12020092 it
CITY"OF CUPERTIN,-O`BUILDING'PER'NIIT
BUIL6ING°ADDRESS: 10208 TONI.CT CONTRACTOR:Synap ss,Electric PERMIT NO:1,2020092
OWNER'S NAME: DONALD&KATHERINE DISNEY•TRUSTEE DATE ISSUED.'02%21Y2011
OWNER'S PHONE: 4086845207 PHONE,NO:
❑ LICENSED CONTRACTOR'S-DECLARATION„ GPERMIT C
BUILDIN
INF.,O: BLDG ELECT PLUMB
Licen'se,Class �.D Lic., rJr
C MECH -" RESIDENTIAL COMMERCIAL
;Contractor S�N�°Ps� _ ( '(t;2 Date ( C 7012
I hereby affirm'that I am,licensed'under the provisions of Chapter,.9 JOB DESCRIPTION:INSTALL NEW.EV STATION AT GARAGE
- o _ y -
r(commencing!wiih Seciion.7000)of Division3'of the;B_usiness Bc Professions LOCAL
Code,and that;mylicense,isi,nlull,force,and.e_ffect. .
I heretiy�affirni,under:penalty ofperjdr.'y'one:ofthe:follorving,two*clarations:
1 have and'wi11,maintain a certificate,of consent-to self.irisure fon Worker's
Compensation,as provided,for bySection370-0 of the Labor'ICode,for the
performance-of the work for which this oermit_is issued
I have and will maintain Workers Compensation Insurancejas provided'forby
Section 37000t1heaLabor Code,for the-performance:of the work;forwhich`this Sq:Ff-Floor Area;: Valuation:,51200
°permiiis,issued. -
APPLICANT`CERTIFICATION APS Number:'316231'04.00 Occupaneff-ype:
.I certify thaYGhave.�read"this applicationaandstate;that the,abovd>iriforination,is
correct.II�4gree to comply with'all'
city•anii county`ordinarfces'and:state laws,relating
to,building construction and��here6y auttionze"representatives oftHis,city to enter
upon the,above�mentioned property,for inspection,purposes..ii(we)agree'to save: PERMIT EXPIRES.IF WORMS NOT STARTED
inderiinify,and keep harmless the City of Cupertino'agamstl_iabilmes;judgments, WITHIN 18O DAYS OF.PERM.IT ISSUANCE OR
costs and,expenses,wh'ich-may,accrue again said`Cityin consequence of the
grant�ng'of,tfiis permit: Ad'diiionally;Fthe_apphcant understands and will.comply 180 DAYS PROM LAST CALLED INSPECTION.
with all,non-poin= _ egulatilons per-'the Cupertrimo`Muriicipal'Code;,Section
9:1'8: — l
7 Issued b te;.
Signature Date "D
I
0 OWNER=BUILDER DECLARATION RE-ROOFS:
I hereby affirm that .-am exempt from'the�Contractor's License Lawsfor.onerof All roofs shall be inspected•prior to any roofing material b0ig installed.If a=roof+is
the?following-two,reasonss installed without first obtaining;an inspection,I agree toxeniove all new materials for
i;
CITY OF CUPERT N
r'
FEE,ESTIMATOR-BUILDING DIVISION jh
. ADDRESS: 10208 toni ct. DATE: 02/21Y2012 REVIEWED BY: bobs.
APNBP#: /�� � a 'VALUATION: $1,200
*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD,o.r Duplex PENTAMATION SOLAR-RES
USE: PERMIT TYPE:
WOR!< install new e.v. station at garage local:
SCOPE
iaa:., �';.. f &1, `.825.� }r c fi ..
,
Li
:;i�r,ter'..fT?.4,I7. t•t{g.' l,.v,.._. .:f',^:,i''.,_..... ., AK'.'?i. : ...,..
NOTE:This estimate does not iifclude fees due to other Departmeiats(i.e..Planning,Publie Works,Fire,Sanitary Sewer•Distriet,School
District,etc.)._-These:ees are based.on,the, relinkna "iia Urtnation+availdble acid are<onl' •tzn esiinaate: :CtniMet.tlie,De t or i d in'l-in o.
FEE ITEMS (Tee Resoliitiorr 11-053 L' ?'Ulla • FEE Q TY/FEE MtSC ITEMS
Plan'Check Fee: $0.00 # Alternative Energy System
'Supp(. PC"Fee: Q Reg. Q OTQ,Q hrs $0.00 $1'00.'00 I.CHRGSTA EV Charging Station
PME Plan Check-
$0.00 -
Pe_mit Fee* $0.00
Suppl. insp. Fee-0 Reg. &QT Q,Q hrs $0.00
PME.Unit Fee: $0.00
PM Permit Fee: $0.00
0
Work Without Permit? Q Yes <0 No $0:00
A.dvnced Planninp-Fee: $0.00 Select allon=Residential d
Building or Structure
Strong Moti.onTee: IBSEISA11CR $0.50 Select an Administrative Item
Bldg Stds Con1mission Fee: IBCBSC $1.00•
F,r � ;� StIBT�UTAL $1.50 $100.00 ';�TOkTAL�FEE $101.50
..h .._.,..z
Revised: 1/19/2012
ALTERNATIVE ENERGY PERMIT APPLICATION
I,
COMM LIN ITY'bEUELOPMENT"DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE i'CUPERTINO, CA'95014-3255 AE
(408)777-3228 _FAX(408)''777;3333'• buildingQcupertino:orci
" 11PIERTIN0
{I
PROJECT.•ADDRESS + '� p APN,N' S ?.
S I O .
N� e�. ' 1'1I �
�1 S NIS._ 4 I"' ` PHONE Yoe-6,��-ryY-fr e `' E-MAIL
ST7tEET'ADDRESS �, I ,CITY,.STATE,21P FAX N .
= ^ PHONE E-MAIL
CONTACT NAME
STREET ADDRESS - CITY,STATE,'ZIP ,I:sol FAX
❑'OWNER ❑ OWNER=BUILDER ❑ OWNERAGENT^ CONTRACTOR ElCONTRACLO_R AGENT El, ARCHITECT El ENGINEER. ElDEVELOPER ,❑'TENANT
`CONTRACTORNAME' LIC LYSE NUMBER - O LICENSE TYPE �. /0 'BUS:LIC
.COMPANY NAME (I
STREETADDRES - I CITY,STATE'ZIP PHONE
2^ ( �2 �(c�' 9^ 8h
.ARCHITHCTIENGINEER'�NAME i �l LICENSE-NUMBER' BUS.LIC#
COMPANY NAME ' E-MAIL FAX
,STREET ADDRESS. CITY,STATE,ZIP PHONE
USE OF 5, FD,ol;Duplex ❑ Multi-Fatrilly .PROJEum WII.DLAND PROJECT IN
'STRUCTURE: .❑ 'Commercial. �, URBAN,[NTERFACEAREA 01 Yes L) No FLOOD ZONE Yes 0', No
a'
0',SOLAR PANELS ELECTRIC,VEHICtE''CHARGINGSTATION71❑WLAR WATERHEATING% ❑ OTHER:
FORSOEAR'PANELS:, NUMB ROFPANELS/UMTS:r KILOWATTS',(COMMERCIAL'ONLY): TOTAL'VALUATION: C�CJV
DESCRTPTION'OFWORK „r l- � i CqYztr�
RECEIVED;BY� �' �
By my'signature below;.I certify fo each o e' I4in'theoproperty ownet oi;authorized"agent to,act on,tl e,property owner sytiehaIf. I hage readsthis.
