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11090158COVER SHEET 11090158-D 1496 ROSE BLOSSOM DR PERMIT # PROJECT < ADDRESS APPLICANT DATE ?-2-/ L/ -' ( IF& c ri-rt 7 o OWNER Cc vA. 6 c-Ln\e- RES. (LVNG) (GARAGM COMM. SQ. FT. (NM T1. SQ.FT, RES. REMODEL CONTACT (nv-fL JC PHONE# 2 VALUATION (Cost of Project) REQD. PAID NOTES: CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSING M MG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED BY DATE 'TOTAL FEES =©mrm rr�17MAr,01.7MEmjw ■� ���� =mmm ==mm RES. (LVNG) (GARAGM COMM. SQ. FT. (NM T1. SQ.FT, RES. REMODEL CONTACT (nv-fL JC PHONE# 2 VALUATION (Cost of Project) REQD. PAID NOTES: CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSING M MG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED BY DATE 'TOTAL FEES CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1496 ROSE GARDEN LN CONTRACTOR: Tft5— Q -9F. Dr T-6 0417.1CDi PERMIT NO: 11090158 OWNER'S NAME: NANCY & CALVIN GABRIEL SCHAFER ELECTRIC DATE ISSUED: 09/21/2011 OWNER'S PHONE: 2552733 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION (� q 9 1 �2e+I ( BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Il�n`�,�0d��f!1 Lic. II / b�'1Z MECH RESIDENTIAL COMMERCIAL Contractor/J �r a �xeC• 6Xk§ate 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SFDWL SERVICE UPGRADE TO 125 AMPS, INSTALL E.V (commencing with Section 7000) of Division 3 of the Business & Professions CHARGING STATION IN GARAGE LOCATION 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: $2000 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 of the Labor Code, for the performance of the work for i tis permit is issued. APN Number: 36617005.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 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, i costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: / Date: with regulations p uperti o Municipal Code, Section 9.18. Xnon-trce Z �� RE -ROOFS: Signa 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, 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 1 store or handle hazardous 1 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 compliancAwithrtino Mqnde, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Co5, 534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized ag a e: 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, 1 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 9.18. Signature Date CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org ❑ PLUMBING ❑ MECHANICAI /ZLECTRlCAI MEP misc 110%(5f3 ❑ MISCELLANEOUS PROJECT ADDRESS/ c� �os APN # OWNER NAME / V1 M V � / r/ to I PHONE Yo �j �1 E-MAIL STREET ADDRESS�o / ( ` Q `yI CITY, STATE'' C6/JV `/' ��j }� _ /Z * i 7E-MAILc,MAI `O I L( CONTACT NAME PHONE STREET ADDRESS CITY, STATE, ZIP FAX ,/ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ya CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR r �U� L / CSO LICENSE NUMBER LICENSE TYPE I ,l VL BUS. LIC # COMPANY NAME �I Q ^ti E-�e_ere ( C �fC•@(�d �%� ^7 F V-0 / (� IO 1 STREET ADDRESS �I 11� ' n � / may, ` Q �KLICENSE CITY, STATE, ZIP �I / CA_ ' f / PHON ^V ffr?17b ARCHITECT/ENGINEER NAME NUMBER BUS. LIC # COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX [I MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WI DIAND El YES URBAN INTERFACE AREA NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO i5 THE BLDG AN ❑YES HOME? ❑ NO n❑ q.vE�ICCHLER DESCRIPTION OF WORK v� 5 „ ' I,., -tom `, Ie- 'Pei + C Z'io V Lf 0 - 1..�.-c ,vim Z -cod qd f� b . o'y, �/t � � �. •moi � TOTAL VALUATION: RECEIVED BY: By my signature below,I certify toe of the following: I am th pe owner or authorized agent to act on the property owner's behalf. I have read this application and the information I h ded is correc ha escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin mg n` I resents ' s of Cupertino to enter the above -id 'fled pro Ty for inspection puiposes. Signature of ApplicantlAgen Date: Z Z'� �l SUPPLEMENTAL INFORMATION REQUIRED OFFICIASE ONLY VER -THE -COUNTER c Y ❑ EXPRESS U U ❑ STANDARD ❑ LARGE c ❑ MAJOR MHPMrscApp_2011.doc revised 06/21/11 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: p5 -a &rL ---Yl L^ ---C PERMIT # OWNER'S NAME: U ' 0-�jrtr4e PHONE # GENERAL CONTRACTOR: 0-� (o BUSINESS LICENSE # ADDRESS: (,-}ctA CITY/ZIPCODE: at" 61 A-< *Our municipal code requires all businesses 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 A BCO UAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ` I am not using any subcontractors Si ature Date Please check applicable subcontractors and complete the following information: er / Contractor Signyture 912--1 L -2--e Pate 7 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 Til er / Contractor Signyture 912--1 L -2--e Pate 7 CITY OF CUPERTINO Fm -E FEE ESTIMATOR - BUILDING DIVISION NOTE. This estimate does not include fees due to other Depts (Le Public Works, Sanitary Sewer District, School District, etc.). These fees are based on the Drelindnary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 EfC 7/01) ADDRESS: 1496 rose garden In. DATE: 09/21/2011 REVIEWED BY: bobs. 'L (.h. Pr?-�Oi F., APN: BP#: *VALUATION: 1$2,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: ?'t torte. fn.vp. l PENTAMATION SOLAR -RES PERMIT TYPE: WORK sfd service upgrade, E.V. station install in garage location SCOPE 200 amps Electrical $44.00 IERT<200 Services NOTE. This estimate does not include fees due to other Depts (Le Public Works, Sanitary Sewer District, School District, etc.). These fees are based on the Drelindnary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 EfC 7/01) FEE QTY/FEE Elec. Plan Check 0.0 1 hrs $0.00 'L (.h. Pr?-�Oi F., Pui-'... F2- Elec. Permit Fee: IEPERMIT �Irlirr1E•�t,. InsJ;. s1.r,+„•, r`'1,r�,rl; ;,;,,l;.Li Other Elea Insp. 0.0 hrs $44.00 ifeels, InV). Fete: ?'t torte. fn.vp. l hrs NOTE. This estimate does not include fees due to other Depts (Le Public Works, Sanitary Sewer District, School District, etc.). These fees are based on the Drelindnary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 EfC 7/01) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $100.00 Alternative Energy System 1CHR GSTA EV Charging Station Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 200 amps Electrical $44.00 IERT<200 Services Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 Administrative Fee: 1ADMIN $41.00 0 0 Work Without Permit? Q Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Travel Documentation Fee: ITPA VDOC $44.00 Strong Motion Fee: IBSE1SMICR $0.50 Select an Administrative Item 1 Bldg Stds Commission .Fee: IBCBSC $1.001 SUBTOTALS: ; $130.501 $144.00 TOTAL FEE: 1 $274.50 Revised: 09/02/201((1 k Cm N W C ■0 cc cc 9 COMtvil Ih!TY D��ELG?''KENT DEPARTNIEtJT BUILDING DI'JISIOPJ - CUPERTIiJO APpFJ VED at the This set of pians and specifications MUST be kept job site during construction. it is unlawful fd viat make any changes or alterations on same, Official. therefrom, without approval from the Building The Stamping of this plan and sper-iof the violation SHALLons NOT be held to permit or to be an approvalState Law- ,.. nrovisions of any cKy ordinance -- 0 Ln d •0 o E -� 0 75 L E ffi mENS Safety and compliance This document provides instructions to install the ChargePoint® Charging Station and should not be used for any other product. Before installing the ChargePoint® Charging Station, you should review this manual carefully and consult with a licensed contractor, licensed electrician and trained installation expert to ensure compliance with tical building practices, climate conditions, safety standards, and state and local codes. The ChargePoint® Charging Station should be installed only by a licensed contractor and a licensed electrician and in accordance with all local and national codes and standards. The ChargePoint® Charging Station should be inspected by a qualified installer prior to the initial use. Under no chmmstances will compliance with the information in this manual relieve the user of his/her responsibility to comply with all applicable codes or safety standards. This document describes the mosi commonly -used installation and mounting scenarios. If situations arise in which it is not possible to perform an installation following the procedures provided in this document, contact Coulomb Technologies. Coulomb Technologies is not responsible for any damages that may occur resulting from custom installations that are not described in this document No accuracy guarantee Reasonable effort was made to ensure that the specifications and other information in this manual are accurate and complete at the time of its publication. However, the specifications and other information in this manual are subject to change at any time without prior notice. Warranty information and disclaimer Your use of, or modification to, the ChargePoint® Charging Station in a manner in which the ChargePoint® Charging Station is not intended to be used or modified will void the limited warranty. Other than any such limited warranty, the Coulomb products are provided 'AS IS,' and Coulomb and its distributors expressly disclaim all implied warranties, including any warranty