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14050050
CITY IOF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10835 N WOLFE RD CONTRACTOR:SIGN A RAMA PERMIT NO: 14050050 OWNER'S NAME: CUPERTINO VILLAGE,LP 166 S MAIN ST DATE ISSUED:05/07/2014 OWNER'S PHONE: 6507562162 MILPITAS,CA 95035 PHONE NO:(408)935-8178 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL '` SYNERGY-INSTALL(1)ILLUMINATED SIGN License Class(�5 Z-0 k 5- R Lic.# I ],� Contractor ( � ^� _ Date S ?-0 TI I hereby affirm iat I am licensed under the provision of hapter 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2000 I have and will maintain Worker's Compensation hisurance,!as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31605052.10835 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 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 DAY M LAST CALLED 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 -7 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: / r with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. 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. ElOWNER-BUILDERDECLARATION 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 1,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 offer4for 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. 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-insiJre 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. i will maintain compliance wit a Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance as provided for by the Health&Safety Code,S ti ns 25505,255 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date 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 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 purposesf(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 ermit.Additionally,the applicant understands and will comply with all non- o' t source regulations per t#e Cupertino Municipal Code Section Licensed Professional 9 18. Signature Date i SIGN PERMIT APPLICATION /� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ub 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 U CUPERTINO (408)777-3 Q28• FAX(408)777-3333•building(c)cupegno.otcl i 1✓I PROJECT ADDRESS k � , Vj D r ,-.(� APN# OWNER NAv '`J � {C, PHONE E-MAIL �� STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX i ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME�7, A/k-Z LICENSE NUMBER//�/ Tel? E TYKE BUS.LIC# COMPANY NAME �� Jn '■► `r E-MAIL (/ d Cn� FAX - _-SI ddA &f et 77 STREET ADDRESS )/,!e C n CITY,STh�E,ZIF 3!, PH 9 e4 - qr ARCHITECT/ENGINEER NAME , , LICENSE NUMBER ]• BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �U l u (� 1 Ott NA4 ,`&(,4 v"vl p -e (40/1/1 USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGNTYPE NO.OF SIGN AREA VALUATION STRUCTURE: E] Commercial (Y/N) (CODE) SIGNS (SQ.Fr.) (S) SIGN TYPE CODES: 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 TQT� ATION: By my signature below,I certify to each of the following: I am the property owner or orized agent to act the property owner's behalf. I have read this application and the information I hav rovided is correct. I have read the Description of Work and verl It is accurate. I agree to comply with all applicable local ordinances and state laws relating to ldi cons ction. I aut elrepresentatives of Cupertino to enter the above-identified pr perry for inspection purposes. Signature of Applicant/Agent: Date: rrh�' SUPPLEMENTAL INFORMATION REQUIRED � o ici?�4IJs q. ., - 5 Site Plan RLArre> d ., RQu sI I$ ; Elevations s s B DuvcP � —Sign Details-including UL listing(s)applicable, sT ND GI?LAN.,K vI _Structural Calculations(if applicable) k A , 4 Copy of Planning Approval Letter or Meeting with Planning prior to7 s� submittal of Building pp -Permit application. F sNr SignApp_2011.doc revised 03/16/11 I ii CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10835 n wolf rd DATE: 05/07/2014 REVIEWED BY: Mendez APN: BP#: -VALUATION: J$2,000 *PERMIT TYPE: Building Permit PL"2;V(31111'("K IT111': PRIMARY PENTAMATION 1 CEAP5 USE: Sign PERMIT TYPE: i WORK synergy- install 1 illuminated sign SCOPE SIGN TYPE FEE ID QTY SIGN FEE Wall Sign,Electric 1SIGNWELEC 1 $278 I TOTALS: $278.00 L;ec,'t 1'lart f 7xet'l-jtrarh. Plena('heck #Branch Circuits 1 $47.00 IESIGN Elec.Permit Fee: IEPERMIT ;L1ech. T'crnlit Fee: Tlrrmh.Permit Fee: C?ihcrr iL1ec'h,lrtsl=. ()th r Plumb Insp Other Elec.Insp. 0.0 $47.00 A'It-O", Ir?.t. FCC. Phn)Ah. sp. Fee: I ler Imp,1 ;e NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053&.1711113) FEE