13030169CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10975 N WOLFE RD
CONTRACTOR: ALLEN SIGNS INC
PERMIT NO: 13030169
OWNER'S NAME: CUPERTINO VILLAGE, LP
1982 STONE AVE
DATE ISSUED: 03/29/2013
OWNER'S PHONE: 6507467512
SAN JOSE, CA 95125
PHONE NO: (408)280 -6500
❑ LICENSED CONTRACTOR'S DECLARATION
F 3
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class CA5 Lie. #
j
Contractor A Date a 4Ch
MECH RESIDENTIAL COMMERCIAL
I her eby affirm that I a li ensed under the provisions er 9
JOB DESCRIPTION: INSTALL ILLUMINATED CHANNEL, LETTER SIGN -
(commencing with Section 000) of Division 3 o the Business & Professions
CHINESE
LETTERING FOR CHINESE VILLAGE CHRISTIAN MISSION
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 bySection.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
Sq. Ft Floor Area:
Valuation: $1800
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31605051.10975
Occupancy "Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
Issued by:z! /rG Date: '1-3
Signature
❑ OWNER- BUILDER DECLARATION
RE- ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 hereby affirm under penalty of perjury one of the following three.
declarations:
I have and will maintain a Certificate of Consent to self - insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section'3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner o i rized ag t: 3
forthwith comply with such provisions -or this permit shall be deemed revoked.
Date:
APPLICANT:CERTIFICATION
CONSTRUCTION' LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
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
ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CUPERTINO
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(@cupertino.org
PROJECT ADDRESS D q ') _
APN # O S / /L
/ T
OW / PHONE6� E -MAIL
U (/ ( J
STREET AD RESS /I CITY, STATE, ZIP ,/,� j� J FAX
K /
CONTACT NAME ; rn
JVJ
PHONE ,� py� _ ��
GO v
E- MAIL
STREET ADDRESS
CITY, STATE, ZIP
FFAX
118 2,
❑ OWNER ❑ OwNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONv Oi� N N ('
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #���
yRAG7
�f 1
�`
-
COMPANY NA E
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP 5` ` _
(/�
PHONE _ _�� —��
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK t ^
USE OF SFD or Duplex ❑ Multi - Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: Commercial
(Y / N)
(CODE)
SIGNS
(SQ. FT.)
M
SIGN TYPE CODES:
,
17.5
V w —
B - BANNER SIGN M - MONUMENT (GROUND) SIGN
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVED BY:
TOT ATriQN:
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 I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' g ns on. I authorize representatives of Cupertino to enter the above- identiifie property for inspection purposes.
Signature of Applicant/Agmt: Date: -41, l 3
SUPPLEMENTAL INFOk4TION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
OVER- THE - COUNTER
BUILDING PLAN REVIEW
_
Elevations
Sign Details - including UL listing(s) applicable
/❑ EXPRESS
PLANNING PLAN REVIEW
Structural Calculations (if applicable)
❑ STANDARD
❑ OTHER:
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ LARGE
submittal of Building Permit application.
