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12050166 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDREss: 22332 REGNART RD CON HIM']OH: SCI IAEPER PER)III NO: 12050166 ELECTRIC CO INC OWNER'S N:\>lE: RAJENDRA SHAH 2346 LETIIS CIR D.%IT ISSCEb:05/22/'_012 O\CNER'SPUONE: 4082481274 MORGAN HILL.CA 95037 PHONE NO:(ms)77h-I05U ❑ LICENSED CO\IRACfOR'S DF-CI-ARAIION r r r BL /� nn BUILDING PERNII T INFO: DG FIRC II PLUMBI,iccnsc(aass_C V hie./! 8 93a r r r //��/ MFCII RfaIDF•N'IIAI. (:OMNIERCI,%I. Contractor ��'c•dJ44 Dale l ZZ j"j� 1 hereby affirm that I non licensed under the provisions of Chapter JOB DESCRIPHON: INSI AI.I.I.V C'IIAR(iING ST:\ZION IN SI'UP'I.(i,V ,N(iI (commencing with Section 7001)of Division 3 of the Business& Professions - Code and Ihat my license is in full force and effect. I hereby affirm under penalty of perjure'line of the following tw'o deehv:tions: I haw and trill maintain a ceridicme Of consent to sell'-insure Ibr Worker's Cmtpens lion.as pro%ided for MSection 3700 of the Labor Code,for the performance of the work feu which this permit is issued. Sq.FI Floor Area: Valuation:S1200 I have and will maintain Worker's Compensation Insurance.as provided lett by Scclion 3700 of the Labor Code.for the performance of the work lit Ili- [itis :\I'N Number:36639005.00 cc q' upan 'I}pr: perntil is issued. ,U'1'LIC,\N'I CF-RTIFICA'IION I certil'%'that l have rttW this application and state[hal the above inlbnnation is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree la comply with all cin%and county ordinances and slate laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to buildine construction.;md hereby authorize representatives ofthis city to enter upon the above mentioned property for inspection purposes. We)agree to save 180 DAYS '1 OM LASI" CALLED INS[) 'CfION. indemnity and keep harmless Elie Cil%of Cupertino against Ia bilines,Judgments. costs,and expenses which mor accrue against said City in consequence of the e— gr,mling of this croon. Additionally,the applicant understands and will comply Issued by: G Date:J /2 with all nun. 0' so lice regal, it, pe lie Cupertino Municipal Code,Section 9.18 j RE-HOOFS: _ DateAll roofs shall he inspected prior to any roofing material theme installed. Ifa roof is installed without f irst obtaining an inspection. I agree to rnnmc all new materials for inspection. ❑ 0\\'N E R-BU11.1)EH 1)ECLARA""LION 1 hereby :dTinn that I am exempt from the Contractor's License Law for one of Samalure of Applicmtl: Date the fallowing pvu reasons: M.I.ROOF CO\'EI(INGS'10 BE CL%SS"A"OR BE 1-1 I'll L as owner of Elie prupergt or my employees with wages as their sole compensation, will do the stork.and die strucore is not intended or oftered lett sale(Sce.7044. Business& professions Code) L as owner it the properly.am cxchuiveN'contracting with licensed contractors to I[AZ.\RDOUS A11A I ERI:\I ti DISCLOSURE construct the project(Sec.7044.business& Professions Code), I have read the hazardous materials requirements under Chapter 6.95 ul the California Ilealth&Rad'el\'Code.Sections 25505,25533,and 2-5534. 1 will 1 hereby affirm under penalty of perjure'ane of the fallowing three maintain compliance wish the Cupertino Municipal Gude.Chapter '1.1'_and the declarations: Health&Safely Code.Section 25532(x)should I store or handle ha zal dous I hove and will maintain a Certificate of Conserv to self-insure for Worker's material. :Wdition:dly,should 1 use equipment or devices which coil hnzaicous Compensation,as provided fur by Section 3700 of the Lahor Code,for the air conhuninants;is defined by II :q':1rra:\ir Quality ?Ice nagenu•nl Uisl reel I performance of the.cork for tchich Ellis permit is issued. Brill maintain enmpliantt•will perlinn\h C a Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by. the