QTY/FEE MISC ITEMS Mcat? Fee: -F-= Suppl. PC Fee: Q Reg. 0 OT 0.01 hrs $0.00 Permit Fee: $278.00 Suppl. Insp.Fee:Q Reg. ® OT Q,Q hrs $0.00 T=PME Unit Fee: $47.00 PME Permit Fee: $47.00 ��rrairri,ctrrrrivc>1"e�,: ' Work Without Permit? ® Yes •) No $0.00 Sign Master Plan: ® Yes SII(F) No $0.00 Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 ]�TALS $420.50 $0.00 TOTAL FEE: $420.50 Revised: 04/01/2014 e Subject: Fwd: Plan Approval From: Shen U (shen.li@synergyeb5.com) To: signarama@sbcglobal.net; Date: Monday, May 5, 2014 4:18 PM ---------- Forwarded message---------- From:Henry,Deena<Deena.henry@kimcoreahy.com> Date:Wed, Mar 26, 2014 at 4:34 PM Subject:RE:Plan Approval To:Shen Li<shen,li@synergyeb5.com>, Genes Sekine<genzo.sekine@synergyeb5.com> Cc:'Zoewenberg, Erica"<eloewenberg@kimcorealty.com> This is approved Deena J.Henry,CSM Property Manager aft"W*0 K I Ofto, M- W REALTY 15 Southgate Avenue,Suite 201 Daly City,CA 94015 f Office(650)756-2162 Mobile(650)730-3236 Fax(650)756-3390 deen a.henryAkimcorealty.com From:Shen Li[mailto:shen.li@synergyeb5.coml Sent:Monday,March 24,2014 4:25 PM To:Genes Sekine Cc:Henry,Deena;Loewenberg,Erica Subject:Re:Plan Approval Hello, Deena Because I cannot find the standard size of sign from the lease. So we measured other stores' signs as reference. Our sign is total 7 English letters- 1 8i high and 13 3.8 3 long. Maybe the drawing shows on the draft looks big,but the length is not more than the length of 3 glasses. I also checked online and found sign picture (attached below)of last tenant. And that sign has 9 English letters and 5 traditional Chinese characters with a "house"logo in the middle. From the picture, the width of that sign almost steped the length of 6 glasses. Would you please provide us more clearly standard?Thank you very much I have attached the last tenent sign picture and our sign draft below. Please review. Thank you and hope you have a good day. On Mon, Mar 17, 2014 at 10:47 AM, Genzo Sekine<genzo.sekine@synergyeb5.con>wrote: Hi Deena,for clarification, are you saying that our sign of 18 inches is too high? If so can you provide maximum height for the sign since all the other signs at the center are 18 inches high? Thank you. Regards, Genzo Sekine On Mar 17, 2014, at 9:10 AM, Tenry, Deena."<Deena.henry@kimcorealty.con >wrote: The floor plan is approved— can you please make the sign smaller and forward for our review -thanks Deena I Henry,CSM Property Manager <image004,png> 15 Southgate Avenue,Suite 2011 Daly City,CA 94015 Office(650)756-2162 Mobile(650)730-3236 Fax(650)756-3390 deena.henry�a,kimcorealty.com From:genzosekine@gmail.com[mailto:genwseldne@gmail.com]On Behalf Of Genzo Sekine Sent:Monday,March 10,2014 5:22 PM To:Henry,Deena Cc:Shen Li;Loewenberg,Erica Subject:Re:Plan Approval Hello Deena, t We measured the other signs in the center and it was 18 inches, thus ours is drawn at 18 inches. I do realize that the rendering makes it look bigger. Can you confirm the maximum height you are looking for? Also,we had to make some changes to our proposed floorplan. Can you review and give us your approval or comments? Thank you. Best, Genzo Sekine Chief Financial Officer Synergy California Green Hospitality Regional Center Genzo.Sekine@SynergyEB5.com US Mobile:408.891.7028 SYNERGY www.SynergyEB5.com On Mon, Mar 10, 2014 at 4:35 PM, Henry, Deena<Deena.henry@kimcoreahy.com>wrote: The sign is too large. Deena J.Henry,CSM Property Manager <image003.png> 15 Southgate Avenue,Suite 2011 Daly City,CA 94015 Office(650)756-2162 Mobile(650)730-3236 Fax(650)756-3390 deena.henrvna,kimcorealtv.com From:Shen Li[mailto:shen.li@synergyeb5.com] Sent:Friday,March 07,2014 7:15 PM To:Henry,Deena;Loewenberg,Erica Cc:genzo seldne Subject:Plan Approval Dear Deena and Erica, I have attached the proposed designs of our office door and sign. Please review and provide comments and approval So we can move forward with our pemlitting and construction. Thank you Best, Shen Shen Li Clients Services Associate Synergy California Green Hospitality Regional Center ShenLi@SynergyEB5.com This email and any attached files may contain content that is considered proprietary and/or confidential.All email content and files are intended solely and strictly for the use of the intended recipient.If you are not the intended recipient you should not read,copy,or forward this email.Please notify the sender immediately by a reply email if you are not the intended recipient and delete the email. Subject to the foregoing,if you are not the intended