of design, merchantability, fitness for a particular purposes and non4nfringemerd, to the maximum extent permitted by law. Limitation of Ilabiltty IN NO EVENT SHALL COULOMB TECHNOLOGIES, INC. OR ITS AUTHORIZED DISTRIBUTORS BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, PUNITIVE, OR CONSEQUENTIAL DAMAGES, INCLUDING WITHOUT LIMITATION, LOST PROFITS, LOST DATA, LOSS OF USE, COST OF COVER, OR LOSS OR DAMAGE TO THE CHARGEPOINTe CHARGING STATION, ARISING OUT OF OR RELATING TO THE USE OR INABILITY TO USE THIS MANUAL, EVEN IF COULOMB TECHNOLOGIES, INC. OR ITS AUTHORIZED DISTRIBUTORS HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Copyright and Trademarks : U2 02010 Coulomb Technologies, Inc. All rights reserved. This material is protected by the copyright laws of the United States; and other countries. It may not be modified, reproduced or distributed without the prior, express written consent of Coulomb Technologies, Inc. CHARGEPOINT is a U.S. registered trademark and service mark of Coulomb Technologies, Inc, All other products or services mentioned are the trademarks, service marks, registered trademarks or registered service marks of their respective owners. Coulomb Technologies has filed several patent applications. SAVE THESE IMPORTANT SAFETY INSTRUCTIONS This Installation Guide contains inportant instructions that must be bilowed during installation of the CT500. Waning: The CT500 must be connected to a grounded, metal, permwilling system; wsystem: or an equipment U grounding conductor most be run with the circuit conductors and connected to the CT5Ws grounding terminal or lead. Zhblaming: The CT500 must be installed by a qualified electrician and in accordance with all local electrical codes and ordinances. t Waning: Read all instructions before installing the CT500. Waning: Adult supervision is required when using the CT500 near children. Waming: Do not operate a CT500 with a visibly damaged cable. Contact Coulomb Technologies immediately. /t blaming: Do not operate a CT500 If the enclosure or the EV connector is broken, cracked, open, or shows any •� other signs of damage. Contact Coulomb Technologies immediately. blaming: Do not put forgers into the EV connector blaming: Do not instal the CT500 near flammable, e)losive, or combustible materials. �\ blaming: Do not operate the CT500 in temperatures outside its operating range of -22'F to 131 °F (-WC to +-55-C). t blaming: The CT500 contains no user -ser Aceable parts. Do not attempt to repair or service the CT500 yourself. If the CT500 requires servicing, contact Coulomb Technologies. t blaming: Ensure that the CT5Ws charging cable is positioned so it will not be stepped on, tripped over, or subjected to damage or stress. blaming: Do not use cleaning solvents to dean any of the CT5Ws components. The outside of the CT500, the charging cable, and the car end of the charging cable should be regularly wiped with a dean dry doth to remove any accumulation of dust and dirt. FCC Declarattion of Conformity This device complies with Part 15 of the FCC rules Operation is subject to the following two conditions: (1) This device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Radio and Television kdarfarence The equipment described in this manual has been designed to protect against Radio Frequency Interference (RFI). However, there are some instances where high powered radio signals or nearby RF -producing equipment (such as digital phones, RF communications ations equipment, etc) could affect operations. If interference to your CT500 is suspected, relocate or tum off nearby electrical appliances during charging, before contacting Coulomb Technologies for assistance. h.*M told Changes or modifications to this product not authorized by Coulomb Technologies could void the FCC compliance. At the end of its service life, this product should be recycled according to local laws and regulations. Contact Coulomb Technologies for recycling information. Contents I IMrodUCOM Beforeinstalling the CT500.........................................................................................»...........................................11 Specifications...... ....... ...._.......__.................................... _............ ....... ....... ....... ................. ..... _........... ................. 12 Wiringinformation .... ............... ..... ........_................. ......... ........ __........ .................. ........ ................................. _...... 13 2 Iestelathm Inshucdone Overviewof steps ------- ...._-------- ....__.»--- _---------- ..