Health&Safety Code, ' c s .5U. 3. d .534. Section 3700 of the Labor Code,for the performance of[he work for which this O permit is issued, wnrr or aulhorizcd ag n . U:uc: I certify'that in the performance of doe work for which this permit is issued I shall not employ anv person in any manner so as to become subject to the Worker's Connpensation latus of'Califurnia. If.after making this certificate of exemption, I CON:S"I RUC"IION LENDING AGENM'Y become subject to the Worker Compensation provisions of Ilhc labor Code. I must I hereln a0'unh that there is a construction lending agency lot Elie pcdbnnaocc of liuthwith connply pith such provisions or(his permit shall be deemed revoked, work's Liu which this permit is issued(Sec. 3097,Civ C.) Lender's Name APPLICAN"I'CF-R-IIFICATION Lender's Address I certify Ilial I have read this application and state that the above in iuntation is correcl. I ugrce to comply with all city and count) ordinances and state Encs relaiin_a to building construction,and hcrehy authorize representatives of Ellis city loaner upon the above mentioned properiv Ibr inSceliOn purposes,(We)agree to Save U(CI I1'rICCI"S UISCL:Vt.\TION indenwifN'and keep harmless the City of Cupertino against liabilities.judglnems. costs,and expenses which may accrue against said City in consequence 01 tale I understand nn'plans shall be used;is public records. granting of this permit.Additionall%,the applicant understands and will comply \% 111 all non-point source reguldions per the Cupertino"lunicipal Code.Section Licensed Proicssional 9.19. Signature Date CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 22332;Regart Road DATE: 05/22/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: 1$1,200 *PERMITTYPE: BUilding,Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION SOLAR-RES USE: PERMIT TYPE: WORK Install of EV charging station in existing residential garage. SCOPE :Nealy. flan Chock Plumb. Plan C/rcck /i/ec. Ilan C'hcck me,.h. I'v,wil Fee: Plumb. Permit Fee: Ekr. Permit Fee: Other.1 fee h. h2sp. Other Plumb/n,cp. Other F/r.c.Insp. 111ech. hnp. Fee: Plumb. hrsp. Fed: /filer. Insp.Fac: 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 Prefimina information available and are only an estimate. Contact lite De r or addn7 info. FEE ITEMS (Fee Resolution 11-053 Elf. 7/11111 FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 F-1-1 # Alternative Energy System Suppl. PC Fee: Q Reg. O OT 0:0 hrs $0.00 $100.00 ICHRGSTA EV Charging Station PME Plan Check: $0.00 Permit Fee: $0.00 77-7 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'unslrurtiun Tu.c: Adtninisi r Live Pere O Work Without Permit? O Yes. '0 No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Travel Docaunenlrniorl Fees: A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: , IBCBSC $1.00 E . SUBTOTALS: $1.50 $100.00 TOTAL FEE: $101.50 Revised: 04/01/2012 GENERA L,PERMIT-:APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I sc CUPERTINO (408)777-3228• FAX(408)7T73 (D) 333•buildinGcuoertino.oro //����n( []PLUMBING MECRAf/MCAL LECMCAL 1210 210 52) l CoUl MISCELIr PROJECT ADDRESS Aa33� ke.. r 1 APN' . O(V 3 q 005' OWNER NAME R e-n ,arca. ( _ PHONE��Q'� -///4�Y 4V,DE� - STREET ADDRESS ((�a330- •/\. _,L'•./aar .� CRY, STATE.ZIPC� 'er}lSKm CA EA.1s6/ CONTACT NAME / ��1 'I dr _I!a PH O G-�/^ ( I h!O E-MAIL STREET ADDRESS234,� rv1 6'f-�,,_, C 0 Zo74 1 b IIIIJJC-A -`50 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT II CONTRACTOR 1CCO�NTRACTOR AGENT ❑\ ARCHITECT ❑ENGINTER ❑ DEVELOPER ❑ TENA.