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15040172 (2)October 15, 2015 Wu Tien -Yue and Hwang Lan -Fen Trust 11570 Upland Way Cupertino, CA 95014 To: Building Department, City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Attention: Patricia Garcia Subject: Building Permit Expiration Notice Site Address: 11570 Upland Way Building Permit Application # 15040172 This letter is to request a 30 day extension for the completion of the project that got delayed due to un- expected business travels that created conflictive schedules between the Contractor and the Owner. At this time Tien Wu is out of the country until October, 27, therefore preventing access to the site for inspection purposes. We will greatly appreciate your understanding. Sincerely, Cesar Simoniak, for Tien ll/u (Owner) Cc: Tien Wu CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11570 UPLAND WAY CONTRACTOR: SLINGSHOT POWER INC PERMIT NO: 15040172 OWNER'S NAME: WU TIEN-YUE AND HWANG LAN -FEN TRUST 164 MAIN ST DATE ISSUED: 04/23/2015 OWNER'S PHONE: 5103771278 LOS ALTOS, CA 94022 PHONE NO: (650) 308-9055 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ��y� n License Class it '7 25 INSTALL (N) EV OUTLET WITH DEDICATED CIRCUIT IN GARAGE , ) ,LLiQic. S(r� /mWej, Contractor 540 Date I hereby affirm rat 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 Sq. Ft Floor Area: Valuation: $1000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 ofthe Labor Code, for the performance of the work for which this APN Number: 36651003 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 DAYS QEPERMIT 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 F LLED 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 `L granting of this permit. Additionally, the applicant understands and will comply ed Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. l� 3_1 5 -- RE -ROOFS: Signature Date ( 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, ani 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. 1 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, 25533, and 25P4. --- Section 3700 of the Labor Code, for the performance of the work for which this Date: S permit is issued. Owner or authorized agent: (— V 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildincI )cr.cupertino.org ` AE PROJECT ADDRESS % r7o v / � /fin - D (!l/` APN # OWNER NAME /oISG/ ��i71vY11�Cc � �.. �•"}�"'� PHONE_5/0-37?-W9 E-MAILC 5;" 7C"7Gc /S�(Gf75.L0�'I STREETADDRESS 11 ('?o ) / -O / / J (C,/pl�L CITY, STATE, ZIP � � O / C14 qsw J FAX CONTACT NAME G• K cC9eS PHONE y-36/i-���� EI -MAIL (�/cG7eS�C5I�?�(S%�].of wc� STREET ADDRESS t / Z f /(./^ �� ( CITY, STATE, ZIP, �j�1 FAXt/ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNED RAGENT ❑ CONTRACTOR E CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /� /_� S `O L OWC� J f( h C LICENSE NUMBER �j�Z/i/ /7 / 77 b LICENSE LYPCB, /� T T BUS. LIC # ! 7 7 COMPANY NAME we E-MAIL GQ�ceveS �s�� s)o� aave� FAX STREET ADDRESS CITY, STATE,ZI,PoS o PHONE /�6 ^3og pO (� l ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF g, SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ NO ❑ SOLAR PANELS 9"FLECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: O D (> DESCRIPTION OF WORK 1 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act perty.alf. I have read application and the information I have provided is correct. I have read the Description of Work and verify it is accur . agre comply with al (cable local ordinances and state laws relating to buildin n, a horize representatives of Cupertino to enter the above-ide/nti ed prope ' spection purposes. Signature of Applicant/Agent: Date: f �� SUP LEMENTAL INFORMATION REQUIRED oz cE usE oivY PW + E" x a OVERTHE•COUNTER EXPRESS Q STAI�bARD ❑ LARGE I ❑, MAJOR PVApp_2011.doc revised 03/16/11 vq^ CITY OF CUPERTINO Em FEE ESTIMATOR - BUILDING DIVISION im,ADDRESS: 11570 UPLAND WAY DATE: 04/23/2015 REVIEWED BY: MELISSA APN: 366 51 003 BP#: *VALUATION: 1$1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: tither Huth. Ins). PENTAMATION SOLAR -RE PERMIT TYPE: 19 WORK INSTALL N EV OUTLET WITH DEDICATED CIRCUIT IN GARAGE SCOPE Elec. Insp. Fee: 2"1n FEE k , `A= MISC ITEMS 1: Mech. Plan (:heck Phunh Plon Check Elec. flan (,'heck alech. Permit Fee: Plumb. Permit Tee: Elec. Permit Fee tither Huth. Ins). 