❑ MAJOR
SignApp_2011.doe revised 03/31/11
CITY OF CUPERTINO
FFF FgTIMATnR — BUILDING DIVISION
Mech. Plan Check Plumb. Plan Check # Branch Circuits 1 1 $45.00
tech. Permit Fee: Plumb. Pe,-mit Fee: IESIGN Elec. Permit Fee: IEPERMIT
Other Afech. 1-ii Other Plumb Insp, Other Elee. Insp. 0.0 $45.00
rlfiech. Insp. Pee: Plumb. Insp. Fee: Ekc-. Insp. Fee:
NnTF.- Thic ectinate does not include fees due to other Departments (La Planning. Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711112)
10975 N WOLFE RD
DATE: 03/29/2013
REVIEWED BY: MELISSA
,W'ADDRESS:
APN: 316 05 051
BP #: 03 41-V &
*VALUATION:
1$1,800
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
PRIMARY
Sign
USE:
PENTAMATION
PERMIT TYPE: 1 CEAP
WORK
CHINESE VILLAGE CHRISTIAN MISSION* *CHINESE LETTERING ** INSTALL ILLUMINATED-
SCOPE
CHANNEL LETTER SIGN
Mech. Plan Check Plumb. Plan Check # Branch Circuits 1 1 $45.00
tech. Permit Fee: Plumb. Pe,-mit Fee: IESIGN Elec. Permit Fee: IEPERMIT
Other Afech. 1-ii Other Plumb Insp, Other Elee. Insp. 0.0 $45.00
rlfiech. Insp. Pee: Plumb. Insp. Fee: Ekc-. Insp. Fee:
NnTF.- Thic ectinate does not include fees due to other Departments (La Planning. Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee: (j) Reg. .0 OT
0.0
hrs
$0.00
Plumb. 11 fech.fElec
Permit Fee:
$266.00
Suppl. Insp. Fee-.0 Reg. Q OT
070
hrs
$0.00
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
Construction 2t7 :
A.dininhs,trative .Fee:
Work Without Permit? ® Yes 19 No
$0.00
Sign Master Plan: ® Yes (E) No
$0.00
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: 1BSEISMICO
$0.50
Select an Administrative Item...
Bldg Stds Commission Fee: IBCBSC
$1.00
a
$402.501
$0.00
$402.50
Revised: 01/01/2013
JOB ADDRESS: U
PERMIT#7: _.i 3 D_ 3
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
;
BUSINESS. LICEXSE #' ;:
ADDRESS: Z
CITY /ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of C_upertirio business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) W.-I-LL BE *SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU CO T TORS HAVE OBTAINED ACITY OF CUPERTINO
BUSINESS LICENSE. "
I am not using any subcontractors:
-
Si nature' `.:. Date
Please check applicable subcontractors and c plete theYfollow ng tafo Mahon 1j
ISUBCONTRACTOR
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
\k, t
Plastering
Plumbing
n -
Roofing
Septic Tank
`
Sheet Metal
Sheet Rock
"
F
F—TTile
Date
Owner / Contractor Signature
:CHINESE CHRISTIAN MISSION BUILDING SIGN ELEVATION: 10975 N. WOLFE ROAD CITY OF CUPERTINO
N
W E
v 0
S
Imp
5" THICK INDIVIDUAL CHANNEL LETTER5, INTERNALLY ILLUMINATED ' ej .2.7/ „,/3,3
3/4” SILVER COLOR TRIM -GAP, RETURN PAINTED WHITE COLQR. _ I
RACE PAINTED SAME COLOR A5 BACKGROUND BUILDING (60)1031.34
5CALE:1 /4 " =1' -0" ' DATE: MAR -01 -2013 3 Ji
I b /buy i
kv /es seed
I h -rib h�-
22'-0" C%10C l T� a7v�
BUILDING P.
FRONTAGE
BUILDING- ELEVATION
'n Mission
_toad
City Of Cupertino
0
ttt �j
J�
r. -' c"E1iFrd By:
IZECEIVED
MAR 2 9 2013
UNITY DEV ! ^RW.'J Dt- PARTMENT
JILDING DI` -l.10N - CUPERTINO
#10 5CREW MIN. 4 _
PER LETTER APf I`.'+. ?cA :_D
1/4" LAG SCRENTKTOSet Of
fans and spe:;ificatlons MUST be kept at the
BUILDING WOOD jezy6bK d
ing construction. It is unlawful to make any
TOP & BOTTOM 0 4' -0'�r1
s or alterations on same, or to deviate
therefro
without approval from the Building Official.
TRAN5FORMER
The stampi
g of this plan and specifications SHALL NOT
SHEET METAL RA E- 4%d i
permit or to be an approval of the viciation
WITH DI5CONNECTO�V�CI-L.r
YY ��
islons of any Ordinance or State Law.
NEON
/City
PLASTIC FACE BY
DATE
_ �.
