B-207-0263CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0263
11228 STAUFFER LN CUPERTINO, CA 95014-5150 (366 09 045) ANTHONY LEWIS .
INCORPORATED
SAN JOSE, CA 95126
I OWNER'S NAME: KURUMA DENNIS K AND MARGARET K TRUSTEE I I DATE ISSUED: 02/14/2017 I
OWNER'S PHONE: 408-313-8808 I I PHONE NO: (408) 217-8621 I
i111L�s]►E _ t s ' � �
License Class C-10 Lic. #851107
Contractor ANTHONY LEWIS INCORPORATED Date 08/31/2017
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
w Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
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.
Date 2/1412017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
two reasons:
I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
I, as owner of the property, 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.
a. 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 2/14/2017
BUILDING PERMIT INFO:
X BLDG ELECT _ PLUMB
_ MECH X RESIDENTLAL _ COMMERCLAL
JOB DESCRIPTION:
(IS) EV CHARGING STATION (50 AMPS) - GARAGE
Sq. Ft Floor Area: I Valuation: $1200.00
APN Number: Occupancy Type:
366 09 045
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
Date: 02/14/2017
RF -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 01f Applicant:
Date:42/1 %2017
TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Ow" ner or authorized agent:
Date: 2/14/2017
I hereby affirm that there is a cons c ion lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARC'HITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
4014, 02(P3
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildin-gQcupertino.org
PROJECT ADDRESS I �ZO
vL �A iy
APN #
OWNER NAMEn0 v{ JG
>�
PHONE(i ��j 3 [ y ��K��
¢,C�{nQ ja,
E-MAIL
STREET ADDRESS a > eg fj r
CITY, STATE, ZIP
1�
"
CONTACT NAME ,n/t
PHONE
E-MAIL
STREET ADDRESS j (�/� 1 S
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENTCONTRACTOR
❑ CONTRACTOR AGENT ❑ ARCBTTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �� `� � (
LICENSE NUMBER �� �. � � �+
/
LICENSE TYPE )` I
GCJ
A
BUS. LIC # I I "7�i� C
�j �
COMPANY NAME
0n
E-MAIL 1i
�I� f t tYIC•C
FAX C
STREET ADDRESSf i�� '
A24
CITY, STATE, ZIP
en Se
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME Ul ��
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD Or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOOD ZONE ❑ Yes ❑ No
❑ SOLAR PANELS
ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:M0
((��,,JJ��ff
DESCRIPTION OF WORK
r elm c� N-56
lef t/
occ, J i �1
RECEIVED BY _
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 p ovided is rrect. 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 b Ing s tion. I authorize representatives of Cupertino to enter the above-identi4 properly for inspection purposes.
Signature of Applicant/Agent: Date: 1 e— I�' l
SUPP INFORMATION REQUIRED
OFFICE USE ONLY:
OVER-THE-COUNTER
F-
. ❑ - EXPRESS
U
El STANDARD
a-..�
LARGE
❑ b(AJOR
PVApp2011.doe revised 03116/11
Ld
PSI
ME -01
s-+
L)j I - — — 1
I
6MA
N"
a
(D
LU
F-
ui
LLJ
C12
LEI
C6wti
LJ
PSI
ME -01
s-+
L)j I - — — 1
I
6MA
N"
n
I
An�hqpyjxwis Inc.
Building and Elwrical
Load Calculation for Existing Dwelling Unit 220.83
L GEN EERAL LIGHTING: Table 220.1"2
34�—jSq. ft, x 3 VA = -- -- C? �_ -7 VA
Small Appliances: 2 10.11 (C) (1) and (C) (2)
�OVAx �2— circuits =----'~�000 VA
Laundry: 220.52 (B)
ISOD VA x I circuit (SOO VA
Total: VA
2. FIXED APPLIANCES: 220.83 The nameplate rating ofthe following:
C,
A. All appliances that are fastened in place, permanently connected, or located to be on a specific circuit.
Dishwasher
M
(1500) VA
Disposer
(800) VA
Compactor
;Z
a)
<
(99) VA
Microwave
(1300) VA
Spa/Pool Motor
(12,000) VA
Attic Fan =
..........
M
(1600)'`µ°'A
B, COOKING EQUIPMENT: Table 220.55; Notes
Cc] A _VAx-%=-VA
Col BS76-0 VA x 4&0 % VA
A
Col C _ VA x - %= VA
Total `46 VA
C. DRYER: 220,54; Table 220.54
GOC VA x �—QQ VA
D. WATER HEATER:
W
Total VA
M
;Z
a)
<
M
CD
(D
0.
..........
M
W
zz"
C
00 -0
0
M
X
z
M
3. APPLYINc DEMAND FACTORS: Table 220.83 (A) or (B)
I " 8000 VA x 100% V A
Rcmainin '5 VAx40%;6�VA
Total- ----- [ - 6 VA
-------------------
A/C UNIT I -VA x ]00% = _q3LOVA
A/C LIN IT 2 -VA x 100% =. T�O VA
EVSE I VAx]00%=� VA
EVSE 2 = VA 100%=--- VA
Total VA
Total of A/C Loads and A]] Other Loads: VA
4. ELECTRICAL SERVICE:
Total VA VA
VA/240 volts Amps
MITHMUMConductor size Q) copper GEC copper
ID
U!
(D 71 71
CA, 6
M
IT r Ci
0
C
Cl)
M
0
Questions? Contad the Ter, -0a TcrhmcM Support r Cam
Ghai'gung I nMa I III okws CDR n 1650 681 6 a32 (Monday Fn day) ` 877 798 3752 (2417)
INSTALLiN(3 YOUR 240 VOLT OUTLET
The recommended home charqing installation for Tesla vehicies is a 240 volt NEMA 14-
50 outlet. This outlet is commonly used for electric ranges and large recreational
vehicles, Installed with a 50 amp circuit breaker, this Millet enables a recharge rate of
about 25 miles per h0Lffr.
Consult a licensed electrician to review [tie electrical load Of Your home prior to
installation. They wifl design your charging system and obtain a permit for a general
purpose NEMA 14-50 outlet from Your local building department. After installation, the
electrician will schedule an inspection to approve the new electrical circuit and design.
This guide provides reference for specifications to install this outlet Since each
Installation is custom to the home, all hardware for the NEMA 14-50 outlet will be
provided by Your electrician.
NEMA 14-5,0 DETAR-S,
* Voltage: Single phase, 208-250 Volt AC supply, 60 Hertz
C:
* Circuit Breaker: 50 Amp (125% overICUrrent protection)
* Operating Current,. 40 Amp (maximurn continuous current)
Conductors: 6 AWG, Copper Wre Only, Upsize wiring for installations
over 150 feet
Ground Fault Circuit interrupter: Not required
Service Disconnect: Not required
Receptacle Recommendation: High quality, industrial! grade
receptacle
• Ventilation: Not required
• Outdoors: Install Wth NEMiA 3R rainproof enclosure
;U
PECOMMENDED OUTLET LOCATIONS
CHARGE P(Aif
AVON 01JI1LE'TS
Iii, UR nmw vehide dumgv dual, rina"J"min 15, mlay, Rnilril)WM 18' frh,PVC91100nrJ
FOR YOUR RECO
ELECTRICAL �COMPANIY
PHONE NUMSER
PERMIT NUMS8P
INSTALLATION DATE
3500 Deer Creek, Palo Alto, CA 94304 6 November, 2015 1 Version 1.5
C:
3500 Deer Creek, Palo Alto, CA 94304 6 November, 2015 1 Version 1.5