recipient,all disclosure,distribution,and reproduction,or taking any other action based on the contents of this information is strictly prohibited.Unless it is expressly stated in this communication,nothing herein is intended to constitute a binding offer or agreement of any kind.Warning.Although we have taken reasonable precautions to ensure no viruses or malware content are present in this email,we cannot accept responsibility for any loss or damage arising from the use of this email or attached files. Shen Li Clients Services Associate Synergy California.Green Hospitality Regional Center ShenLi@SynergyEB5.com Shen Li Clients Services Associate Synergy California Green Hospitality Regional Center Shen.Li@SynergyEB5.com STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTGIC Project Name: SYNERGY Date: May 5, 2014 Project Address: 10835 N. Wolfe Rd., Cupertino CA. 95014 Location of Sign Of Outdoor Signs ❑Indoor Signs Phase of Sign Construction Of New Signs ❑Sign Alterations Type of Lighting Control Of New Lighting Controls ❑Replaced Lighting Controls ❑Not Installing Lighting Controls This Certificate of Compliance includes the following components(check all that apply) 19 Mandatory Measures(Lighting Controls) ❑Maximum Allowed Lighting Power ❑ Specific Lighting Sources 1. Certificate of Compliance Declaration Statement(this may be a C10,C45 or other eligible person) • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. • This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24,Parts 1 and 6 of the California Code of Regulations. • 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 ERplication. Name: Rolando Diaz Signature Company: Signarama Phone 408-935-8178 Address: 166 S. Main St. License number(may be contractor's lie#) 653120 City/State/Zip: Milpitas, CA. 95035 Date May 5, 2014 2. Installation Certificate(to be signed by responsible person after installation) Permit number , x e Checked by/Date (Enforcement Agency Use r `s r (Enforcemem Agency Use 9-1 Installation Declaration statement • 1 certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction. • I certify that the installed features,materials,components,or manufactured devices identified on this certificate conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I certify that the requirements detailed on this Certificate of Compliance have been met. 1 will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: Responsible Person's Name: Responsible Person's Signature: License number(may be contractor's lie#) Date Signed: Position With Company: 2008 Nonresidential Compliance Forms October 2010 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Com fiance (Sign Lighting) (Page 2 of 4) SLTG-1C Project Name" Dat Synergy May 5, 2014 3.Mandatory Sign Lighting Controls NOTES.- 1. OTES.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-1 C shall complete Part 3a.Check Yes or No for all of the following statements: 1 I have responsibility for installing the sign lighting controls ❑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 ❑Yes ❑No 3 There are no existing sign lighting controls and someone else will be responsible to install 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 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 ❑Yes ❑No 3b.Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1 C is responsible for complying with the sign lighting control requirements,that person shall answer all of the following uestions: If there are construction documents,indicate where on the building plans the in datory measures(sign lighting control note block can be located: 1 §133(a)l.All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA applicable requirements of§119. ❑ ❑ ❑ §133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA 2 control,or an outdoor astronomical time switch,that comply with the applicable requirements of§119. ❑ ❑ ❑ Exception to§133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ ❑ §133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA sign ower by a minimum of 65 percent during nighttime hours. 