_ _ -..
applicaeon'and,the inforrriationPhave pro ' ed Is co c have read".thesD rref�#oil an vers, it is accurate. I agree,to comply with all applicable local
ordinances;an' g on; ze representahves'of Cdpertino tol'enter the -above
d�state`laws`relatin to buil n= I
Signatuie,of-Applicant/Agent Date:. Z �' �
SUPP TA'L-NFORMATION,REQUIRED
, OFFICEUSEONLY•%:�
'p OYER`T)3E COUN�T'ER
w
F•' ��EXPRESS
I z:
z
Q•LARGE �.
r
PVApp_201a,doc"revised 03%16%1,1
Building Department
City Of Cupertino
Lo 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT 1 N O Fax:408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: -zz "-0PERMIT# --2—,J
OWNER'S NAME: p,, Pr' o PHONE# Lt I
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: ' CITY/ZIPCODE: c.12.
*Our municipal code requires all bu nesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner!Contractor Signature Date
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CT50.0
a
ChargePolnt®.Networked Charging6tati6ns by Coulom chno-Wgies„o fer,
Tuniapalities,corporations, fleets;and u`t111t1es,hlgh "abil l plug'1 electric vehicle
t charging that drivers prefer.The easy to-use stations de multip ower options;:
s P
t integrating aesthetics;and ergonomcs with.,sturdy:con ction—ideg�(ljbr residential,
I
commercial.arrd outdoor public applications. i
)' The CTSOO.chareing;station u a 7=2 kW=sinele output•stationldesigne l for single+and'
- mu[ti,4amily homes,.apartmentssand,condominwm buildings,light commercial,and fleet.
is applications for the'North:American,marketplace-•The station delivers level Il(208'7240:
• p}
V,@ 30 A)charging and,is compafible,.with,ptug=in,eleetric vehicles that^comply with
the,,SAE J1,772,'"plug-imelectric vehicle;eharging;standard_ The.station ssmall size;
.flexibleinterfaces for utility,Automatic Meter Infrastructure(A'MI),make it an ideal
J
solutiomfor homeowners, utilities fleet managers,and property managers-
To,eliminate energy theft and'to'enlianee safety,a.card,reader option is available for
drivers to access and energize the station,with a,ChargePassw card. The s'tation's highly
"visible display guides drivers witli•instruetive messagesand can•be,used,to•disptay
custom adverfisementor greetings for drivers:
t Software Application Sery�ices=
l
Set-pricing and,collectfees provide'24/7-deiver.assistance;control access;.display
advertisements,,track usa e,and_,dia nose the station rerrlotel usin the, rowin suite
V -_. g g Y g' ,g g
` of ChargePointi,Network on-demandlsoftware applications and a web bSrowser..
l; Smart Card Reader"Option-
Provide�o tional driverbillin andreustom accessteontrol',
, L p '_._.. g p,(edenting electr,icity,theft
and enhancing;safeiy;.with arrintegrateds-staridards-based RFID-reader that,accepts
t ChargePass cards.,
Intelligent Power Control
�• .. ,,„,, •„ Ensure,power is del vered!only when_a,driver is authorize&and the EV-cord is properly
inserted.-
Vacuum.F.lorescent tl:isplay:with Multiple Language Support
Display instructive,advertisement,and greeting'messages in many languagesion the bright,easy-to=read display.,
Integrated Fault„Detection
• Ground Fault Detection: Integrated hardware,,ground-fa_ultdetection circuitry.wifh;auto reiry and driver notification.
over-Current Detection:.Disconnects power to;prevent nuisance breaker'tripsiat service:panel-..Auto retry:and•driver notification.
Ptug-Dut Detection:Algorithm,disengaees:power-and notifiesAhe driver When a plug isfremoved,
Over=the-Air Station Upgrade
Keepcharging,atation current'with;future and evolving EV needs by,upgrading station firmware'remotely''over:the=air.
Utility.Grade,Energy°Meter
Provideacc-urate+bi-directional energy Mea sureinent"With integrated,power metering circuitry.
