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14010080CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7412 STANFORD PL CONTRACTOR: GREENTECH ELECTRIC PERMIT NO: 14010080 OWNER'S NAME: SARATOGA, CA 95070 PHONE NO: (408) 280-1180 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ INSTALLATION OF EVC STATION IN GARAGE 30 AMPS License Class 02/10 Lic. # 9Jr 083 Contractor 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: 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 Sq. Ft Floor Area: Valuation: $500 p rformance of the work for which this permit is issued. ave 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: 35932027.00 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 WITBIIN 180 DAYS OF PERMIT 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 DAYS FRO T CALLED 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 y/ / / Issued by: Date: / granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 918. / RE -ROOFS: f Signature Date l /�F /(� 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. ❑ 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505 2553 , and 25534. Section 3700 of the Labor Code, for the performance of the work for which thisI Owner or authorized agent: Date: /!rC 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 CONSTRUCTION LENDING AGENCY 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 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 ofCupertino 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 I COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \ou CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building0moerfino.orrm �J AE PRAJECrADDRESS 7412— 53TA NFORD PLACE APNlr 35132©07. OU - OWNERNAMESOON r ( xZ CITY OF CUPERTINO NP F.F.F F.CTIMATOR — RITILDING DIVISION imADDRESS: 7412 STANFORD PL DATE: 01/14/2014 REVIEWED BY: Mendez MISC ITEMS APN: BP#: *VALUATION: $500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex hrs PENTAMATION SOLAR -RES USE: PME Plan Check: PERMIT TYPE: WORK INSTALLATION OF EVC STATION IN GARAGE 30 AMPS SCOPE Xlech. flan Check Ph.tmb. Plan Check Elec..Plan Check ;Lli>ch. Permit Fee: Plumb. 1'ermit Fee: F.lec. Permit Fee: Other ;ilech. Insp. Other Plumb Insp. Other Elec. Insp. Allech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l M Q M MM $1.50 $106.00 $107.50 Revised: 01/01/2014 FEE ITEMS (Fee Resolution 11-053 E . 7if /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Fi I # Alternative Energy System $106.00 ICHRGSTA EV Charging Station Suppl. PC Fee: Reg. Q OT'. p;0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeeO Reg: Q: OT b.0 hrs $0.00 PME Unit Fee: $0.00 PW Permit Fee: $0.00 Consiruction :Tar. �.Ll7Y1lr7iStrative .Fee Work Without Permit? ® Yes . (E) No $0.00 Advanced Planning Fee $0.00 Select a Non -Residential Building or Structure Travel Documentation Fees: Strong Motion Fee: i$SEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 M Q M MM $1.50 $106.00 $107.50 Revised: 01/01/2014 EXISTING 200 AMP MAIN SERVICE PANEL 3/4" EMT CONDUITALONG EXTERIOR SIDE WALL OF HOME TOR JG 3/4" EMT CONDU€T TO BE RAN ON €NTEMOR GARAGE WALL SURFACE TO EVSE INSTALL LOCATION NSTALL LOCATION INSIDE GARAGE STANFORD PLACE.'�' t:, ^,! f .. r_,. �1 - -. i DEPA,R-IIMENT bu4LDi;N Ciil; ii S1i-'-'UP-E I INO "D T, >> -t of p)^ns and spec. Icat ons MUST be kept at the ,w' con r .rul -flan. It is unlawtui to make any c > Or a:t'atiot is on same, or to deviate the-, E m, w0,hout approval from the Building Official. SL .Il- NOT —C'val i i anca or v L.Lol Law. PE N10. IOON ONG 7412 STANFORD PLACE. CUPERTINO, CA 95014 SCOPE OF WORK: INSTALL (S) 40 APAP, 240 VOLT aRCUIT BREAKER IN EXISTING UTILITY PANEL. INSTALL 3/4" EMT CONDUIT ALONG EXTERIOR SIDE OF HOME TO CRAWSPACE OPENING. RUN 8/3 ROMEX WIRE THROUGH EXISTING CRAWLSPACE TO GARAGE.. RUN 9/3 ROMEX WIRE OR EMT CONDUIT UP ALONG S€ DE OF GARAGE WALL, ACROSS INTERIOR CEILING OF GARAGE TO OPPOSITE END, RUN 3/4" EMTCONDUIT ALONG INTERIOR SIDE WALLSURFACE TO EVSE INSTALL LOCATION. EVSE & CONDUIT WILL BE MOUNTED TO EXISTING SURFACES OF THE HOME. OFFICE C0116'S; CUPERTINO ' Building Department _r JAN 2 Cali ,-..,,€� t;ODE COMPLIANCE F,,ev)ewed By: cam j �;���12.1G �Tta�S 9A:W06,A, q�0 Ell OAAIC, 4 COP 0 2011 AeroVironment, Inc. All rights reserved V-4 I"I This guide is a reference for Municipalities inquiring about the use, installation and compliance of the AeroVironment EVSE-RS with the National Electric Code and Local Codes. AeroVironment, Inc. Model EVSE-RS Product and Installation Overview The EVSE-RS is a device which offers a simple and safe way of providing electricity to the on -board charger in an Electric Vehicle. NEC 625 Compliance • 625.2 Definitions. • Personnel Protection System: A system of personnel protection devices and constructional features that when used together provide protection against electric shock of personnel. • 625.5 Listed or Labeled: UL Listed 2594 • 625.9 Electric Vehicle Coupler: J1772 coupler SAE North American standard • 625.13 Electric Vehicle Supply Equipment: Permanently connected and fastened in • Place. No exposed live parts • 625.14 Rating: 30 amp output