14010151 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11775 RIDGE CREEK CT CONTRACTOR:GREENTECH ELECTRIC PERMIT NO:14010151
12333 SARATOGA SUNNYVALE RD DATE ISSUED:01/28/2014
OWNER'S NAME:
SARATOGA,CA 95070
11
[V--' LICENSED CONTRACTOR'S DECLARATION
JOB DESCRH'TION: RESIDENTIAL[] COMMERCIAL
�Z) g ,g3t� INSTALL EVC STATION IN GARAGE 9000 KW
License Class Lic.#
Contractor
Date 4 �
I hereby of r in 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:
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 Valuation:$800
p rformance of the work for which this permit is issued. Sq.Ft Floor Area:
JVhave 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:36604046.00 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 WITEIN 1 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 ROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 1.28'14
,��'1 ,
costs,and expenses which may accrue against said City in consequence of the Issued by: Date: �T
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:
Signature Date 02 41 All roofs shall be inspected prior to any roofing material being installed.If a roof is
V installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Date:
Signature of Applicant:
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 roe y g HAZARDOUS MATERIALS DISCLOSURE
property,rty,am exclusive) contracting with licensed contractors to
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 bythe Health&Safety Code,Sections 255 ,2�and 25534. �
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date:
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 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 950143255 \�
CUP ERTIN0 (408)777-3228•FAX(408)777-3333•building0cuper ino.org
Is
PROJEcT ADDRESS 11-775 R I DCS E CREEK C. "r''e ' (
STREETADDRESS //775 R'CO E CKEF-KOf"ITY.STALE.ZR' �fU PE R TIN® FAX
ME
CONTACT NA ,� /� PHOM E-MAIL:
S PMT ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-auumfm ❑owmm Amw COMIRACTOR ❑COMRACTDRAOEM ❑ ARcm-mcT ❑ENOUIFm ❑ DEVELOPER ❑mmANT
comEtACTONM � �50W-T "� / ��1AVU�L CQIV Bus-L'" 322— Sp
CoMNYNME GREEN
TEM FLW—TRIG F MAm FAX
SIREr:T waDREss / 3 SSA J�T11 ,a M NYV Lir,STATE" sA RA'TGC--,A C4 '%,S),280-1180
ARCH=C 1WGE,IEER NAME Lif�+NSE NUINBER BUS LIC/
COMPANY NAME E-MAX FAX
STREET ADDRESS QTY,S/•ATE,ZIP PHONE
USE OF O(SFD or Duplex ❑ Muhl-Family PROmm IN WILDLANDPRo]E\cr IN
STRUCTURE ❑ Comnmercial URBAN rEiRFACE AREA ❑ Yes ❑ No FLOW . ❑ Yes ❑ No
❑SOLAR PANELS ELECTRIC vmcm CBARam s Im mN E SOLAR WATER MATING ❑ OTHm
FOR SOLA PANELS NUMBER OF PA�N-ELS/U M: / KQ.OWATTS(COi RCIAL ONLY}.�Oo TOTAL VALUATION:
DESCRII''I'!ON OF WORK /A'S/ A J ) A T I O Al OF jEVSE //V &A R ACS E t CJ
i
By my signature below,I certify to each of the followbW I am the property owner.or authorized agent to act on the f.-I have read this -
application and the information I have provided is conwt. I have read the Dperipdon of Work aml verify it is accinum. I agree to comply with all applicable local
ordinances and state laws relating of Cupertino to enter the above-ii lifted{xo rly for n purposes.
Signature of Applicant/Ageat: Date:
SLTPLEMENrAL WORMATION REQUIRED
PYApp 201 Ldoc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 11775 ridge creek ct DATE: 01/28/2014 REVIEWED BY: Mendez
APN: I BP#: "VALUATION: $800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Du 12X PENTAMATION SOLAR-RES
USE: p PERMIT TYPE: i
WORK install evc station in ara e
SCOPE
01
'x
Mr�
/tech. Plan Check Plumb. Plan Check Elec,Plan Check
ilech.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
F1,f,/',
;�1ech.Insp. Other Plumb Insp. EIF-1- Other Glee.Insp.