01 ❑ ❑ Exception 1 to§133(a)3.Si s illuminated for less than one hour per da during daylight hours. Y NA P p Y g ❑ ❑ 3 Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ ❑ Exception 3 to§133(a)3.Only metal halide,high pressure sodium,cold cathode,or neon lamps used for Y NA illuminatin signs or parts of signs. ❑ ❑ §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 ❑ ❑ ❑ 4 receiving a demand response signal that is sent out by the local utility. Exception to§133(a)4.EMC required by a health or life safety statue,ordinance,or regulation,including Y NA but not limited to exit signs and traffic signs. ❑ ❑ Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1 C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Com fiance (Sign Lighting) (Page 3 of 4 SLTGIC Project Name: Synergy Date: Y 9Y May 5, 2014 4.Maximum Allowed Lighting 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 5 ecific lighting sources method of compliance A B C D E I F G H I J ca Allowed Watts Design Complies? w Watts Y/N � 3 41.1 Field UN o A co vi Inspector a w` w x Check that w 0 Q k 0 Sign -05 .a 3 N A -�° Complies > C N _0 II II o II a. CAI W r-+ Q 0 ✓ U O Description ✓ F 0 16.72 1 12 200.64 60 Y ❑ ❑ ❑ ❑ ❑ A Symbol or code used on the plans(whenplans are required)and other documents. B A narrative description of the sign,or location of sign on the building;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 ISOJEC 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"I"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 PD=watts in column F. H Show the to installed watts in the sign,as determined according to the applicable provisions of§130(d or e). I 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 This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1 C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Com fiance (Sign Lighting) (Page 4 of 4) SLTG-1C Project Name: Synergy Date: 5, 2014 5. Specific Li:alitin;a Source Method of Compliance Certificate of Compliance and Field 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 lightin2 Dower 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 below) List all that apply Complies ❑ ❑ ❑ ❑ 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 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 complies with 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 ISOJEC 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 ISOJEC 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 compliance. Specific Light Source Compliance Method. The sign(s)identified above use only the following lighting technologies: List all applicable numbers 1 throw 10 that apply in column D above for each row. I High pressure sodium lamps 2 Pulse start or ceramic metal halide lamps served by a ballast with >88%efficiency 3 Pulse start metal halide lamps that are:5 320 watts,are not 250 watt or 175 watt lamps,and are served by a ballast with>80%efficiency 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 ower supply efficiency_>68%with rated output >current 50 mA D Fluorescent lamps with a minimum color rendering index(CRI)of 80 6 (Note:when using electronic ballasts for compliance,lamps with a CRI<80 may be used 7 Light emitting diodes(LEDs)with a power supply with> 80%efficiency Single voltage 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 applicable requirements of the Appliance Efficiency Regulations Title 20 9 1Com act fluorescent lamps that do not contain a medium screw base sockets E24/E26 10 1 Electronic ballasts with a fundamental output firequency frequency >20 kHz E This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 Store Frontage 40 feet s 16.72 Sq. Ft. __ e.'. Ranch Market + ; 133.82 in ; D � PROPOSED i "-� �..,� .x �. ..., � .... .0 SIGN LOCATION, F ` Cupertino4trElage gtt Shetlg Kee Bakery Shy Li,(3D Shopping Center � ® r;'anta'S41ea Cafe c '.quickly Guan Hong Houseytt,, LED CHANNEL LETTERS �'( TelienTeata ` 5trutbfa�id.Eta orCate ,t4': 1. Beam ro9 ' 96V(� til fong.lumlplMng U (p''4;G.,, fxsafeGal�sre.�� Ca 2. Returns: Black .040 x 5"Alum. � Jewelry& a1ch`� i © 3. Lighting: White LED system Its. L 4. Non- Corrosive lag bolt x 9 I 5. Faces: Yellow Acylic � t 3 t Edinburgh i6. Raceway painted yellow V� ¢ .. t, 7. Water drain hole ' r ® �0 8. 12V output 5A 60 watt transformer O 9. Disconnect switch E I _ pp q Cupp @ ULA roved s ; ,. � Venture Staff UnkoftheWest r$:, � _ ± 10835 N.Wolf. Rd., Cupertino CA. 95014 Pr.urwi gr _. tr 01% . `10 AlEm\ \ 0, f PLOT FLANS COMMUNITY DEl/=LOPPAIENT DEPARTMENT f< CHECKED BY BUILDING DIV. 0N-CUPERTINO MUST be kept at the - '; 1. IL i.> unia4�r� ® ul to make any l i1g, or to d�I-e SIGN*A *RANA _ .,`ie Build;g Official. DATE. WHERE THE WORLD GOES FOR SIGNSt "CationsE:`H_A ! NOT ACUPERTINO - BLDG. DPW a1 Cr fl v; �n Building Departnent 166 S. Main Street,Milpitas, Ca. 95035 �n a (408) 935-8178 Fax: (408)935-8177 's��V1a_ email: signarama@sbcglobal.net S�7/ �_`l'E�"� `�; rt.�� CGDE COMPLIANCE Llc.#653120 C-1 0,C-45 _.L.Y D_SOa��_ z_. Reviewed By: