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14090070 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10711 RAE LN CO TTQR: PERMIT NO: 14090070 a v+-I n J\52,-Vic-e-5 OWNER'S NAME: GACHINA DOROTHY R TRUSTEE&ET DATE ISSUED:09/12/2014 OWNER'S PHONE: 4084464701 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL TEAR OFF(E)COMP ROOF,USE(E)CAP,INSTALL(N) License Class Lic.# G-3 ` 30 LBS FELT,CLASS A COMP ROOF SYSTEM(24 SQ'S) Contractor l,li JAC-vc� Date ,P- I P -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. 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:$11000 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 APN Number:35607056.00 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 WITII N 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 FROM LED 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 granting of this permit. Additionally,the applicant understands and will comply Is Da e. with all non-point source regulations per th upertino Municipal Code,Section 918. RE-ROOFS: Signature Date r/;X- ey All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection, agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION /y Signature of Applic ��PDate: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: LL ROOF COVERII GS 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 I store or handle hazardous I 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 compliance with the Cupertino Municipal ode,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255!p,25533, 534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agenDate: 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 purposes.(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 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 REROOF PERMIT APPLICATION O COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 c u�t_tTt'K a '(408)777-3228• FAX(408)777-3333•building a�cupertino.or4 v`V PROJECT ADDRESS APN# 3;5 6 - a OWNERNAME 1. /"/ � PHONE O — 3 MATT STdFT ADDRESS CITY,STATE,ZIP i FAX CONTACT NAME _f_ HONE B-MAIL • p�Cil � 7 STREET ADDRESS. CfTy,STATE,ZIP FAX ❑ OWNER' ❑ OWNER-BUILDER ❑.OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME O� LICENSENUMBER LICEN�T BUS.LIC.41 4;e # COMPANY NAME E-MAIL - FAX v1CC STREET ADDRESS ^J CITY,STATE,ZIP PHONE r� �'�3 c ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.[7r # COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: N VALUATIO G, oc sTRvcnJRE: ❑ Commercial EXISTING ROOFTYPE:. ElBUII - ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHIN ❑OTHER(SPECUrY) REMOVE/REPLACE YES IF NO, PLYWOOD ❑ %i' ❑ _ PLYWD ❑OSB PITCH: ROOF ❑NO #LAYERS! TTHICKNESS: 115/8" TYPE: ❑CDX 12 CLASS. PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SH.NGLES El WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT DESCRIPTION OF WORK: �� ��C��S ,�/ ' 4`%/� � C•t'� CT By my signature below,I certify'to each of the following; I ain the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I haveprovided is-correct. I have read the De n 'on of Work.and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to_building c�ction. I aut a re tives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Ag ent: Date: Nis SUPP NTALINFORMATION QUIItED f building 3 is associated with a Home Owner's Association,provide letter - - , of approval from HOA. Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturers Installation Specifications. Provide signed copy of Cupertino:s Tear-Off Policy. Reroof.4pp_2011.doc revised 03116/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10711 RAE LN DATE: 09/12/2014 REVIEWED BY: MELISSA APN: 356 07 056 BP#: *VALUATION: Isi1,000 xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 SFDWLROO WORK TEAR OFF E COMP ROOF USE E CAP INSTALL N 30 LBS FELT CLASS A COMP ROOF SCOPE SYSTEM (24 SQ'S) FEE ID ROOF AREA s.f. 1 REROOFFRES 2,400 ,9ecil. M'arf Check 111,11il tz Plum('heck LYet.. f'aa-C''zc>clr /'tumb. 1�ec L_j07he; 1'r mh Inst=. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E .' 7/1/13) FEE QTY/FEE MISC ITEMS Plan A5'uPpl, P('Fc Ph rest 1;./11ec7r.;''l'le Permit Fee: $408.00 Per~rni!Fee=: Co71.17IVA,fi.0�7 71}r. Work Without Permit? 0 Yes (j) No $0.00 Plar'lnirlK fees: t T"1I?''/Int C`ttft'te't%1tr1lGl'l Fees: Strong Motion Fee: 1BSEISMICR $1.43 Select an Administrative Item Bldg Stds Commission.Fee: IBCBSC $1.00 4 ° - r $410.43 $0.00 T(JTAL FEE: $410.43 Revised: 08/20/2014 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL CIJPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408) 777-3228-FAX(408)777-3333-buildinoO-)cupertino.org PROJECT ADDRESS APN# 3 r0 - 0 ?- - 050 10Z,4�� Z(!!� 11 + OWNER NAME I PHOTE-MAIL E-MAI STREET A06iESS CITY, STATE,ZIP FAX CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME / / E-MAIL FAX -.1r, 'Xe,,,rV-16 STREET AD ESS CITY,STATE,ZIP PHONE 3-2 I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes. 2. An inspection request can be scheduled up to one business day before the requested inspection date. Please schedule inspections online or call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30- 2:30pm (Friday) to schedule inspection. For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that phase of the work is completed. The building inspector will be available within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs) and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window. 