B-2016-3075CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3075
19624 HOMESTEAD RD CUPERTINO, CA 95014-0607 (316 05 047) PUTT
CONSTRUCTION
SANTA CRUZ, CA
95060
OWNER'S NAME: GOOD SAMARITAN UNITED METHODIST CHURCH
OWNER'S PHONE: 831-600-5273
191 M 01&i DI MCI \.RITO l[ORKi 1 t 1\
License Class a Lic. #516934
Contractor PUTT CONSTRUCTION Date 10/31/2018
I hereby affirm 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.
DATE ISSUED: 01/18/2017
NO: (831) 458-0203
PERMIT INFO:
X BLDG —ELECT -PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
(1) 190 PANEL (2 ARRAYS) ROOF MOUNTED PV SYSTEM
I hereby affirm under penalty of perjury one of the following two declarations: (51.604kW)
1. 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
e" performance of the work for which this permit is issued.
7 ; 2. 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 which this
permit is issued. Sq. Ft Floor Area: Valuation: $100000.00
APPLICANT CERTIFICATION
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, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature's -, Date 01/18/2017
N
I hereby affirm that I am exempt from the Contractor's License Law for one of the
APN Number: Occupancy Type:
316 05 047
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 01/18/2017
following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 01/18/2017
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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
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 which this
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 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 forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
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, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 01/18/2017
TO BE CLASS "A"
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, S ctions 25505, 25533, and 25534.
Owner or authorized agent:l
Date: 01118/2017 CON TRI
NLENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lenders Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPER740, CA 95014-3255 AE
(408) 777-3228 - FAX (408) 777v-1333 - buiIdlna6-cuD%t1no,orc
5— za4 '30
PROJECT ADDRESS 19624 Homestead Rd.
APN9 316-05-047
OWNFRNAME
Tom Oelkehjd�i�r�exw�
Z72 650-642-4945
F -MAIL
STREET ADDRESS I
19624 Homestead Rd.
CITY, STATE, ZIP
Cupertino, Ca 95014
FAX
CONTACT NAME Jason Segers
PHONE 831-600-5273
info@sunsupsoiar.com
STREET ADDRESS 719 Swift St. Ste 7
CITY, STATE, ZIP Santa Cruz, Ca 95060
FAX 831-316-7169
13 OWNER 0 OWNER -BUILDER El OWNER AGENT IVIGNTIACTOlt n CONTRACTOILAORKT 0 ARCHITECT n ENGINEER 13 DEVELOPER 171 TENANT
CONTRACTOR NAME
Suns Up Solar, a dtv of Putt Construction
LICE SENUMBER
516934
,WE
B, C-10, M
BUS. LTC
40242
COMPANYNAME suni Up Solar, a div of Putt Construction
&MAIL info@sunsupsolar.com
"AX 831-316-7169
STREET ADDRESS
719 Swift St Ste 7
CITY, STATE, ZIP Santa Cruz, Ca 95060
PHONE
831-425-1717
ARCHITECTiENGINEER.NAME Paul Kenneth Zacher
LICMIsrNum"ER S3878
BUS, Lie#
COMPANY NAMEB-MAU,
PZSE, Inc. Structural Engmeers
FAX
STREET ADDRESS 8150 Sierra College Boulevard, Suite 150
CITY. STATE, ZIP Roseville, Ca 95661
PHONE 91L16 -961-L3960]
STRUCTURE: n/counnercial
URBAN INTERFACE AREA n Yes WN,
,,,_j NW
rLooDmNu 11 Yes
&(SOLARIIANELS
❑ MECTRIC VEHICLE CHARGING STATION
-SOLAR WATER HEATING
❑ OTHER:
FOA.901ARPANEL S. NUMBER.OFPANF-LS/UNJTS: 190 LG 300s KILOWATTS (COMMERCIAL ONLY): 51.604kW DC
TOTAL VALUATION: 100,000
DESCRIPTION -OP WORK Install 51.604kW (DC) solar PV system. 190 LG 300w modules with 4 SolarEdge SE 14.4KUS inverters.
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1have read this
application and the information have provided is coiroct. I have read the Description of Work and verify it is accurate. I agree tOComply with all applicable local
ordinances and state laws relating to b 'ng construction. I authorize representatives of Cupertino to enter the ahove-id Itiried property for inspection purposes.
Signature of ApplicanVAgent: Date:
SUOM, MEN JAL INFORMATION REQUIRED
�S
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Certificate: 2550613
Project: 2599697
Issued to: SolarEdge Technologies
1A Abba Eban St
Harzeliya, 46733
Israel
Attention: Meir Adest
Master Contract: 243363
Date Issued: February 5, 2013
The products listed below are eligible to bear the CSA
Mark shown with adjacent indicators 'C' and 'US' for
Canada and US or with adjacent indicator 'US' for
US only or without either indicator for Canada only.
ic® S"a�v ugol�;
Issued by: Sarah Ugolini
C us
PRODUCTS
CLASS 531109 - POWER SUPPLIES - Distributed Generation Power Systems Equipment
CLASS 531189 - POWER SUPPLIES - Distributed Generation - Power Systems Equipment
-Certified to U.S. Standards
Photovoltaic Integrated Power Optimizer, Model OPJxxx-LU where xxx represents the wattage up to a
maximum value of 330.
Notes:
Optimizer is certified as a component to be used in conjunction with a certified/listed photovoltaic module
where the suitability is to be evaluated in the end application.
APPLICABLE REQUIREMENTS
CSA -C22.2 No. 107.1-01 - General Use Power Supplies (Reaffirmed 2006)
UL Std. No. 1741 - Inverters, Converters, Controllers and Interconnection System Equipment for Use with
Distributed Energy Resources 2nd Ed. (Jan., 20 10)
UL Outline of Investigation 3730 - Outline of Investigation for Photovoltaic Junction Boxes
CUI��EIR T'1140
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Fhe I Gate 360 can be configured to monitor nearly any type of FIV systern. Fhe standard configuration consists of an industrial
grade datalogger and revenue grade energy meter mounted inside a weatherized enclosure. All LGates are shipped with
integrated disconnect breakers making field installation much simpler. In addition, each unit can be configured to aggregate
data frorn a large variety of peripheral devices such as inverters, string/sub array combiner boxes and weather stations.
The LGate uses the R5485 IModbus protocol to communicate
with downstream devices. Any device that suppovts KVodbus can
be connected and monitored by the LGate. Upto 32 devices can
beconnected through the KVodbus loop. All data is collected,
Once the I Gate collects and stores ')erformance data from
connected devices, itwill ul,,)Ioadbatches ofdata atregular
intervals to I ocus Energys 5o|arNOCnm mebapp|icadon The
LGate can transmit data over EthernetorceUu|arnetworks The
dmestampedand then stored innon volatile memory. This integrated databggercanbeset tocommunicate thmughalmost
interval data isstored locally until the next scheduled up|oad y type of local area nelwurk.
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100 Clients per Logger
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32 Clients per Logger
ANSI C12.20 Class 0.5 (Power Meter)h(
CAN/CSA-C22.2 No. 14 listed Industrial Control Panel
UL Listed 508A listed Industrial Control Panel
Enclosure Rating NEMA 4
Weight 30 Ibs+
Dimensions 20" L x 16" W x 8" H
Environment -30 C to 70 C, 95% RH, non -condensing
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Voltage Inputs 277/480V, 120/208V
Phases Single phase, Split phase, Three phase at 50 or 60 Hz
Current Inputs mV full scale output CTs
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V i( V i(V i(. 10 c u s i, I II3 M All rights reserved.
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