B-2017-1042CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1042
20364 GILLICK WAY CUPERTINO, CA 95014-4413 (369 36 009) REPUBLIC ELECTRIC
MANTECA, CA 95337
OWNER'S NAME: DAS NIRMALENDU AND SAGORIKA DATE ISSUED: 06/29/2017
OWNER'S PHONE: 408-625-4136 I I PHONE NO: (408) 667-9249
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lie. #969279
Contractor REPUBLIC ELECTRIC Date 01/31/2018
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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 er the Cupertino Municipal Code, Section 9.18.
Signature Date 6/29/2017
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).
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. 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 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 6/29/2017
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(N) EV CHARGING STATION (60 AMPS)- GARAGE
Sq. Ft Floor Area:
$1450.00
APN Number: Occupancy Type:
369 36 009
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
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 ofApl
Date:/6 29/2017
ALL ROOF COVERINGS TO BE CLASS "A"
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
225555005, 25533, and 25534.
Owner or authorized agent:
Date: 6/29/2017
CONSTRUCTION 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
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.orp
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PROJECT ADDRESS
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❑ ENaNFER ❑ DEVELOPER ❑ TENANT
CO TRACTOR NAME _
LICENSE NUMB ER
LICENSE TYPE
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COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE: ❑ Commercial
URBAN INTERFACE AREA ❑ Yes \jj No
FLOODZONE ❑ Yes IN No
❑ SOLAR PANELS
ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
Lam, OTHER 1
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION J So
DESCRIPTION OF WORK
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FREIE[VEDB'r-�
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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 owner's behalf. 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 withal] applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -ides
fied property for inspection purposes.
Signature of Applicant/Agent: —jkc
Date: U 211-1
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OVER-TH]"OUNTER
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P VApp_201 1. doc revised 03/16/11
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingna.cupertino.org
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED, SIGNED. AND RETURNED TO THE BUILDING DIVISION
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 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 -burning 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 R314 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 wiring.
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 California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below.
Address: %0 �.6
&_� 1 (k; C.k( ,514a
"-q/pw C,41�0(c
Permit No.
Specify Number of Alarms: # Smoke Alarms: F7I # Carbon Monoxide Detectors:
1 have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
i'. _M� ca o
Signature..........:..'.V...:...................................................................Date: �T
...............................................................................................................................
Contractor Name:
Signature.................................................................. Lic.# ......................................Date:
Smoke and CO forrn.doc revised 09/27/16
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPER'TINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building Ca.cupertino.org %
Pen -nit No.
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.
❑ 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
q
mbing, 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?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
10
Go to Question 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.
$ 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 fonn..
Please check ONE of the following:
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 property undergoes 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
pluinbing 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 Califomia 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.
I Owner or Owner Agent's Signature: �p.� Vl.0Yy'6 Date: U EU 0 6 / 2Jor1;A
Upon completing and signing this Certif1date, please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 01105/17
Plu -ln Electric Vehicle Load Calculator for Leel 2 Cha in
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 loads may vary. For amore precise analysis, use the nameplate
ratings for appliances and other loads and consult with a trained electrical professional)
Check all Applicable
Loads (%1")
Description of Load
Typical Usage
Watts Used
GENERAL. LIGHTING AND RECEPTABLE OUTLET CIRCUITS
Multiply the square footage of house x 3
3 watts/sq. ft.
Q
KITCHEN CIRCUITS
Kitchen circuits
3,000 watts
C>
Electric oven
2,000 watts
cs
Electric stove top
5,000 watts
c'
Microwave
1,500 watts
Garbage disposal under kitchen sink
1,000 watts
Automatic dish washer
3,500 watts
37
Garbage compactor
1,000 watts
Ej Instantaneous hot water at sink
1,500 watts
LAUNDRY CIRCUIT
Laundry circuit
1,500 watts
C
Electric clothes dryer
4,500 watts
�f5'
HEATING AND AIR CONDITIONING CIRCUITS
Central heating and air conditioning
6,000 watts'
U
Window mounted air conditioning
1,000 watts
Whole -house or attic fan
500 watts
Central electric furnace
8,000 watts
Evaporative cooler
500 watts
OTHER ELECTRICAL LOADS
Electric water heater (storage type)
4,000 watts
Electric tankless water heater
15,000 watts
HI I Swimming pont or spa
3,500 watts
ELECTRIC VEHICLE CHARGER CIRCUIT
Level 2 electric vehicle charger wattage rating
_:;o 00 `
TOTAL WATTS USED
(dn f 0
INSTRUCTIONS: Using the "TOTAL WATTS USEW 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 I. In column 4, write in the size of your existing service panel (main breaker size). If your
existing service panel (column 4) is smallerthan 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 D.