INSTALLATION DETAIL PERMIT
rC .
F i-A 2 9 2013
All designs & art works belong to Allen Signs, Inc. Any duplication is prohibited. COPY RIGHT 2012
OjFFlCE COPY,
i
tw A
R
CatCKp`
0-47V 3
y
ar.nr:. n
ter.
I A All designs & art works belong to Allen Signs, 11
4dp 0any duplication is probibited. COPYRIGHT 2010
E -m ail address. allensigns @yahoo. com
Tel :408/280 -6500 Fax :408 /280 -6700
1982 Stone Ave. San Jose. Ca. 95125 State Lic. # 834580
CHINESE CHRISTIAN MISSION BUILDING SIGN EL.EVATION: 10975 N. A'OLFE ROAD cro,'OFf-UP"TINO
N
-1
Li-7-0'7-r 11
T
W Tfk k IXTTEkb, INTEXNALLY ILLI)KNOEP
VA Reum #AINIED WHITE COILM
�eAa 0 PSAME coihK AS oAarRGxmv BuLDIf*
5GALE: DAM MAK•01-2VIO
BUILDING ELEVATION
is Christian Mission
N. Wolfe Road
4,
#10 SCKLW
nx Lfmg
1/4' LA5 SCREW MV
'N a
ILDIN I WOW M'EtAwk,
TRANSFOWER
W.A' RACE-WkY
WITM "4NEF'T
WON
PLASTIC FACE
°fy -'V w
.0 dex4pr C, art "rki M
E-malladdress- a1h
All designs & art works belong to Allen Signs, Inc. Any duplication. s prohibited. COPAICAT 201 2 r *1.4681280-6500 1
IN5TALLATION DETAIL
'l'o: MaNrsa
property Manager
Realty Corporation
outhple Avenue
City. CA "M
y
-6W74&75t2
,650-7$6-3390
(gUmcorealty.com
APPROVAL:
DATE;
11 L t-,. ASE FAY i RACK TO U5.
:.MTH-, 6NN'URE, THANK Yf)Jj
°fy -'V w
.0 dex4pr C, art "rki M
E-malladdress- a1h
All designs & art works belong to Allen Signs, Inc. Any duplication. s prohibited. COPAICAT 201 2 r *1.4681280-6500 1
E
�
A-I 7
MAC 2
?
Certificate of Compliance..(Sign -Lighting)
(Page 1 of 4) SLTG-1C
Project Name:
Ck► A-is, e-
SS 1, avi
Date: -3 L2,0
Project Address: Wq 7�--- W� iTe
N The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
Location of Sign . I "I. I ,1 -114 'Odtdobi'Si&i
❑ Indoor Signs
Signature
Phase of Sign Constru ction PP Signs
. E3 Sign Alterations
Allen Signs, Inc
.
'
Type of Lighting Control M New! fi tin
I
9 Controls ❑ Replaced Lighting Controls
❑ Not Installing Lighting Controls
This Certificate of Compliance mciudes the'following components (check all that apply)
Q-45. 834580
E3 Mandatory Measures O• ighting,Cohtiq!s)
❑ Maximum Allowed Lighting Power
13 Specific Lighting Sources
1. Certificate of Complia'tice Declaration` Statement (this may be a CIO, C45 or other eligible person)
IN I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
correct.
N I am eligible under Division, 3) of the, California Business and Professions Code to accept responsibility for the lighting design.
Pq This Certificate of Complianid'e'" identifies the lighting features and performance specifications required for compliance with
Title 24, Parts I and 6 of the California Code of Regulations.
N The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Name: Kimberly Lin
Signature
Company:
Phone
Allen Signs, Inc
408-280-6500
Address: 1982 Stone Ave
License number (may be contractor's lic #)
that a signed copy of this Installation Certificate is required to be included with the documentation the ilder provides to the
j i to
Q-45. 834580
City/State/Zip:
San Jose, CA 95125
Date
2. Installation Certificate (Wbe signed by responsible person after installation)
Permit number
Chqq4oby
(Enforcement Aonck Use
Use
Installation Declaration statement
y f d- ifii Ii i
e
X I certify under penalty o perjury, im, ex aws"ofthe State of Cali ormation provide�q 9, end
correct.