--------------- _.._----- ............... ........... .......................................... ........ 24 Step1- Check box for correct contents ..... ....... ............ ............ ........ ............ _....... _..... .......... ...._.......................... 2-2 Step2 -Attach holster ................ ------------------ ---------------------------------------------------------------- ------------------------- 2-3 Step 3 - Attach antennas....._-..... 2-4 Step4 - Remove front panel ................ ----- ..--- ..----- ..------------- ..----- _... ........ ......................... ...... .. ............................. .. 2-5 Step5 - Mount to wall_.................................................................._._..._......._.........._....._......................_..............2-6 Step6 - Install conduit..._ ........ --- ...-------- .._--- ..--- ....------------- __....------ _------- .....»....... ..... ............................ _............... 2-8 Step 7 - Conned wires to wiring terminal& ....... ........ ........ ................... _.... ................. .................. ......... _............. ... 2-9 Step8 - Replace front panel..........._..»........................»..._.........................._.----..................................................2-10 This document provides step* -step instructions on how to install any CT500 ChargePoint® Charging Station. Before Installing the CT500 • Ensure that the appropriate wiring circuit protection, and metering is in place at the installation location. For details, refer to the specifications (page 1-2) and wiring diagrams (page 1-3). • Ensure that the type of modem in the CT500 station that you are installing is compatible with the type of modem coverage available at the installation site (CDMA or GPRS). • Disconnect power. • Determine the appropriate mounting location for the CT500. The CT500 is designed to be secured to a masonry wall or a hollow wall with wood studs 16" apart If this is not the case, prepare an appropriate mounting surface. • Familiarize yourself with the installation procedure by thoroughly reviewing Chapter 2 'Installation Instructions.' 1-1 ChargePolnt® Cha►grrg Stations Sp;CIf cations Electrical input Input Power 7.2 kW Input Voltage: 208/240 VAC Input Current: 30 A Input Power Connections: Line 1, Line 2, Earth Reoommended Service Panel Breaker. Dual 40 A double pole breaker (non-GFC1 type) on dedicated circuit Standby Power. 5 W typical Electrical output Output Charging Power: 72 kW Output Voltage: 208/240 VAC Output Current: 30 A Output Charging Connector. SAE J1772Tm 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 ratings Safety Compliance: Complies with UL 2594, UL22311., 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 *Q Operating Humidity: Up to 95% non -condensing Enclosure: NEMA 3 per NEMA250-1997 Terminal Block Temperature Rating: 212" F (1000C) Maximum Charging Stations per 802.15.4 Radio Group: 100. Each station must be within 150 feet of at least one other station. 12 Introduction Wiring Information "K30 L3 L2 METER NEU Ll LOCK NEU L1 l2 M� CHID MAIN BREAKER 2aV 40A, 2 POLE BREAKER MAY BE CONNECTED L2 Ll TO ANY TWO PHASES.TERMDM cisco �' tnna 20A, SINGLE POLE BREAM MAY BE CONNECTEDTO ANY PHASE m z 24Ov 10 L2 NEU METER L1 LOCAL SMwCE FANEL NEU L1 L2 GND MAIN BREAKER _ 2b V 2 L TERMNAL KE 20A, SINGLE POLE BREAKER MAY i BE CONNECTED TO ErMER PHASE. N 7 m u 1-3 After the appropriate wiring is in place at the installation site (see "Wiring information" on page 3), you are ready to install the CT500. You will need: • CT500 ChargePoint® Charging Station components (seepage 2-2) • 11/2" (38 mm) conduit • #2 Phillips screwdriver • 3/8" socket wrench Overview of steps Installing the CT500 ChargePoint® Charging Station involves a few simple steps: 1. Check box for correct contents (see page 2-2) 2. Attach holster (see page 2-3) 3. Attach antennas (see page 24) 4. Remove front panel (see page 2-5) 5. Mount to wall (see page 2-6) 6. Install conduit (see page 2-8) 7. Connect wires to wiring terminals (see page 2-9) 8. Replace front panel (see page 2-10) These steps are detailed in the remainder of this chapter. 2-1 DATE�...,. PERMIT NO. r� p CC.ri:,,•'' , :' D_s�El_��P,"aici�lT DFPARTh?ENT �. BUILDING DWIS40N - CUPERTINO APPROVED This set of plans and specifications MUST be kept at the W jo,. site du6-ig construction. It is unla"lul 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 be held to pormit or to be an approval of the violation of any provisions of any City Ordinance or State Law. BY DATE�...,. PERMIT NO.