3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked-down or removed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of I/"per foot of slope and demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed. 7. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee. The re-inspection fee shall be paid before another inspection can be scheduled. Dy my signing below,I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are required to installed in accordance with Sections R314 and R315 of the 2013 California Residential Code. Signature of Applicant/Agent: Date: ReroofPolicy_2014.doc revised 01/15114 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19058 STEVENS CREEK BLVD CONTRACTOR:ALLEN SIGNS INC PERMIT NO: 14090069 OWNER'S NAME: UNITED POLARIS LLC/OLIVIA JANG 1982 STONE AVE DATE ISSUED:09/12/2014 OWNER'S PHONE: 4089058798 SAN JOSE,CA 95125 PHONE NO:(408)280-6500 �- - LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ /�- VIVA THAI BISTRO-INSTALL(N)LED CHANNEL LETTER License Class C-'T, Lic.# 8-34-S SIGN TO(E)CIRCUIT Contractor Al '&A SW Date I hereby affirm that I am licensed Ader 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. 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 Kdl 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 APN Number:37507046.19058 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 WITIHN 180 D ERMIT 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 D OM L 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 Cl Z granting of this permit. Additionally,the applicant understands and will comp sued by: �' e: with all non-point source re ulations per the Cupertino Municipal Code,Section 9.18. Q (r' RE-ROOFS: Signature Date ` 7' All roofs shall be inspected prior to any roofing material being installed.If a roof is A� 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 I store or handle hazardous I 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 compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance;as provided for by the Health&Safety Code,Sections 255 533, d 25534. Section 3700 of the Labor Code,for the performance of the work for which this (Z r permit is issued. Owner or authorized agent: Date: 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 purposes.(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 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 W� SIGN PERMIT APPLICATION (^ o COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION v\0 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 b CUPERTINO (408)777-3228• FAX(408)777-3333•building@cupertino.otg PROJECT ADDRESS I q OWNER NAME ! J �� PHONE E-MAIL l 0'/�Y/!S STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME PHONE7-7 E-MAIL STREET ADDRESS 2 CITY,STATE,ZIP C FAX 14 ElOWNER 13OWNER-BUILDER13OWNER AGENT 4C CONTRACTOR 11 CONTRACTOR RAAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME /� LICENSE NUMBER LICENSE TYPE BUS.LIC# rA i or— ` COMPANY NAME A S E-MAIL FAX STREET ADDRESS (J i/ �• CITY,STATE,ZIP ^0 PHON:4q ?� -6 ARCHITECT/ENGINEER NAME J LICENSE NUMBER (�^C BUS.LIC# C� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK � 31 USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: ❑ Commercial (Y/N) (CODE) SIGNS (SQ.FT.) _ - (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 _ TOTAL VALUATION: By my signature below,I certify to each of the following: I am the pr —owmrbrauthorized e property owner 1 ehakf_1 have read this application and the information I have provided is correct. I have read the Description of W verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to 'I n onstru on. I authorize representatives of Cupertino to enter the above (-iden ified pr perry for inspection purposes. Signature of Applicant/Agent: Date: —f SUPPLEMENTAL INF TION REQUIREDORM, __MM,M, oFFsc +lzsE of Tg t N. _Site Plan L? AN. VON Fc Elevations E7I2ESS sDINcPrhl IEW� Sign Details-including UL listing(s)applicable k _Structural Calculations(if applicable) ' GE C oT1I '°' p, _Copy of Planning Approval Letter or Meeting with Planning prior to t4 `F"i submittal of Building Permit application. r SignApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19058 STEVENS CREEK BLVD DATE: 09/12/2014 REVIEWED BY: MELISSA APN: 37507046.19058 BP#: `VALUATION: 1$2,000 *PERMIT TYPE: Building Permit 111.-I:0'CHI,( PRIMARY Sign PENTAMATION 10EAP5 USE: g PERMIT TYPE: WORK VIVA THAI BISTRO - INSTALL N LED CHANNEL LETTER SIGN TOE CIRCUIT SCOPE SIGN TYPE FEE ID QTY SIGN FEE Wall Sign,Electric 1SIGNWELEC 1 $286 TOTALS:MUM $286.00 r ,b .1fecia. !'ion T'himb. Plan Chc;c l,, #Branch Circuits 1 $48.00 1'e;'ralit Fee: Plumb. I'erm;r T�z<a: IESIGN Elec.Permit Fee: IEPERMIT C)r/,c r.11',A Inrp C dw? Plumb Imp Other Elec.Insp. 0.0 $48.00 LA,,,h, ftaah, Fec,,: Phunb. L•rsp. Fee: t:-lc:r,Ins", t'eC. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS N Ili �, 11 Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 Permit Fee: $286.00 Suppl. Insp. Fee-.(F) Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Work Without Permit? 0 Yes (E) No $0.00 Sign Master Plan: 0 Yes (F) No $0.00 Travel Documentation Fee: I TRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $0.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $431.56 $0.00 TOTAL FEE: $431.56 Revised: 08/20/2014 STATeOF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 06/13 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE—DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-LTS-01-E Sign Lighting (Page 1 of 4) Project Name: . Date Prepared: Project Address: 0 S Location of Sign M Outdoor Signs 0 indoor Signs Phase of Sign Construction M New Signs 0 Sign Alterations Type of Lighting Control M New Lighting Controls 0 Replaced Lighting Controls 0 Not Installing Lighting Controls This Certificate of Compliance includes the following components(check all that apply) 0 Mandatory Measures(Lighting Controls) 0 Maximum Allowed Lighting Power 0 Specific Lighting Sources DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation uth,�or Na e: Documentation Signa P 1 Company: L Signature Date: Allen Si ns Inc V! rO Address: CEA/HERS Certification Identificati (if pli ble): 1982 Stone Ave City/State/2i Phone: San Jose,CA 95125 408-280-6500 RESPONSIBLE PERSON'S DECLARATION STATEMENT 1 certify the following under penalty of perjury,under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance(responsible designer). 3. The energy features and performance specifications,materials,components,and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations. 4. The building,design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application. S. I will ensure that a completed signed copy of this Certificate of Compliance shall be 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 completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. m • Responsible Designer Naet L%`,o Responsible Designer r Company: Date Signed: Allen Signs Inc "O f Address: 1982 Stone Ave License: C45,834580 City/State/Zip: San lose, 1 25 Phone: 408-280-6500 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2013 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 06/13 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE—DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-LTS-01-E Sign Lighting (Page 2 of 4) Project Name: Date Prepared: 3.Mandatory 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 for the entire construction. 3a. Statements of Responsibility:Any person signing the Certificate of Compliance Declaration Statement on page 1 of 4 on this SLTG-1C shall complete Part 3a.Check Yes or No for all of the following statements: 1 1 have responsibility for installing the sign lighting controls M 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§110.9 and§130.3 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§110.9 and§130.3 and someone 5 else 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-1C is responsible for complying with the sign 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 §130.3(a)1.All indoor sign lighting is controlled with an automatic time-switch control or astronomical time- Y N NA switch control. ❑ ❑ W §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N NA 2 switch control,or an astronomical time-switch control. ® ❑ ❑ EXCEPTION to Section 130.3(a)2A:Outdoor signs in tunnels,and signs in large permanently covered outdoor Y NA areas that are intended to be continuously lit,24 hours per day and 365 days per year. ❑ §130.3(a)2B. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides the ability to automatically reduce sign lighting power by a minimum of 65 percent during nighttime hours. Y N NA 3 Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ ❑ day and night. EXCEPTION to Section 130.3(a)2B:Outdoor signs in tunnels and large covered areas that are intended to be Y NA illuminated both day and night. ❑ §130.3(a)3. Demand Responsive Electronic Message Center Control.An Electronic Message Center(EMC) Y N N/A having a new connected lighting power load greater than 15 kW has a control installed that is capable of ❑ ❑ 4 reducing the lighting power by a minimum of 30 percent when receiving a demand response signal. EXCEPTION to Section 130.3(a)3:Lighting for EMCs that is not permitted by a health or life safety statute, Y NA ordinance,or regulation to be reduced by 30 percent. ❑ Field Inspector Notes: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2013 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 06/13 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE—DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-LTS-01-E Sign Lighting (Page 3 of 4) Project Name: Date Prepared: 4.Maximum Allowed Liahtine 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 Specific lighting sources method of compliance) A B C D E F G H I J Symbol OPTIONAL—Energy Complies Filed Inspector Description of the Sign Verified Label(see Allotted Watts