.Insp.Fee: Plumb. Irrsp.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,etc). These fees are based on the prelimina information available and are onjE an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Alternative Energy System
Suppl. PC Fee: (E) Reg. Q OT F6.o hrs $0.00 $106.00 1CHRGSTA EV Charging Station
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cctnsli-rtction Tax:
Adinini.strative -ee:
Work Without Permit? ® Yes No $0.00
Advanced Planning Fee. $0.00 Select a Non-Residential
Building or Structure
Travel Documentation-Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldiz Stds Commission Fee: 1BCBSC $1.00
$1.50 $106.00 � o $1
Revised: 01/15/2014
LIVING SPACE r
BRINDA SHAH
11775 RIDGE CREEK COURT
CUPERTINO,CA 95014
EXISTING LAUNDRY ROOM SCOPE OF WORK:Install(1)40 AMP 240 VOLT circuit breaker in existing
EXISTING 100 AMP 3/4"EMT 100 AMP subpanei located in the laundry room.install 3/4"EMTzonduit
RECESSED Sk16PANEL CONDUIT from subpanel to wall mounted charging dock,Conduit will be mounted
to existing surfaces of the laundry room wall.Charging dock will be
mounted to existing wall surfaces inside the garage.
Cv v;','!;; -e'r 11_V7 OP;,i'',ENT DEPARTMENT
EYSE•RS INSTALLLOCATlt1N L.,;LL9.VU ei!L'i:�i .i•d-CUPER T INO
r9
26 t c�r•'.�..A�no snA^it'�cations MUST be kept at the
2D' t .(i _ . Jtt is ujj :a .;`u!to make any
onI same,or to deviate
3-CAR GARAGE SPACE ;_ iJ_• I t ;1i1 the Build?ng Off 1c1al.
n=<;' -n ¢i~"ations SHALL NOT
riloval ol-the violation
Jianie or S oata Law.
EXISTING 125 MAIN l
SERVICE PANEL
.144h
DRIVEWAY
CUPERTINO
Lry
l.IMin DePRrtment
���� 2 8 20
fr'w4 P Ai4Z� REVIEW`— FOR CODE COMPLIANCE
C RECRED By
Reviewed By. .��°
i)t',TE
. 0 IF.
.00-011
OATS �'
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C:1
AM Ask
2011 AeroVironment, Inc. All rights reserved
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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.
r
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.
Number of Freq Hz Voltage AC Current Operating
Phases Amps Temp
19 N
Power Disconnect switch Charging Dock
distribution (i#applicable)
panel wall stud
T
1 . Choose wire entry location
HOLE IN REAR OF
HOLE ON UNDERSIDE OF CHARGING DOCK CHARGING DOCK
Al \,
til,U
Bottom View '
Rear View
2. Attach the mounting plate
Mounting plate
p 0
Large hole for conduit utility wires
a Smail holes for
Charging Dock mounting holes mounting plate
to wall stud O Flat�washer Lag bolt
Wall stud - ~J
O0f----- ------ ------ -------
4
48- O
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
� -Z
y'k a.
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 Block
s
Ground Strip
Ground Wirer
Two power wires
5. Install the front cover
#10 Torx screws—Torque 12in/Ib
t
fr
4M
r
Removing the trim ring
A'�iGf'� � lYiO
1 11
Access hole : Outer ring
6. Complete the installation
~ a c o
- ---------
a
RON
t
FRONT PANEL COMPONENTS
The charging dock is r€celuircg
AC pavier. START
READY TO CHARGE Press to begin a charge.The
P%,,charging dock is ready to POWERFRESEW oPONER ESR ESE NT and READY
;;
charge orcharg ng is paused. READY TOCHARG€o G S RT €T CHARGEicthts rnuctbe on.