X I am eligible under Division 3, of the Business and Professions Code t. c - C onsibility for ce`nW;i V4Q&f-WtWffdUrized
representative of the person responsiblelfor construction.
X I certify that the installed'fe1tures, materials, components, or manufa" Fes i4p h M3ertificate conforms to all
d specification 0 ed by the
applicable codes and regulations,. and the installation-is consistent with the plans and specification p o edbythe
enforcement agency..
CE
m
X I certify that the requirements detailed on this Certificate of Compliance have been met.
lav &0
V I will ensure that a completed, signed copy of this Installation Certific"W' ng
s. r�
permit(s) issued,forthe.byilding,'-pnd made. available to the enforcement agency for all applicable ins ctions. I understand
ble in n understand
that a signed copy of this Installation Certificate is required to be included with the documentation the ilder provides to the
j i to
building owner a t occnp
Company Name:
Allen Signs, Inc
Responsible Person's Name:
Responsible Pe 's ignaturq.
Kimberly Lin,..
I
A
License number (may b"
-Pcwi,tion With C ompTly/
834580
Project Manage
4
2008 Nonresidential Compliance Forms October 2010
J-
MAR MAR 2 9 2013
Certificate of Com fiance (Sign Lighting) a e of 4 SLTG -1C
Project Name: C i�
ri s h I 6�
Date: i
3. Mandato Sign Lighting Controls
NOTES:
1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power.
2. The Mandatory Measures (sign lighting controls) are required for compliance with the sign lighting Standards. If the person
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the
sign, general contractor, or architect shall be responsible to have the sign lighting controls installed.
3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible,
alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance
Declaration Statement or the entire construction.
3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG -iC shall complete Part 3a. Check Yes or No for all of the following statements:
1
I have responsibility for installing the sign lighting controls
Y
❑ Yes, complete parts 3a and 3b of this form ® No, complete part 3a of this form
2
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
control, or an outdoor astronomical time switch, that comply with the applicable requirements of § 119.
❑ Yes Q No
3
There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
2
❑ Yes ® No
Y
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and I will be
4
installing compliant sign lighting controls
❑
❑ Yes ® No
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and someone else
5
will be responsible to install compliant sign lighting controls
NA
❑ Yes R) No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG -1C is responsible for
complying with the sin lighting control requirements, that person shall answer all of the following questions:
If there are construction documents, indicate where on the building plans the
mandatory measures (sign lighting control note block can be located:
1
§133(a)1. All indoor sign lighting is controlled with an automatic time switch control that complies with the
Y
N
NA
applicable requirements of § 119.
❑
❑
M
§133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo
Y
N
NA
control, or an outdoor astronomical time switch, that comply with the applicable requirements of § 119.
Kl
❑
❑
2
Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
❑
$I
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce
Y
N
NA
sign power by a minimum of 65 percent during nighttime hours.
❑
❑
Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours.
Y
®
NA
❑
3
Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
❑
1 IM
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for
Y
NA
illuminating signs or arts of si s.
❑
§133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than
Y
N
N/A
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when
❑
❑
in
4
receiving a demand response signal that is sent out by the local u tility.
Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including
Y
NA
but not limited to ej&si= Ed grqft g0s.
❑
Field Inspector Notes:
UrNut UUVJT�"
2008 Nonresidential Compliance Forms October 2010
cm
Certificate of Com fiance (Sign Lighting) (Page 4 of 4 SLTG -lC
Project Name: �
s C'hri ` I S ►
Date:
t3
5. Specific Lighting Source Method of Compliance
Certificate of Compliance and Held Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are, signs using the maximum allowed Li afiting power method of compliance)
A
B
C
D
E
OPTIONAL
Field
ENERGY
Specific light source used for
Inspector
Symbol
VERIFIED
compliance
Check that
or
Description
label
Shall include only lighting
Sign
Code
(see instructions
technologies listed below
Complies
below)
List all that apply
Internally Illuminated Letter Sign
❑
8
❑
❑
❑
❑
❑
❑
❑
{
❑
❑
A
Symbol
or code used .onthe plans when. plans are- d and
other documents.
