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15060043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21559 EDWARD WAY CONTRACTOR:WILLOW GLEN PERMIT NO: 15060043 ELECTRIC INC OWNER'S NAME: SAN JOSE,CA 95125 PHONE NO:(408)289-9725 ! LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 0 INSTALL(N)NEMA CAR CHARGING STATION IN License Class t! Lie.# r � GARAGE Contractor _V\A,4 `!�, � 141( Dat e. I hereby affirm that I am licensed under the provision of hapter 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: 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. Sq.Ft Floor Area: Valuation:$1890 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 APN Number:35619004 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DA E ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY D INSPECTION. 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, ed by: Date: with all non-point sour e r gulations per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signature Date (I go- All roofs shall be inspected prior to any roofing material being installed.If a roof is 7 installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Muni 'pal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,255 3 pd125534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: D. permit is issued. 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 918. Signature Date ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(cDcunertino.org PROJECT ADDRESS �/l i q 7APN CONTACT NAME PHONE E-MAIL Matt Londre (40U705-3661mattOwl' len c .con STREET ADDRESS P.O. Box 8430 CITY,STATE,ZIP San Jose CA 951551 FAX(408)289-9725 ❑OWNER, ❑ OWNER-BUILDER ❑owNERAGENT ® CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Mark Londre 591918 C. 15897 COMPANYNAMEWillow Glen Electric E-MAIL mark@willowglenelectr C .com STREETADDRESS_.O. Box 8430 CITY,STATE,ZIPSan Jose, CA 95155 IIINE( 408)289-9725 ARCHITECTIENGINEER 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 WH.DLAND PROJECT IN STRUCTURE: ❑ Commercial I URBAN INTERFACE AREA ❑ Yes W No FLOODZONE ❑ Yes ❑ No ❑SOLAR PANELS 1 i ELECTRIC VEHICLE CHARGING STATION 1 ❑ SOLAR WATER HEATING ❑ OTHER FOR SOLAR PANELS: NUMBER OF PANELSfUNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: P/ (/�Ja 1✓ DESCRIPTION OF WORKl✓-eGC7Qa� Q'/ ( CZ CL G�/[7'K A ( j D By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro rty er's behalf. I have read this application and the information I ha v r ided is co et. I have rea the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating t i g con autho' e repre entatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicantlAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED 0M- CE USE ONLY w ❑ OVER-THE-COUNTER o. ❑-EXPRESS x ❑ STANDARD U ❑ LARGE a ❑ Ant..IOR PVApp 2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21559 EDWARD WAY DATE: 06/05/2015 REVIEWED BY: MELISSA APN: 35919 004 BP#: *VALUATION: $1,890 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION SOLAR-RES USE: SFD or Duplex PERMIT TYPE: i WORK INSTALL N NEIVIA CAR CHARGING STATION IN GARAGE SCOPE , , w ,tech. Plari Check Plwxh. Plan Checl hlec..Plan Check blech. Perrnit Fee: Plumb.Pelmil I ee: I Elea Permit Fee: Other A'fech. 1rup. Other Plumb Insp. E1__L_ Other Elec.Insp 141ech. InsP. Fee: Plumb. tush. Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 f f. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # Alternative Energy System Suppl.PC Fee: Q) Reg. Q OT T0.0 hrs $0.00 $109.00 ICHRGST,4 EV Charging Station PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:Q Reg. 0 OTp,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non-Residential Building or Structure 0 Travel Documentation Fees: Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldy Stds Commission Fee: 1BCBSC $1.00 SUB'I OTALS: $1.50 $109.00 TOTAL FEE: $110.50 Revised: 05/07/2015 �n Stull ova mw 9.40V. 30A ded c4{ej �! c,� Wel L i�Gvi+ ��'► � NEM A (0-30 recep*uck �.� q SOIy P��ec�ed wall vv-)(:F +0 fke- Sa-age- bo,; 11%4516IL Av. jc,raye . T c ;f ci;+ 4111 - 1 ` a"AIV)'LOT LANSCAKED BY fro Yn �.�,(,.;►,� - ATE _I taw e�,:,54445 IaSA mal'" PuvLe( to + recqfGc(R- lvCa-low► . cEpvpl, PLANNINd JIJJN CUP RTINO T COMMUNITY DEVELOPMENT DEPAI BUILDING DIVISION - CUPERTINO APPROVED This s t of plans and spe ifications.MUST be kept at �` ��0� `o�✓� 6'G;�G� job si during constructKrp V44awful to make ny Chan es or alterations on same, or to cievi to ��� a�� Coo �Q��, theref om, without apprPoval from the Building Offic al. The St.roping of this plan and ifications SHALL N T y 4ra� �.ae` `�C, ��C) be S to permit al of the violat on �� t of any `�� IddA DATE pGtzi (it \' /.Sv 6 0o Y.3 PERMIT# 7 9a �3 -00'4t Way `� S Residential Electrical Load Calculation Site Location: Prepared by Malini Bhattacharya Willow Glen Electric,Inc. 1 L L 10, b 21559 Edward Way PO Box 8430 L E C T R 1 C Cupertino,CA 95014 San Jose,CA 95155 (408)221-6391 (408)289-9725-office General Lighting and Receptacle Loads[220.12] 3 watts per ft, x 111F27735 = 6,405 Small-Appliance Branch Circuits[220.52(A),210.1(C)(1)] 1,500 watts x 2 = 3,000 Laundry Branch Circuit(s)[220.52(B),[210.11(C)(2)] 1,500 watts x 1 = 1,500 10,905 Fastened-In-Place Appliances Kitchen Bath(s) Outisde/Miscellaneous [220.53] Refrigerator(s) = 780 Instant Hot H20(s) = Exhaust Fan(s) = Hot Tub = Dishwasher(s) = 1200 Hood Exhaust(s) = Jacuzzi Tub(s) = Pool Equipment= Garbage Disposal(s) = 720 Gas Range(s) = X600 Radiant Heating = Vacuum = Microwave = Gas Oven(s) = = 30A circuit = Trash Compactor = Wine Fridge(s) = = 30A Circuit = _ = Sump pump = Total Fastened-in-place Appliance Load 3,300 Clothes Dryer(s)[220.54] 80% x 240 x Derating Volts Amps 5,000 OR Name Plate Rating of Clothes Dryer Ranges,Ovens,Cocktops,and Other Household Cooking Appliances[220.55] 80/ x 240 x® = 6,400 Derating Volts Amps AND/OR Name Plate Rating of Cooking Appliances = 6400 Heating or Air-Conditioning System(Compare the heat and A/C,and omit the smaller.)[220.60] Air Handler/Furnace 120 x Volts Amps Air Conditioning Unit 6,504 55% x 240 x _ 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 6,504 x 100% = 6,504 Electric Space Heating - x 100% _ First 8kVA of all other loads 8,000 x 100% = 8,000 Remainder of all other loads 17,605 x 40% = 7,042 Total 21,546 Current Minimum Amperes 21,546- 240 = 89,$ Current Minimum_ 125 Amps 17 Size Service orat (voltage) (minimum amperes) Feeder[240.6(A)] � � '1,urrently Electric Vehicle(s)[625.14] 125% x jjjj240 x 2,.; ;i" 200 Derating Volts Am / IRr•.:..`/�`/ " Minimum Amperes with Added Load Minimum Size j..� Divide the total 28,746_ 24'0' = 119.8 -Service 6}�' der , 25 Amps 2. w/Adder d `�\ wiY Bded loav volt-amperes by (voltage) (minimum amperes) P W the voltage. [240.6(A)] n % NOTES �y (�� �� Q All References are to 2014 National Electrical Code. ��fi Need help finding a qualified electrician,or have questions about home charging installation? IN Contact Tesla at:Charginglnstallation@teslamotors.com or 1-877-798-3752 INSTALLING YOUR 240 VOLT OUTLET Every Model S includes the Mobile Connector,which is a 20-foot long cable with a setof adapters for standard electrical outlets.The NEMA 14-50 adapter ensures the best charging experience with the Mobile Connector. Tesla recommends installing a 240 Volt outlet with a NEMA 14-50 receptacle where you plan to park your vehicle.This is a common outlet,often used for home appliances,and the electrician you hire for the installation will provide all necessary materials.You can charge your Model S from this outlet at a rate of 29 miles per hour. �J Below you will find all relevant information required for an electrician to complete the installation. Note:municipal building departments frequently require a permit and inspection for any electrical modifications in your home.Any licensed electrician will be able to take care of this paperwork and provide a copy for your records. w DETAILS W c Voltage:Single phase,208-250 Volt AC supply, 60 Hertz 0 N Current:50 Amp circuit breaker/40 Amp continuous current N Wiring Recommendation:6 American Wire Gauge,copper conductors only 250V E Ground Fault Circuit Interrupter: Not required ° Service Disconnect:Not required 0 Receptacle Recommendation:High quality, industrial grade receptacle 0 Location:Install near vehicle charge port, maximum 15 feet away. Minimum N 18 inches above ground. aElectric Code Compliance: Installing electrician will source permit and zinspection as required by local municipal building department RECOMMENDED OUTLET LOCATIONS FOR YOUR RECIARC% ONE OR TWO VEHICLE GARAGE ELECTRICAL COMPANY 7 PHONE NUMBER Q EMAIL ADDRESS i CHARGE PORT PERMIT NUMBER ® OUTLETS 0 .. INSTALLATION DATE TS S LR 3500 Deer Creek,Palo Alto,CA 94304 1 Nov.2014 1 Version 1.0 CUPERTINO Address 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 • building(cDcupertino.org FILE �_ � 7 7 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 have been tested and are operational, as of the date signed below. I have read and aciree to comn1v with the terms and conditions of this statement ....