rating. Continuous load • 625.15 Markings: — (A) For Electric Vehicle Use Only (Denoted on EVSE-RS Label) — (B) Ventilation not required (Denoted on EVSE-RS Label) • 625.16 Means of Coupling: Conductive J1772 connector and EVT rated cable • 625.17 Cable: EVT rated cable extra heavy usage • 625.18 Interlock: Proximity switch de -energizes when unplugged • 625.19 Automatic De-Energization of Cable: Cable break away feature. • 625.21 Over current Protection: Shall be sized for continuous duty 125 % - 40A Circuit Breaker • 625.22 Personnel Protection System: Proximity switch, GFI protection, Breakaway cable, Trouble annunciation light for faults and NEMA 3 Rain Tight enclosure. • 625.23 Disconnecting Means: For electric vehicle supply • equipment rated more than 60 amperes or more than 150 • volts to ground, the disconnecting means shall be provided • and installed in a readily accessible location. • 625.25 Loss of Primary Source: Contactor opens upon loss of power. INSTALLING THE EVSE-RS Specifications: ■ For use with Electric Vehicles ■ Ventilation not required ■ NEMA Type 3 Rain Tight enclosure ■40 Amp. circuit breaker rating. Do NOT use a Class A circuit breaker with the EVSE-RS Charging Dock. 1. Choose wire entry location HOLE ON UNDERSIDE OF CHARGING DOCK Bottom View 2. Attach the mounting plate HOLE IN REAR OF CHARGING DOCK Rear View O Flat washer Lag bolt o0 0l--- ------------------ ------- 0! fl 00--- - - ------3 ------ 0 —Wall stud 3. Attach the Charging Dock to the mounting plate a. Torque the screw to 40 in/Ib. Upper mounting hole Flat washer Socket head screw -- ------------EMED 4. Wire the Charging Dock a. Torque the terminal block screws to 20 in/Ib. b. Torque the Grounding Strip screws to 20 in/Ib. Terminal E Ground. Ground Two power i 5. Install the front cover #10 Torx screws— Torque 12in/Ib =MV46h,na-M Removing the trim ring n - ulnar ring 6. Complete the installation FRONT PANEL COMPONENTS POWER PRESENT The charging dock. is r eiwing AG power, READY TO CHARGE The charging dock ss ready in charge or charging is paused. VEHICLE CONNECTED The connector Is property connected to the uehide port or the chan3e is complete,. VEHICLE CHARGING The vahir_le is Ding charged. TROUBLE Thera is an erroc. lay rerrrcWhig the connecter, and insaMng bads into, the vet -fide, If Trouble indicator is still illuminates! Call Customer Service at 1 77) N€� CAS EVor 1 (877) 654.2738 or visit Customer Service can the web at.www.nis,anusa.comileaf START Press to begin a change. The Pt tr"aER PRESENT orad READY O CHAKiF :icy: r*..s must: be on. STOP Press to manually rte p char,;ieg. The devicawill shop autrrma icatly w ham it reaches full charge. RELEASE BUTTON Press to r€iease the Connertcr iron,# the c`rarcgi ro dock or thc- c„1.id+a port. CHARGING THE VEHICLE Noss & I:SL bion'` ills Utwrap t}a?.: &J@ $frim 06FInGcter to rdame a around the cable Vmr,,r ftm the dxk. VENCLE COMECTEa tcemnectmImgyartoika rraexs€mrn fir• xeanvci a -- 4rrARr uhargxrgwdbemn vaWia chem }tet, Man a a rtomatroat . hem R4msertW, theirEHICLE e. a charging begsna, the TECHlot mthe "" a VEHICLE CHARGING kaht charging dock wA ftmwe, will begin 4a bbi,& Tf€sae 1i no naa to pmas START_ VEHICLE f5sriu r Chartgng wffli atop automatically `cher} the EHIGLE " when complete. Year can mnually Ct-4sRGI G fight stops charging bar rising STOP. bhnlanq on the charger, When READY TO CHARGE E press the butter; on tha kfit blinks, remove tha connector crxmemr to rreleasa. fmm flra srahide cf ga pat. If Puil to resns+ae from you have greased STOP, you can vehide charges ort. pm" START tD ree'surns cbariging_ i SPECIFICATION EVSE-RS Connector SAE J1772 compliant Voltage 208VAC to 240VAC Frequency 60/50Hz _................ Output Current 30A max .............................................................:.............................. Input Current 40A max Operating Temperature -22°F to 122*F -30°C to 50°C Storage/Transit Temperature -40*F to 140°F -40°C to 60°C Relative Humidity Up to 95% non -condensing Dimensions 12" x 12" x 8" (approximate) Weight 10 lbs. (excl. cable) Cord Length _.._. _.. ....._ Up to 25' available ....1.- .......... .......... Enclosure NEMA 3R Regulatory Compliance UL cUL, CE, CTick listed Information andspecifications subject to change. 02011 AeroVironment, Inc. 15_0111_10147 The EVSE-RS Charging Station charges all SAE J1772 -compliant vehicles — including both electric vehicle (EV) and plug-in hybrid (PH EV) models — in the convenience of the home garage, workplace, condominium, apartment, or retail parking structure. The Home Charging Station safely and reliably delivers AC power to the vehicle's on -board charger and features a weather -resistant NEMA 3R enclosure for indoor and outdoor installations. The EV Charging Station can be installed by one of our independent certified licensed electricians who also facilitate necessary permitting and inspection, and provide information about EVSE-RS use to the customer. An optional module is available to enable WiFi, Zigbee, or cellular network connectivity. * Installation services available in certain areas, contactAV for additional information.