Design Watts Check that sign Or Code instructions below) y�N complies L H VI 3 x us 0 H Q C L E 3 aNi N W C N OJ = L C I II O ++ a tkaw - Q Q F 3 0 U ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ A Symbol or code used on the plans(when plans are required)and other documents. B A 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 140.8 of the California 2013 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 by C 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 in square feet. E List"1"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(LPD=watts)in column F. H Show the total installed watts in the sign,as determined according to the applicable provisions of§130(c). I Enter Y if the number in column H is less than or equal to the number in column G. Otherwise,the sign does not comply. J This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2013 STATE OF CALIFORNIA SIGN LIGHTING ' CEC-NRCC-LTS-01-E Revised 06/13 CALIFORNIA ENERGY COMMISSION ` .. CERTIFICATE OF COMPLIANCE—DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-LTS-01-E Sign Lighting (Page 4 of 4) Project Name: n 1 t Date Prepared: ts f:192 S.Specific Lighting 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 lighting power method of compliance) A B C D E OPTIONAL Specific light source used for Symbol ENERGY VERIFIED compliance Field Inspector Check that Sign or Description label Shall include only lighting Complies Code (see instructions technologies listed below below) List all that apply LED Letter Sign 8 ❑ ❑ ❑ ❑ ❑ 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 140.8 of the California 2013 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 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,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 through 10)that apply in column D above for each row. 2 High pressure sodium lamps Metal halide lamps that are pulse start or ceramic served by a ballast that has a minimum efficiency of 88 percent or 2 greater.Ballast efficiency is the measured output wattage to the lamp divided by the measured operating input wattage when tested according to ANSI C82.6-2005. Metal halide lamps that are pulse start that are 320 watts or smaller,are not 250 watt or 175 watt lamps,and are served by 3 a ballast that has a minimum efficiency of 80 percent. Ballast efficiency is the measured output wattage to the lamp divided by the measured operating input wattage when tested according to ANSI C82.6-2005. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 percent D 4 when the transformer or power supply rated output current is less than 50 mA.The ratio of the output wattage to the input wattage is at 100 percent tubing load. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68 percent 5 when the transformer or power supply rated output current is 50 mA or greater.The ratio of the output wattage to the input wattage is at 100 percent tubing load. 6 Fluorescent lighting systems meeting one of the following requirements:A.Use only lamps with a minimum color rendering index(CRI)of 80;or B.Use only electronic ballasts with a fundamental output frequency not less than 20 kHz. 7 Light emitting diodes(LEDs)with a power supply having an efficiency of 80 percent or greater; Single voltage external power supplies that are designed to convert 120 volt AC input into lower voltage DC or AC output,and have a 8 nameplate output power less than or equal to 250 watts,shall comply with the applicable requirements of the Appliance Efficiency Regulations(Title 20). 9 1 Compact fluorescent lamps that do not contain a medium screw base sockets(E24/E26). E This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2013 VIVA THAI BISTRO BUILDING SIGN ELEVATION 19058 STEVENS CREEK BLVD. CITY OF CUPERTINO, CA 95014 uFo.f. FICE 3 COP 'CONU.L.APPROVED ELECTRICAL SIGN 3 5 5.f. NECT TO EXISTING CIRCLE JUNCTION BOX Plywood Backing� Gsf�C ® ® 2'x d"Stub [s O Stucco Fascia N N Plywood backing 5"Channel letter Return —*;—Prlmary electrical source A'o, �YT- Trim cap —Junction Sox with 5"THICK INDIVIDUAL CHANNEL LETTEREDisconnect Switch'' ' ,I YL Acrylic Face LED FOR INTERNALLY ILLUMINATION. *:I, ;' --Power Supply 3/4"BLACK TRIM-CAP,RETURN BLACK COLOR,ALL LETTERS WILL BE#2037 YELLOW COLOR TOTAL 51GN AREA=3.5+26.3J2Suare.feet LED Strip ` f; ^#18 AVM Jumper Wire Op►�E 'w�' Mounting Bracket—f.� I. #8)2.5"screw min.3 per letter SCALE: 1/4"=1'-0" DA x`. Trim Cap 114"Drain Hale 1 O 9© ,/ - m 4 05 `o p Cr 111 �e - CD � =r cD p aBy Opp eN z a 3 0 ; CL �, O Viva Thai Bistro p o 3 ua p 1111. 20'-0"STORETAg0;k, 19058 Stevens Creek Blvd. p isz c®it C:C `� WE City Of Cupertino N w 0 O n vii R Z 0 mom in tz (a STEVENS CREEK O 7 O O_+ n -r a 0zm ■1l 0 v m ° cai cn m czi a u, -A. U, ID 'g_o Is so C: - (D O O W p C L4 -4 SCALE: 1/4"=1'-0" DATE:AUG-20-14 m Cr -- t�O m Z1 m 3 REt'l y� D O m — r- 0 p .�' s 1S;�ne1` L:�✓� CD SEP 12 2094 0 o.� 1982 Stone Ave San Jose,Ca 9 nY All designs&art works belongto E-mail:a[lensigns@yahoo.com 8-280 6500 fAX 408 80 6700 Allen Signs Inc.any duplication 4 State Contractor License#834580 prohibited Copy right 2014