1
2
3
4
Check the
appropriate line
(,)
Total Watts Used
(from previous page)
Minimum Required Size of
Existing 2411 -Volt ElecWcal Service
panel (Main Service Breaker Size)
Identify the Size of Your
Existing Main Service
Breaker (Amps)**
H-
up to 48,000
100 amps
118,001 to 63,000
125 amps
£3,001 to 78,000
150 amps
Zoo AM
78,001 to 108,000
200 amps
108,001 to 123,000
225 amps
**Note that the size of your existing service (column 4) MUST be equal to or larger than the Minimum
Required 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 chargee.
STATEMENT OF COMPLIANCE
By my signature, I attest that the information provided is true and accurate.
Job Address: 2-C:) Q`i C:a + t.i c_ r— LAJs2v Y c u rig.--i±-Ncy _ C jf 4-IS6 i Lr
Signature,
(Print job address)
(411-2"41 i--)
(Signature of applicant) (Date)
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 servicecapacity 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.
Y
THIS PLAN SHALL REMAIN ON
THE JOB AT ALL TIMES DURING
CONSTRUCTION
20
Se
% EMI
2 #6 TH
1 #10 T
P"MMENT
-OPPMEN,
20 9UILDIN�..' 'DIVISION - CuTPEERTINO
APPROVED
Tris set 3f plans:1-:1 51 to kept at the
ste d,-ru-', -Ict W. It is to make y
J, � :- Ij I : 11 'i
chanqc�s on sa,-Tie, or to deviate
-1
pfov,-?Ifrari the ELJJing Offid3l
The S1,3rrping .!an and s, 41, % - SHALL NOT
te hekd tc per—it i is be p;,, Gonrc)va; of the viol,�,',;ton
Of an VISiOfps any C: IrOl �'e T State Law.
BY -j
DATE
200 AMP Main Service Panel
NIRMA LENDU 'D AS
Circuit 240V40 AMP
20364 GILLICK WAY
.... ......
Cupertino, CA 95014
Tesla Charger
P"MMENT
-OPPMEN,
20 9UILDIN�..' 'DIVISION - CuTPEERTINO
APPROVED
Tris set 3f plans:1-:1 51 to kept at the
ste d,-ru-', -Ict W. It is to make y
J, � :- Ij I : 11 'i
chanqc�s on sa,-Tie, or to deviate
-1
pfov,-?Ifrari the ELJJing Offid3l
The S1,3rrping .!an and s, 41, % - SHALL NOT
te hekd tc per—it i is be p;,, Gonrc)va; of the viol,�,',;ton
Of an VISiOfps any C: IrOl �'e T State Law.
BY -j
DATE
200 AMP Main Service Panel
NIRMA LENDU 'D AS
Circuit 240V40 AMP
20364 GILLICK WAY
Cupertino, CA 95014
Tesla Charger
WALL CONNECTOR
The Wall Connector is a ' esla specific charging station, hard wired and permanently mounted to a wail of
lost. Redesigned in Spring 2416, highlights include:
Compatible with Model S and Model X
a Customizabte power settings to fit any electrical 5ystern
e Power sharing: Link up to four Wall Connectors to a single circuit
e Two cable length options: 8.5' or 24'
* indoor and outdoor rated
Have a licensed electrician review the eiectricat load of your home prior to instaliatiom As with any horne
improvement project. a. permit and city inspection may be required.
RECHARGE RATES FOR STANDARD AND HIGH AMPERAGE CHARGING
Statldard 60 -amps 34" 30*
(4811, drawl
I-0gh Amperage 90-anip' 52* 46*
(727A draw)
'Numbers hawed an a 90D configuration and 240 -volt power supply_ Recharge speeds tvray vary- hpferto the wait Connector
iristadatinn guide for ;Aditional power level options_
RECOMMENDED LOCATIONS
CHARGE PORT
RECOMMENDED LOCATION FOR 24' CABLE
RECOMMENDED LOCATION POR 8.5' CABLE
E
ADDITIONAL RESOURCES
EMAIL
C H A RG I NG I N STAL LAT I O N@TESLA. COM
PHONE
650.681.6133 (M -F)
24/7 TECH SUPPORT
877.798.3752
WEB
TESLA.COM/SUPPORT
ONLINE STORE
SHOP.TESLA.COM
T —= Si L i=i 45500 Fremont Boulevard, Fremont, CA 94538 1 May, 2016 l Version 3