Minimize the need°,for on-site;mamtenance,with'real time rem Coulomb
Remote Diagnostics and Control -
ote•alarm monitonng;and`control. Technologies
4A
Network Interface Coulomb.Technologies,jhc.
Wireless;andlcellular network,interfaces allow seamless integration with'otheaChargePoint Network dam?:oeu Ade.
- pbell,,e495008;6901 USA'
and ChargePoint Network application services. uStolhlree:+1'877=370 3807
' www.coutombtech.com
Smart Grid Compatible: www.mycF argepomt:net
Enable”Time-Of.:Use.(,TOU).,pricing�and demand response by integrating',with,Advanced_Metering
Infrastructures'(AMis)..
Listed,by Underwriters Laboratories lnc. C us
LISTED
-- - 1 —P I./,N:73-0010 0 1 01 Rev.,2
Charge.P#i3 ,
by Coulorrmb Technologies-
Mechanical Drawi-ngs
CT=5:00
WALL MOUNT (.CT503)
4';in 4_8tm DIMENSIONS
101.6 mm 121.4 mm
22in ,
'558;8 mm,
17.2^in
436 mm
12-.1 in
366.3 mm ❑
,
'22'JAin
560.3 mm
33.2,in
842.5 mm
a�r�.,:.���•.�...�,,.�-,,:.�..,m.,.-,�,.�.,,,�.�--�"°-�,�..���... ,�....�.e-•-. ::.n,..,..,..,�...».�.�•,w�..�-�..:. �,-�.�.-ate � ... ,�..,,.. �. ...
WALL,-MOUNT (CT503) �.
46 in
06 4 ,mm MOUNTING DIMENSIONS
4.5,in F-1 . .....
1 1141mm. .000
' (4x)
.25.lWDIA,AG°:SCREW
6MM DIA:LAG SCREW,
- w�,�,�.•.W,w»-�-.�.,�.,,.�a.,�,,,M.��:" mzw.��-^a�.nr,mr„-•�c�++.,,.,,m>.�•�.,re�...��9n.��.».M-r�.w,.r,«,.y�a�:�,,�u.,.»:�-:.�w..;,,p-�*w�.-r,.m�,�.�+m..�•w-, ...�,..�,...- .e�,�..w...�, - n.,�- _ ,�.;�,,,�-. ..,«,.:�.,.�ac��
r .
Listed by,Underwriters'Laboratoiies Inc.;C UL us
usreo
C,h,a,rg,,eP#oht"
by.Coulomb.Tech.nologies
Speciftat.ons
CT500
Electrical,Input
InpuuiPower 1.2'kW' -
Input Voltage 208'7240 VAC
Input current `i0 A
Input Power Connections; Line 1,line,2,Earth
- a
Required Service,Panel Breaker 40.A'doub'l6pote breaker(non-GFC1 type)on.dedicated circuit
Standby.P.ower ;5'W typical
Electrical Autput
Output Charging Power 7.2'kW
Output Voltage 208/240 VAC
Output Current 30A
Outpui,Charging Connector SAEJ1772-"*EV connector on 18? (5.48 m)cable
Functional Interfaces
Card Reader ISO•15693,,14443
Groundfault Detection 20,1mA.CCID with auto,retry-(15 minuteidetay, j tries)
PCug-Out Detection Power terrninated',per'.SAE.J:17721 specification
'Power Measurement 2%@ 1''S rhinute'intervals
LocaLArea Network 2.4-6HZ 802:15X ynamic nefwork
'W1de•Area,Network .. Commerdal.CDMAV GPRS-Tcellular data network
Safety and,O.perational Ratings .
" Safety Compliance UC•Listed for USA and cUL.certified.for Canada;^Complies,.w.ith UL'2594,UL 2231:=1,, UL 2231'-2, UL 1:998_,
UL.991;NEC.drtide-X25
Surge.Protection. '6 kVA@,3,000'A.In,geographic a eas,s_ubject"toyfrequent thunderstorms,supplementalsurge protection is
recommended.
EMC FCC Part 15-.'Class B.