0111er Plumb Ins). t)tlaef• t lec. Insp. tlech. Insp. Fee: Plunib. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not includefees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n,'ctrirt_ otc L Thoco foot are hated an the nrelimMary information available and are only an estimate Contact the Dept for addn'1 info. FEE ITEMS LFee Resolution 11-053 f f. 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# Alternative Energy System $109.00 ICHRGSTA7 EV Charging Station Suppl. PC Fee: 0 Reg. 0OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. ® OT Fo,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'onstruclion Tax: Administrative Fee: 0 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 A Trut>�>l I�ocurne ntrxlac�n Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 _97 $1.50 $109.00 TO L FEE: $110.50 Revised: 04/01/2015 P"ILOT PLAINS Sheet Index CHECKED p I • 1 ... Title, Index, and EV Quipment Mounting Location � s i a>t 2... Load Calculations & EV Charger Circuit Schematic :. r.... `� sh 3... General Notes 4 ... Level -2 Charger - Installation Mechanical Own Your Energy - 5... Level -2 Charger - Data, UL NEC, NEMA -----------------------------------------------------------IN I ING DEPT Electric veh i Charger Additional Installation manuals, other hardware references r' �� and certifications available upon request v D P E' TI N o l n staff �7'I Vie rm it Permit 2013 California Electrical code; Underwriters Laboratory (UL) listed charging system. As Installation: catickn 40 EV Chargl n Can`, 1.EV charging system information: Level 1 or 2, EVSE system with UL listednumber or other t� ; _ Imarave blot tb alsm i and of two Car�E�' approved nationally recognized testing laboratory, in compliance with UL2202, Standard - Ev y . , for Electric Vehicle (EV) Charging System Equipment". FZe��o • � , T'.,', t='\1 T QV y EV Charger located qn, ite}side�4F� 2.Existing electrical service panel information at the residence. Include EVSE loadand circuit tT It dv the wall from the Mai.r)�e�I��6 - C size to determine if electric panel upgrade is required. Provide load calculations to determine if there is adequate capacity in the existing panel. (CEC220) 2013 APPR ,r,d specifications P.IUST be kep1l at the ;truction. It is unlVifui to make any 3.Panel upgrade and electrical wiring shall be in conformance with the 2013 California I`'r ations on same, or to deviate Electrical Code. i chars i` I th ang, :�proval from the Building Official, an and specifications SHALL NOT The Stamp �� ; of the violation 4.Identify if a second electric meter is required to be installed because of electricutility rate be held to Pr inance or St to Law. for EV charging. of an S.Clarify EVSE locations (garage, carport, interior, exterior, etc.) E PERMIT # 6. EVSE shall be installed -in accordance with manufacturer's guideline and must be suitable pQ� for the environment (indoor/outdoor). If the EV charging equipment is located in an area subject to physical (i.e. vehicular) damage and adequate barrier shall be installed. (i.e. 3to pLiOT PLANS CHECKED BY 4" bollard) Level 2 EV DATE 7.Submit installation guideline as part of submittal. PLANNING DEPT Panel CUPERTINO p Slingshot Power, Designer slingshot.. Equipment in this Electric Vehicle Charging System Title Sheet & Sheet Index Date: 29 -Mar -15 Project Details: Page Number: 164 Main St., Los Altos, CA 94022 Equipment Type Manufacturers and Model Version: 1.0 Ph: 650-308-9055 Scale: None Client: Cesar Simoniak Fax: 650-887-0345 1 Level -2 Charger Tesla Universal Mobile Project: 510-377-1278 Address: 11570 Upland Way California State Lic: 6984488 Drawn: Michael Condon City: Cupertino, California 95014 Standard Method Residential Service Calulation 1.0 General Lighting: 220.: Total 2224 Sq Ft. 6672 VA Small Appliance: 220.52(a) 3 Circuits x 1500 VA 4500 VA Laundry: 220.52(b) Circuits x 1500 VA 1500 VA Applying Demand Factors: Table 220.42 1st 3000 VA x 100% 3000 VA Next 3000 VA x 35% 1050 VA 6672 Remaining VA x 25% 1668 VA TOTAL.................................................................. 