNER'S NAME: APPUSAMY SENTHILAND DANDAPANI SWARNALATHA DATEISSUED: 11/28/2016 OWNER'S PHONE: 650-7034136 PHONE NO: (408) 667-9249 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class M Lie. #969279 Contractor REPUBLIC TRI Date 01/31/2018 X BLDG —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: (N) EV CHARGING STATION IOUTLET (50 AMP) GARAGE I hereby affirm under penalty of perjury one of the following two declarations: REV # 1 - RELOCATE CHARGER FROM SIDE TO CENTER OF m. I have and will maintain a certificate of consent to self -insure for Worker's GARAGE - ISSUED 12/19/16 1iCompensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. " 2. Thave 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: Valuatit:$1200.00 APPLICANT CERTIFICATION 1 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: Occupa cy Type: and state laws relating to building construction, and hereby authorize 369 11062 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 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 ern a Cupertino Municipal Code, Section 9.18. 180 DAYS FRO INSPECTION. Signature Date 12/19/2016 Issued by: MEL SSANAME Dateri-�fQ8fg84tr OWNER -B Ill D R DECLARATION I hereby affirm ,that I am exempt from the Contractor's License Law for one of the ' following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is m. I, as owner of the property, or my employees with wages as their sole installed without first obtaining aninspection, 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 ofApplicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 12/19/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERING S TO BE CLASS "A" OR BETTER m. 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. HAZARDOUS I AATERIALSDISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous mate 'als 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 Co le, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cu ertino 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 5532(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 se 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 Cupe Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Co4 e s 505, 5533, 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: 12/19/2016 1 certify that I have read this application and state that the above information is I to laws CONSTRUCTION I hereby affirm that there is a corjstruction LENDING AGENCY lending agency for the performance correct. agree comply with all city and county ordinances and state relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 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 ARCELIT 1 understand my plans shall be u S DECLARATION sed as public records. Code, Section 9.18. Licensed SiSignature Date 12/19/2016 g Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildiinngp—ccupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATTON / TT I U' u,.vT11T0 M / n-PPPPPFn dAL PERMIT # 201 (1} 5 1 � I BldgApp_2011.doc revised 06/21/11 , Cay, cow PROJECT C ADDREo/SSS� 1VS 7 V jGi >-� �t APN # OWNER NAME I N�� PHOE" t2 S Ct rn � FAX STRE 8 ADDRE SV () CITY, STATE, ZIP n-. C TACT N IT _ -efV)z1 CI�PZ PH �D(P"1 � q rrAA 6 ,bh �J mv+ I^ C 1 Q STREET ADDRESS J STATE, ZIP ��� , FAX ❑ OWNER ❑ OWNER-BUH,DER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 1-13 C K- / YI 01 r' LICENSE NUMBE]q „�j� Zj-I- tom{ ( 1 LICEt TYf E BUS. LIC _ �<' n 1 w 5 C MPANYNAME,. J � v tl PCfI EMAIL FAX STREf � RESI ` ` ,� f� ` , (�% IN C (An' ^ C � cl L+ I`c J✓3 ] / PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE CC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH ❑ ATTACH _ # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG ANRECEIVED VALUATION: PLANNING APPL # E] NO PLANNING APPROVAL LETTER EICHLER HOME? NO ; By my signature below, I certify to each of the following: I am the property owner or aut iorized agent to act on the property owner's behalf. I have read this application and the information I have pro id I is correct. I read the scription of Work and verify it accurat . I agree to comply with all applicable local ordinances and state laws relatin o b lm d g onstmc T auth ' .e re resentatives of Cupertino to enter the aibove ide/n�ti ed pro erty for inspection purposes. Signature of Applicant/Agent: Date: 1 )vl SUPPLEMENTAL INFO ON REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLANRMEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. © LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to 0 MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. © ENVIRONPIFENTAL HEALTH BldgApp_2011.doc revised 06/21/11 , Cay, cow .......... ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPER't INO (408) 777-3228 • FAX (408) 777-3333 • buildingAcupertino.org PROJECT ADDRESS APN # NIG �� U V PHONE `� O g Ja� U EMAIL STREET ADDRESS � � Q yI �� CITY STATE, Z� f U Th- tm FAX CONTACT NAME L . (� lj �1 C 'f L �� C1 C PHOI �� '92�E-Mn �y �1c cat fri c l,ai.( Cu STREET ADDRESSW cly CITY, STATE, ZIP FAX Y`nn" - C ct C GlE:.3 ❑ OWNER El OWNER-BUILDER►n ❑ OWNER AGENT ❑ CONTRACTOR NONLRACTOR AGENT ❑ ARCHITECT 1-1ENGINEER ❑ DEVELOPER El TENANT CONTRACTOR NAME , C�a f LICENSE W 4�� ^ LICfrNSE TYPE BUS. LIC 4 ``t ) c� - 3 COMPANY NAME Eh( FAX STREET ADDRESS �Yy CIT/3� r1OY o YTATE, I� C. PHOI\� Ch— ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLANn ' _ PRO.IECT IN STRUCTURE; E) Commercial URBAN INTERFACE AREA El Yes E AVO FOOD ZONE ❑ Yes No ❑ SOLAR PANELS ELECTRIC VEHICLE CHARG G STATIONCt ( ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UIQITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK _----• < l Sidl By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr ner's b e read this application and the infonnation I have provided is correct. I have read the Description of Work and verify it is accurate. I a y with all applicable local ordinances and state laws relating to b ing construction. I authorize representatives of Cupertino to enter the ab I - en�ti} d property for inspection purposes. Signature of Applicant/Agent: Date; SUPPLEMENTAL INFORMATION REQUIRED PVApp_201Ldoe revised 03116111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:- CONTRACTOR: PERMIT NO: 14-2016-3177 10518 S BLANEYAVE CUPERTINO, CA 95014 (369 11062) REPUBLIC ELECTRIC MANTECA, CA 95337 OWNER'S NAME: APPUSAMY SENTHIL AND DANDAPANI SWARNALATHA DATE ISSUED: 11/28/2016 OWNER'S PHONE: 408-835-8430 PHONE NO: (408) 667-9249 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC -10 Lic. #969279 Contractor REPUBLIC ELECTRIC Date 01/31/2018 X BLDG _ ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH XRESIDENTIAL 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 EV CHARGING STATION/OUTLET IN GARAGE I heaffirm 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. 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: $1206.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 369 11 062 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 gainst said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per toe C pe ino Municipal Code, Section 9.18. 180 DAYS FROM LAST CA S.P + CTION. F VI Signature F f Date Issued by: MELISSA N OWNER -BUILDER DECLARATION Date: 11/28/2016 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 m. 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: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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 s. 1 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 ; material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become to the 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, c ` s 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: i 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 CONSTRUCTION LENDING AGENCY 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 (Sec. 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 DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S 1 understand my plans shall be usedd a as public records. Code, Section 9.18. Licensed Signature Date Professional CUPERTINO ;3uild'ing Department NOV 2 8 2016 REVIEWED FOR CODE COMPLIANCE C, 0 c - Foo 0 i0 W3 0 0 cam rn um, i C, 0 0 fn Q-("'� 0 0 cr rl TIN >�, WO I Lgj I \�,� PLOT PL.A CHECKED ey DATE G CPT p -r PLANNING CUPERTINO- 30 { J� S 4� 30 { J� 40 AMP WALL CONNECTOR - NEMA 14-50 DIE -TAILS INST,4LLAT ION GUIDE To take full advantage of your Tesla 4o amp Mall Connector, work with an eisctriciatr to install a NEMA 14-50 outlet where you pian to park your MQdei 5, The NEMA 14-50 outlet meds to be installed with a 50 amp circulir_breaker; this will Provide a msxlrnutn of 40 amps to the vehicle. Charging at maximum amps may not always be necessary and can be adjusted manually from the Vehicle touchscreep. Use the vehicle controls to adiust charging to 30 amps for daily use, or up to 40 amps for ocoasions when faster charging is required, The 40 arclg Wait Connecter cable is 20 feet long, install outlet wlithin 13 feet of the Vehicle charge port (rear, driver side). For the best experience, plug in your Model S every night to top off the battery. Voltage: Single phase, 205-250 volt RC supply, B0 hertz Current: 50 amp Circuit breaker! 