B
A narrative description of the Riga, or location of sign on the building; and the location of sign on construction documents
C
OPTIONAL - Check this box only if this sign has a permanent, pre - printed, factory- installed ENERGY VERIFIED label, confirming that
this sign compliesvith the Section 148 of the California 2008 Title 24, Part 6 Standards, using the Specific Lighting Source Method of
Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards
Institute in accordance with IS07MC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection
program carried out by a Type A Inspection body in accordance with ISO /IEC 17020. For signs with such an ENERGY VERIFIED label,
column `D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance. An
ENERGY VERIFIED label is not needed for com liance'
Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies:
List all applicable numbers 1 throi 10 that apply in column D above for each row.
1
High pressure sodium lamps
2
Pulse start-or ceramic metal halide lamps served by a ballast with > 88% efficient
3
Pulse start metal halide lamps that are <_ 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast
with > 80% efficient
4
Neon or cold cathode . lamps with transformer or power supply efficiency 75% with rated output current < 50 mA
S
Neon or cold cathode lamps with transformer or power supply efficiency >_ 68% with rated output current > 50 mA
D
6
Fluorescent lamps with 'a minimum color rendering index (CRI) of 80
(Note: when using electronic ballasts for compliance, lamps with a CRI < 80 may be used
7
Light emittin . "diodes LEDs with a power supply with > 80% efficiency
Single voltagei LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8
output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as
complying with ;the,a . licable requirements of the Appliance Efficiency Regulations Title 20
9
1 Com act fluorescent lams that do not contain a medium screw base sockets (E24/E26
10
1 Electronic ballasts with a fundamental output frequency > 20 kHz
E
This page
doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
4ib' 0-
Certificate of Com fiance (Sign Lighting) Pa e 3 of 4 SLTG -1C
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Date:
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4. Maximum Allowed Liehtina Power Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 5
of this Certificate of Compliance if there are signs using the S ecific lighting sources method of com liance)
A
B`
C
D
E
I. F
G
H
I
J
A
Allowed Watts
Design
Complies?
Watts
Y / N
9
w
U
N
O ��
i /1N
/
N
y
1+
VI
cc
w
d
3
^� r i
-moo A
ao
.y
Field
,
c
3
Inspector
o
w
2 °
Check that
o
U
Sign
F
Complies
Description
✓
Internally Illuminated Letter Sign
❑
❑
❑
❑
❑
❑
A
Symbol or code used on the plans when plans are required) and other documents.
B
A narrative description of the sign, or location of sign on the buildin • and the location of sign on construction documents.
OPTIONAL - Check this box only if this sign has a permanent, pre - printed, factory- installed, ENERGY VERIFIED label, confirming that
the sign complies with the Section 148 of the California 2008 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power
method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized
C
by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO /IEC Guide 65 by the American National
Standards Institute in accordance with ISO /IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual
inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY
VERIFIED label, columns `D' through `I' are not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional
method to validate compliance. An ENERGY VERIFIED label is not needed for compliance.
D
The sign area insquare feet.
E
List "I" if the sign is internally illuminated. List "E" if the sign is externally illuminated.
F
Allowed watts per square foot. Enter 12 if the sign is listed as' P' in column E. Enter 2.3 if sign is listed as "E" in column E.
G
Multiply the square footage in column D times the allowed Lighting Power Density LPD = watts in column F.
H
Show the total installed watts in the sign, as determined according to the applicable provisions of § 130(d ore .
I
1 Enter Y if the number in column H is less than orequal to the number in column G. Otherwise, the sign does not comply.
J
I This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010