Operafing Temperature' =22-°F to 122T(=30`.0 to+50°C)
Ope'r'ating�Humidity .95%•hon-condensing
Endosure• NEMA3R
Terminal Block`Temperature Rating, 212` F(100'C)
Maximum Charging„Stations.per 24:Eachstation-must bewithin;150 feet"line7of sight”of one gateway'station.
j802.1.5,4',Radio Group
Approximate Shipping Weights- 26 lbs(12,kg)
CoulomtS;Techndogies,Inc,reserves the right to alter;product urrenngs'and,specifications at any,time without notice;and.rs noFresponsitite for typographical a.graphical errorstlwt may appear in this document.
'Li sted,by.0nderwritersLaboratoriesInc.,C iWL DS
LISTED'
C,h,, . ..rge
by°CoulombTechnologies
Dr.-dering Information
CT50®'
WALL MOUNT {,(7503)
' —•M: sm 5
Pk
.. .. .rcr - -,-�++,e .....avm,n ma,..«..rrvm+m�'x�e,.- ..mr•�^�T'e* �`
�thnmxf:•aee.:s,s+vxmn _.wn.� -.,mm".am+'i^.xx:.-. -,:.-�e.,.,. .•. .
Ortler'ili,g;Information Order Code Examples
Specify;model numberfollowed tiy.the;'applicable code(s).`The�order
node sequence is; If"orderin this The ordercod'e would 6e
g•.
Mo"deLModem-.SMd-Loca_l Are&'Network-Wdrranty WalhMount,with CDMA
G'ateway'Modern,.RFID Card - CT503=C6MA•RFID-ZIG
Option OrderCode Reader,'and LAN.
Model
WaU;Mount iCT503'.
Walt Mountv4th,GPRS:Gateway
Modem' Modem, and'USA,GPRS SIM CT503;CPRS SIM1
'Integra[;C_DMA,Chu.gePoirib _-CDMA
Gateway Modem
Integral GPRS:ChargePoint: Wall Mountwith Card Reader,.
Gateway'Modem GPRS P N,and cswar antyrlextended, CT503 RFID-ZIG-EWSRFIDZIG
SIM
USA GPRS'SIM ,SIM1
Canada GPRS',SIM . `:SIM2`,
Card"Redder
'RFVC6tdReader RFID•
LocglAled•Ne[work.(LAN)` 1
'802:�TS':4 w,iretess interface :ZiG
Warrarity _ _ l
S Year Parts Only�gxtended Warranty For pricing'and additional,product
-ew5GW: information contact the distribufor:in' our r
Gateway '_ Y
5 Year-Parts Only,Extended Warranty- area.'FoCa complete list of distributors'Vo:ao
;EWSGWRFIDZIG
Gateway LAN ,and C@rd'.,Reader' -www Coulombteth:com and click-Purchase.
_ :TYear Parts Orily:Extended Warranty:
-EW5RFIDZIG:
" ... Card;:Reader'and LAN
'Specijy;attleost-one;mddem or-'L�AN(oplion,(or-both) -
C:oufomb;TecHnologibs, tnc.' 1`692 Dell Ave.•-Camb ell, CA 95008.6901 USA
408'.84i-4560'-877370.3802 lnfoogoulombtech,com
www:coulainbtech.com www:nrychaigepoint net „
Listed,by,Underwrilers'Laboratofies Inc. c p$
LISTED'
Copyright®2010 Coulomb Tec_hnd_ogies Inc All'nghts reserved CtMPG POINT rs a U S.,regrstered,trademark%seiv ce marks:and an 6'registeredlogo mark of Coblomb Technologies,Inc.All otherproductspr
- - _ -.- -e4 J -• .w eg '.� .y Pec i- -- rs.Coulornb'Technologieshas severaCpatent applic5tions filedi"
services mentionedare;the`trademark's,service marks,r �stered trademarks,or r istered'service,marks'oftheir.res trve owne' _