5718 VA 2.0 Fixed Appliances: 220.53 "It shall be permissible to apply a demand factor of 75% for four appliances other than eletric ranges, clothes dryers, space heating equip, air-conditioning equip.) YES/NO VA Dishwasher YES 900 VA Disposer YES 600 VA Min=r°urn6 A%VG Cu Wire Crated 75 deg C! L1, L 10 A%IVGGroundwls'r 4("p nrjr, 1 5%yoltaxr d7op • 11 19 Microwave YES V G Compactor NO 0' VA Pool/Spa NO OVA Attic Fan NO 0'VA Other 0 D` VA TOTAL.................................................................. 1968.75 VA YES/NO VA 3.0 Eletric Dryer: (5000VA) 220.55, Table 220.54 5000 VA x 100% NO`VA 4.0 Cooking Equipment: Table 220.54 Oven 7200 VA x100% YES 7a'VA Range 11000 VA x 100% YES VA Col C kW Other 0t, y VA TOTAL.................................................................. 15200 8.0 5.0 Heating or A/C: 220.60 (non-coicident loads) VA Heating unit 1500 VA x 100% NO VA A/C U nit 6000 VA x 100% YES MVA Heating Pump 1500 VA 100% NOVA (loads) ............................ Take Largest Load 600(1` 6.0 Largest Motor 220.14(c) = 430.24 & 440.6 0 E 0 VA x 25% 7.0 EV Charger Level 2 9600) VA YES 9600` VA slingshot 164 Main St., Los Altos, CA 94022 Ph: 650-308-9055 Fax: 650-887-0345 California State Lic: 6984488 ELECTRICAL LOAD TOTAL Service Total VA = 38486.75 VA/240 = 160.36 Amps Equipment in this Electric Vehicle Charging System Equipment Type Manufacturers and Model 1 Level -2 Charger Tesla Universal Mobile ERS Charger Leve G OUPERTINO 3uiiding Depatment APR 2 2 2015 REVIEWED FOR CODE COMPLIANCE Reviewed BT ly 200 A M3JI [tic.=� Pit 200 t'4. GENERIC Li'_ N IN AC ILoad Center 172 P016 50 Amp Circuit Breaker Slingshot Power, Designer Load Calculations & EV Charger Circuit Schematic Date: 29 -Mar -15 Project Details: Page Number: Version: 1.0 Scale: None Client: Cesar Simoniak Project: 510-377-1278 Address: 11570 Upland Way -, Drawn: Michael Condon City: Cupertino, California 95014 ABBREVIATIONS A ........... Ampere AC ........ Alternating Current BLDG.. Building Structure CONC... Concrete. DC ......... Direct Current EGC....... Equipment Grounding Conductor (E).......... Existing EMT....... Electrical Metal Tubing GALV.... Galvanized GEC....... Grounding Electrode Conductor GND....... Ground HDG....... Hot Dipped Galvanized I .............. Current Imp......... Current At Maximum Power Isc........... Short Circuit Current kVA........ Kilovolt Ampere kW .......... Kilowatt LBW ....... Load Bearing Wall MIN........ Minimum (N) .......... Neutral NEUT..... Neutral NTS ........ Not To Scale OC .......... On Center PL ........... Property Line POI......... Point of Intersection PV .......... Photo Voltaic SCH........ Schedule SS ........... Stainless Steel STC........ Standard Testing Conditions TYP........ Typical 2Pole ...... Grounding System(N) & GND UPS........ Uninterruptible Power Supply UFER...... Grounding system to foundation V.............volt Vmp........ Voltage at Maximum Power Voc......... Voltage at Open Circuit W............ Watt 3R ........... NEMA 3R, Raintight slingshot 164 Main St., Los Altos, CA 94022 Ph: 650-308-9055 Fax: 650-887-0345 California State Lic: 8984488 LEGEND E) Utility Meter & Warning Label Ey'a,F Inverter W/Integrated DC DISCONNECT DC DISCONNECT & WARNING LABELS AC DISCONNECT & WARNING LABELS .,I JUNCTION BOX DC COMBINER BOX & WARNING LABELS DISTRIBUTION PANEL & WARNING LABELS LOAD CENTER & WARNING LABELS DEDICATED PV SYSTEM METER CONDUIT RUN ON EXTERIOR CONDUIT RUN Equipment in this Electric Vehicle Charging System Equipment Type Manufacturers and Model 1 Level -2 Charger Tesla Universal Mobile UNGROUNDED PANEL ❑ POSITIVE GROUNDED PANEL ❑ NEGATIVE GROUNDED PANEL ❑ MICROINVERTERS ❑ THIS PROJECT SHALL COMPLY WITH: Scale: THE: Client: Cesar Simoniak 2013 CA BUILDING CODE 510-377-1278 2013 CA PLUMBING VODE Drawn: 2013 CA RESIDENTIAL CODE City: Cupertino, California 95014 2013 CA ENERGY CODE 2013 MECHANICAL CODE 2013 CA CITY / COUNTY FIRE CODE California Code of Regulations Title 24,, Part 3 California Building Standards Commission Basad on 201 1 NabGna9 Eiactheal Code Buildirld Deem Q�; APR. � 2 2015 REVIEVVED FOR CODE OOMPLIANCE Reviewed BY X Slingshot Power, Designer Page Number: 3 General Notes Date: 29 -Mar -15 Project Details: Version: 1.0 Scale: None Client: Cesar Simoniak Project: 510-377-1278 Address: 11570 Upland Way Drawn: Michael Condon City: Cupertino, California 95014 X Slingshot Power, Designer Page Number: 3 O CD 0 0 E CD 0 .0 0 0 CD i0 cm (D >0 . . . . . . . . . . . . . . . . . . . . . . . . . CDQ) C I_- LO 0) 0 3: &.� — C: co 4D cL 4) E in E 0 0 0 04) C) (D L9 (D 0) `zr Li > z a) C D (D Cn z C) ca n 0 UJ CO CL F_ 0 < E E 0 CL (D 0 r - (D 43 C) X > CL Lr) 0 — Cn 4) r_ Zia M 0 0 _J 0 E r_ (D 4- 0 -0 -a _J 0 < 0 C (Z 0 co 0 0 0 (D 4) Z a 0 L_ r LL. - -a 4) 0 E ca — ca co (J-) 0 2 (D 0 E 75 (.0 UJ Cr z > C &_ = 0 UJ M 0 12 (a >0, 0 CL a -cc CL d 2 :3 0 LU CX z 0 0 Z v E Z Z 0 0 LU 0) U_ Co . . ..... . CUPERTINO E Building Department E (D A= C:J = 0 0 _ Cr E .0 APR 2 2 2 0 a 015 co (D U o(D ■ .2- 7 LU 0 g r 0 U-) REVIEWED FOR CODE C Z 6 Z 0 COMPLIANCE Cc zCa z LU Reviewed By - 0 CL CL 0 0 16 4) E 0 U) cc 0 4-cs 0 UJ __J C' (D 4- Q) LO U_ -0 .J N NJ < 4-i *� *L- _0 4) im a 4Z=> p a 2(D LJJ U) 0 0 r Slingshot Power, Designer Equipment in this Electric Vehicle Level -2 Charger Installation Note -Mechanical slingshc,>t Charging System Date: 29 -Mar -15 Project Details: Page Number: 164 Main St., Los Altos, CA 94022 Equipment Type Manufacturers and Model Version: 1.0 Ph: 650-308-9055 Scale: None Client: Cesar Simoniak Fax: 650-887-0345 1 Level -2 Charger Tesla Universal Mobile Project: 510-377-1278 Address: 11570 Upland Way California State Lic: 6984488 Drawn: Michael Condon City: Cupertino, California 95014 CHARGING RATE OF 32 MILES RANGE PER HOUR AT MAX POWER "--'_7*"N The Universal Mobile Connector is ideal for road trips or as an alternative to the High Power Wall Connector. The Universal Mobile Connector is highly flexible - it includes a NEMA 14-50 adapter and 10 new dryez-s additional adapters are available for purchase. The Universal Mobile Connector enables a complete NEMA 14-30 30 10 recharge in 6 hours or less. Store the Universal Mobile Connector in the trunk for road trips, and enjoy the freedorn of plugging your Roadster into nearly any outlet, an ere. TECHNICAL SPECIFICATIONS 0 MaximumCurrent: 40A NENU Ll 4-30 generators 30 to 0 Voltage: 120-240V & Maximum Power: 9.6 kW -a a Cord Length.- 18 ft I-OW UNIVERSAL CONNECTOR CHARGE TIMES 0i'd dryers Charge times vary by outlet type and adapter. NENU 10-30 30 10 Breaker Charge Adapter Outlet Rating (Amps) Time- (Hours) motel AC units NEMA 6-20 20 14-5 NE 4A 14-50 RVs (hwkuted) 50 6 CUPERTINO NEMA 6-15 AC units, 15 19 Building Department EA, APR 2 2 2015 electrical vuelden REVIEWED FOR CODE COMPLIANCE NEMA 6-50 50 6 standard 3-prong, Reviewed By: NEMA 5-20 hiAff Current 20 37 AC w2its, connnerew equipment stwuhrd 3 prong 17 4./A NEMA 6-30 30 10 NEMA 5-15 15 48 / l I h t 164 Main St., Los Altos, CA 94022 Ph: 650-308-9055 Fax: 650-887-0345 California State Lic: 6984488 Slingshot Power, Designer Equipment in this Electric Vehicle ChargingSystem Level -2 Charger Datasheet & Information Date: 29 -Mar -15 Project Details: Page Number: Equipment Type Manufacturers and Model Version: 1.0 Scale: None Client: Cesar Simoniak I Level -2 Charger Tesla Universal Mobile Project: 510-377-1278 Address: 11570 Upland Way 5 Drawn: Michael Condon City: Cupertino, California 95014