��!......................................................................................Dater .�. ..... Contractor Name: Sinature...................................................................Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03/18/14 e- 0? 5 CVPERTINQ WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aPcupertino.org ` Owner Nam -e M A Z 1 j A' 1 1 A C 'H A �*) A Permit No. �i S "nba) �3 Address , I S-,5- 9 W6' -#P W ,A R )D W (a`% ERT-) No CA 96 -Lo )4 Please refer to the attached California Civil Code Sections 1101.1— 1101.8 which are part of this Certification form. 1. Is your real properly a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. ©wnei' Si ratite: certifying that, due to the age or configuration of the properly 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. Sign below and skip the rest of the form. ® _eh'!tSignature -a 2-0I 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. o QSu&g_ti6 4. VENo Go to strri 4. �� lc�1 T1s 4. I�s ,YYour real property built and available for use or occupancy on or before January 1, 1994?f:lo _ My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 tluough 1101.8 do not apply. Sign below and skip the rest of the form. � Date ,�� My real prop6l �fs built and available for use or occupancy on or before Janua�iy 1,p1"994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. 0 J .,)4y property is a single family residential realproperly. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing .fixtW-66-t be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 200, all>non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless tler 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 plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB407 2015. doc revised 02104115 1. Ori"or before January 1, 2019, all non-coinpliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or _ improvements). UWe, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures~ 7e replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1 f01.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirexents, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table below. or Owner Agent's) Signature: Date: Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. .N'on=C-ompl'an Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) ;..j Maximum Water Usage/Flow Rate Fixture Type`; Water Usage =f 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate ;;:.: x'2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family ) Multi -Family Commercial ' _ Residential Residential Water Closets i' eed 1 6 — ,. i Single flush toilets: 1.28 gallons/flush (Toilets) r gGallons/flush` . i Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals ExCeedj- 0 'Gallons/flush 0.5 gallons/flush Showerheads' Exceed 2.5 -2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of .gallons per minute -',U.S. EPA WaterSense Specification for Showerheads ' (A hand-held shower is considered a showerhead.) ! 'For multiple showerheads serving one shower, the combined flow rate of all i showerheads and/or other shower outlets controlled by a single valve shall not i "exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to 'allow only one shower outlet to be in operation at a time. Faucets — .Exceed 2.2 gallons' .;Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory ;--per minute iminute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets j ? 0.8 gallons per minute @ per minute @ 60 psi; X20 psi minimum 0.8 gallons _.; per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute - '@ 60 psi Faucets — .Exceed 2.2 gallons ' 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen'per minute J60 psi @ 60 psi psi Faucets -:; " ?May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ ; ,default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 160 psi 1.8 gallons per minute ;Where faucets meeting @ 60 psi ';the above are unavailable, Where faucets meeting `aerators or other means the above are ay be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. J.,—If—the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shownNif�i,§ i16t required. to be up�ed a SB4072015.doc revised 02/04/15