40 amp continuous draw Code: Circuit installation should meet National Electric Code (NE -0) vAre and breaker ratings. in genera[, this means 6 AWG wire for installations under 1013 feet Check local code for exact requirements, Ground Fault Circuit Interrupter (GFCIY Not required Service Disconnect: Not requited Cunei: Install within 13 feet of driver aisle taillight (vehirfe is aver i6 feet long) and minimum 18 inches above the around RECOIKIMENDED OUTLET LET LOCATIONS One or two Vehicle aanq a f y - a G 3¢¢ 3 GROUND ON Top W,E. MA 14-sllr lm aq,e to SCaIF f-2.2 4ir rets �` T n eo vehicia garuga Le�gonLl � ..i 4 r E til�i Need help finding an electrician, or Rave quostlons about home charging installation? Canoiact Tesla at: Cbargtnginatnilatinn@teslamt)tors.com or 650.681.6133 Plu -In Electric Vehicle Load Calculator for LC 12 Chargiqg INSTRUCTIONS; Review the list of electrical loads in the table below and check all that exist in your home (don't forget to Include the proposed Level 2 charger). For each item checked, fill in the corresponding "Watts Used" (refer to the "Typical Usage" column for wattage information). Add up all of the numbers that are written in the "Watts Used" column and write that number in the "TOTAL WATTS USED" box at the bottom of the table, then go to the next page to determine if your existing electric service will accommodate the new loads. (Loads shown are rough estimates; actual toads may vary. Fora more precise analysis, use the nameplate ratings for appliances and other, loads and consult with a tralned electrical professional.) Check all Applicable Loads (-/j Description of LoadTypical Usage Watts Used GENERAL LIGHTING AND RECEPTABLE OUTLET CIRCUITS Multiply the square footage of house x 3 13 watts/sq. ft. D365_ ---),()95- )09 -KITCHEN KITCHENCIRCUITS Kitchen circuits 3,000 watts 31100 Electric oven 2,000 watts 2000 Electric stove top 5,000 watts 6000 Microwave 1,500 watts 1500 Garbage disposal under kitchen sink 1,000 watts 1000 Automatic dish washer 3,500 watts 3500 Garbage Compactor 1,000 watts Instantaneous hot water at sink 1,500 watts LAUNDRY CIRCUIT Laundry circuit 1 1,500 watts 1500 Electric clothes dryer 1 4,500 watts 4500 BEATING AND AIR CONDITIONING CIRCUITS Central heating and air conditioning 5,000 watts 11111111 Window mounted air conditioning 1,000 watts Whole -house or attic fan 500 watts Central electric furnace 8,000 watts 8000 Evaporative cooler 500 watts OTHER ELECTRICAL LOADS Electric water heater (storage type) 4,000 watts 4000 Electric tankless water heater 15,000 watts Swimming pool or spa 3,500 watts ELECTRIC VEHICLE CHARGER CIRCUIT Level 2 electric vehicle charger wattage rating 15000 TOTAL WATTS USED ( , 0 �t INSTRUCnONS: Using the "TOTAL WATTS USED" number from the previous page, check the appropriate line in column 1 and follow that line across to determine the minimum required size of the electrical service panel shown in column 3. in column 4, write in the size of your existing service panel (main breaker size). if your existing service panel (column 4) is smaller than the minimum required size of the existing service (column 3), then you will need to Install a new upgraded electrical service panel to handle the added electrical load from the proposed Level 2 charger. The table below is based on CEC 220.83(A), 230.42 and Annex Q. .1 2 3 4 Check the appropriate line ( ) Total Watts Used (from previous page) Minimum Required Size of Existing 240 -Volt Electrical Service Panel (Main Service Breaker Size) Identify the Size of Your Existing Main Service Breaker (Amps)** up to 48,000 104 amps z 48,001 to 63,000 125 amps „ 2 CSC) A -a-,) 63,001 to 78,000 1.50 amps 78,001 to 108,000 200 amps 108,001 to 123,000 225 amps **Nate that the size of your existin service )column 4) MUST bee ual to or lar er th n the Minimum Re lied Size (column 3) or a new larger electrical service panel will need to be installed in order to satisfy the electrical load demand of the EV charger, STATEMENT OF COMPLIANCE By my signature, I attest that the information provided is true and accurate. Job Address 1 C)51 S„ 4G Vi (Print job address) Signature - 4(c o applicant) In addition to this document, you will also need to provide a copy of the manufacturer's installation literature and specifications for the Level 2 charger you are installing. Note: This is a voluntary compliance alternative and you may wish to hire a qualified individual or company to perform a thorough evaluation of your electrical service capacity in lieu of this alternative methodology. Use of this electrical load calculation estimate methodology is at the user's risk and carries no implied guarantee of accuracy. Users of this methodology and these forms are advised to seek professional assistance in determining the electrical capacity of a service panel.