4
TROUBLE
0
VO4KIE CONNECTED STOP
TheconnectorI n properly Prsmtomenuafly stop char inrg.
connected to the vehicle port The devicegill stap aLAornaticaliv
or the chaiga is complete. when it reaches full charge.
VEHICLE CHARGING
The vehicle is baing charged:
TROUBLE
Tbere
is aii Griot Try rerrKwing
the connector and insetting back
into ttie vehicle.If Trouble
Indicator is still ilturninated rail _..
Customer Servire at 1(877)lam
GAS EV or 1(87 t)554-2738 or
v-sit Customs,'Service can the RELCJL4E BUTTONga batsa .n steno=a.ccinlieaf. Press to releasethcConnector
frarn the charging d Y_k or the
cehide part.
`.
In
s,.
CHARGING THE VEHICLE
Pmss the buttm on taxa €.trrvr the cable frm
o,rnnoctcf to r€ sem.it ammd ft.cables hanger,
m the n:tiwpq dwk
VEMCLECONNECTED••
arNar
hw—vt�nr""ctxfirmlyiritvthQ arae eas p els will begin
"er,fdg churcie F_4t.vvfhol <urtoinatic«lE;g+<When
ting€nserf�i:tha"v;Ji�",(.E a€�xxnrwe3s+u 8 ch�igiru� &g€ns,the.
% c`14ECTEDliltinnthe e O VEHICLECHAlGINC�light
cP ing dock w'1 io urremata. €1 begin blink.Thera
is no riegd to prssn START.
vEMeLE ctutNG
•
OvrAKr Charring Wilt stag eutorn timN Whin thu VEHICLE
STOP When omplete. "fou ti an manually CHARUNG light strop;.^
stop dording by pre'ssing STOP, blinlang on the charger,
When thq READY TO CHARGE press the button care the
light blinks,ramove the conm;4ctrw cor nE ctor to release.
from the vehicle charge port.If Nell to rer iov€i from,
you have "ed 910P,you can whi'cle charge purl.
press START to resume charging.
AM
RillPf i A, 102
0 •
f f
x
' f �
M � 'CS des fheY ' rr'yd B
4 �
c�u
F
TC # T
6
_.'
MA i
Mtilt
� 1 aven�en�l fti � "'AN
\• Electnclans w1#1'- r zaOe
�-
to
x � � n The EVSE-RS Charging Station charges all SAE J1772-compliant
vehicles—including both electric vehicle(EV)and plug-in hybrid
(PHEV)models—in the convenience of the home garage,workplace,
condominium,apartment,or retail parking structure.The Home
SPECIFICATION EVSE-RS Charging Station safely and reliably delivers AC power to the
Connector SAE J1772 compliant vehicle's on-board charger and features a weather-resistantVE(I� Ra
.... . >; f
Voltage 208VAC to 240VACc� la6�a�1s
.
Frequency 60/50Hz The EV Charging Station can be installed by one of our independent
Output Current 30A max certified licensed electricians who also facilitate necessary permitting
Input Current 40A max and inspection,and provide information about EVSE-RS use to the
Operating Temperature 22°F to 1221F customer.An optional module is available to enable WiFi,Zigbee,or
-30°C to 50 C cellular network connectivity.
_................... _.....
Storage/Transit Temperature -40°F to 140°F
-40°C to 60°C
Relative Humidity Up to 95/0
non-condensing
Dimensions 12"x 12 x 8"
(approximate)
Weight 10 lbs.(excl.cable)
........
Cord Length Up to 25'available
'p
Regulatory Co111111111111 "1mpliance UL,cUL,C11111-_111_1______...-1_11E ick
CrUL C V
listed
C E
Information and specifications subject to change. -' «" V...._._. "Installation services available in certain areas,
contactAV for additional information.
02011 AeroVironment,Inc.
15_01 11_I 0147