�T fOMRACTOR NAMF/v( r i S S. _ A /�( S�EyNI�°fft �Z al L CN E-TO BUS.LIC N / /� ©''7 COMPANY NAME cJVIJ`Qe C)44 . QC �O •JC�t�i l'e `.I -(C�/I(fGC.OLi F 1V(�I r46-/075 STREET ADDRESS� I 1 /�_. CI'fl'( �rAl'E.J,�P �L I'I CA PHON""fo6 -n b- `'5a ARCHiTECTIENGINEER NAME li LICENSE NUMBER 1` BUS.LIC p o I O COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE.ZIP PHONE USE OF SMat DUPLEX ❑ MULTI-FAMILY PROJECTDJD WDIAND ❑ YES PROJECT IN YES IS TNM BLDG AN ❑ YES '='G: COMMERCIAL URRAN[NTFRFACE AREA NO FLOOD lDNE ( NO EICTiLFR HOME? L�(NO DESCRIPTION OF WORK - //��/�) r vI Mel+ TOTAL VALUATION' 2 RECEIVED BY: By my signature below,1 certify to c f the following: I am theRe er or authorized agent to act an the pmperry owner's behalf. I have read this applicarion and the infonnaricn v is co L 1 have prion of ork and verify it is accurate. agree to c ply with all applicable local ordinance and state laws rclati g 1 au nentativ Cupertino to enter the abovre-i ntifiW pm arty for inspecrion pui�oses. Signature of ApplicanUAge Date: SUPPLE AL fNFORMATION RE D OFFICE USE ONLY OYER-THE-COUNTER `r ❑ EXPRESS 1 V ❑ STANDARD U E ❑ LARGE ❑ MAJOR MEPMacApp_1011.doc revised 06/11/ll CAL-Warlir!v f ri-4 ?-!501'/ wh Mai n SIjc 'Pli O tieVI t�rvi-� ct�61e 2- 10\1 4oA cr*01 CUPE VINO Building Del iartment y� I MAY 12 2012 — -- ----L--� REVIEWED FOR kNCE Reviewed By: 3 CAIZ� KA-6-6 RP'CE:g VEI> MAY 2 2 2012 COMMUNITY DEVELOPMENT DEPARTMENT BY. BUILDING DIVISION-CUPERTINO APPROVED This set of plans and specifications MUST be kept at the Job site during construction. It Is unlawful to make any changes or alterations on same,or to deviate therefrom,without approval from the Building Official. The stamping of this plan and specifications SHALL NOT j '®PYbe held to permit or to be an approval of the violation OFFICE of any pr CIslons of any City Ordinance or State Law. BY Atj DATe411MI M PERMIT NO. 12 Q5-7121 Lo W ChargeP#int by Coulomb Technologies CT500 ChargePoint® Networked Charging Station d•. 71 J,t �f J ' I a^ `�yr Y- • . Installation Guide Coulomb Technologies Coulomb Technolo"Ina. 1692 Dell Ave Camooll,CA 950088901 USA us mil free:+14773703802 --CQubmwO.wm www.nlYohazBeWl�nO Part Number.7500102401 Revision:LO Introduction Wiring Information MK30 Ll Ex MDEB NEU Ll MK ]F1N1(F MM @1D NEU L1 f MNN BI1FNm1 Mov 90A,2 POLE BBFAI®i MAYBE CONNECTED � .:� YOANY7WOPNASES. $ rnm 4 .�¢ 200.sDKdE POLE eBEAIO:n MAYBE CONNEMI)M ANY PNASE 0 MDY,10 u NPI METER IOCK Ll sor X6 NE1) L1 @ID MAIN 911F11DA MOV ^L1 m � (1Sry 60WLL 100.SINGLE POLE ERFAl0iBMAY z 6aa1 BE CONNECTED TO ERHEB PHASE 0 1-3 �. ChargePolnt®Charging Siadons Specifications Electrical Input Input Power. 7.2 kW Input Voltage:208/240 VAC Input Current 30 A Input Power Connections:Line 1, Line 2, Earth Recommended Service Panel Breaker:Dual 40 A double pole breaker(non-GFCI type)on dedicated circuit Standby Power. 5 W typical Electrical output Output Charging Power. 7.2 kW Output Voltage:208/240 VAC Output Current 30 A Output Charging Connector.SAE J3772-EV connector on 18' (5m)cable Functional Interfaces Card Reader. ISO 15693, 14443 Ground Fault Detection:20 mA CCID with auto retry(15 minute delay,3 tries) Plug-Out Detection:Power terminated;per SAE J1772-specification Power Measurement 2%at 5 minute intervals; IEC class 1 capable(special order) Local Area Network: 2.4 GHz 802.15.4 dynamic mesh network Wide Area Network:Commercial CDMA or GPRS cellular data network Safety and operational ratirWs Safety Compliance:Complies with UL 2594, UL2231-1, UL2231-2, UL 1998, NFPA 70, NEC Article 625 Surge Protection:6 kV®3000 A. In geographic areas subject to frequent thunder storms,supplemental surge protection is recommended. EMI Compliance: FCC Part 15 Class B Operating Temperature:-22"F to 131'F(-30'C to+55°C) Operating Humidity: Up to 95%non-oondensing Enclosure: NEMA 3 per NEMA250-1997 Terminal Block Temperature Rating:212"F(100°C) Maximum Charging Stations per 802.15.4 Radio Group: 100. Each station must be within 150 feet of at least one other station. 1-2