15040037 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20100 STEVENS CREEK BLVD CONTRACTOR:A D&C DESIGN PERMIT NO:15040037
OWNER'S NAME: CUPERTINO STEVENS LLC 2060 WARM SPRINGS CT APT 4 DATE ISSUED:04/06/2015
OWNER'S PHONE: 4087506062 FREMONT,CA 94539 PHONE NO:(510)625-9566
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
g
License Class SAFARI KID- INSTALL ILLUMINATED SIGN
G Lic.# �d /
Contractor Date
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:$1200
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:36903002.00 Occupancy Type:
permit is r sued.
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 DAYS FRO 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 the0'/I Cy
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
ROOFS:
V Y — ,
Signature Date �(� any r All roofs shall be inspected prior to y roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:�p_�S
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
918.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 /
CUPERTINO (408)777-3228• FAX(408)777-3333•buildino aacupertino.orp-
NEW CONSTRUCTION;-„ E].--A111DDITION ❑ ALT/E�RjApTI�OON/TI ❑_.REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS O I®O ��^ _, /��1r �6'
OWNERNAME p � PHONE ` Q E-MAIL
STREET ADDRESS fl `^ CITY, STATE,ZIP. I FAX
CONTACT NAME } �/L PHONE, E-MAIL
STREET ADDRESS CITY;STATE,;ZIP FAX
❑'OWNER ❑-O'WNER-BUILDER:"' `..❑"OWNER=AGENT U�CONTRACTOR.?'❑CONTRACTOR AGENT ❑..ARCHITECT ❑ENGINEER,:,❑ DEVELOPERS ..-❑TENANT
CONTRACTOR NAME /�-D& � LICENSE NUMBER y q f LICENSE TYPE �(r� BUS.LI I
COMPANY NAME �, & C �5 �� E-MAIL �_at 9_tb&(0 N.O . ` ,Co vY\`f FAX
STREETADDRESS M � �' F� CITY,STATE,I'ZIP! J �JyF'�. ! �� PHONE(
ARCHITECT/ENGINEERIN'AME !�/ y�(dye lam, LICENSE NUMBER ysa y o' I BUS.LIC9
COMPANY NATE jalC �a�o�`(" - E-MAIL a GT FAX
STREET ADDRESSf 6,J " CITY,STATE,ZIP PHONE
>6-P
DESCRIPTION OF WORT: / T,
EXISTING USE PROPOSED USE CONSTR TYPE *STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
O
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH
❑ATTACH
9 DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES
BEING ADDED? [-]NO ADDITION? ❑No
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF I IS THE BLDG AN - — << TOTAL_VALUATION:
PLANININGAPPLY. ❑NO PLANNITINGAPPROVAL LETTER EICHLERHOME?
By my signature below,I certify to each of the following: I am the property owner or authorized agen o act on the property owner's behalf. I a ad 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 building construction. I authorize representatives of Cupertino to enter the above-identified pro erty for inspection purposes.
Signature of Applicant/Agent: Date: "
SUPPLEMENTAL INFORMATION REQUIRED
��,�pLAla CHECKI'f`PE_:-,t '�- '�-rROLi'LiItG SLiP - r f
New SFD or Multifamilydwellin s: Apply for demolition permit for Y
g pF y p z��DZ'ERTDE COURTED a' BL-II..DLNGPL�3tILEV1E\Y�
existing building(s). Demolition permit is.required prior to issuance of bulldmg ¢as�
' ax o, '� G E.r ��€, .-
permit for new building. '1 ExPitESs ` EZRXN`NING PEA XR. EVLEW. s�K M
gr
_Commercial Bldgs: Provide a completed Hazardous Materials DisclosuregpR17BLivoRxs
form if any Hazardous Materials are being used as part of this project. ' a fi m
� FIREDEPT r05
s
_Copy of Planning Approval Letter or Meeting with Planning prior toi- MEMO N
. SANITARYSE gTVM STRICT $
submittal of Building Permit application. � {
10 W1 IR
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20100 scb DATE: 04/06/2015 REVIEWED BY: Mendez
APN: BP#: 'EVALUATION: 1$1,200
*PERMIT TYPE: Building Permit PLA;"`ClIECK TYPE:
PRIMARY Sig n PENTAMATION 10EAP5
USE: PERMIT TYPE:
WORD [safari kid- install illuminated sign
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 1 $286
TOTALS: v,`h $286.00
k} a
Xfecb. Plan Check PhanL Plan Cheek #Branch Circuits 1 $48.00
b1e1%. Permit Fee: Plume.Permit Fow IESIGN Elec.Permit Fee: IEPERMIT
—L-1
Other;Vkch.Insp. El--L-
Other Plumb Ins)), Other Elec.Insp. 0.0 $48.00
alech. lnsp. Fee: Plumb. hisp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelfhWina information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS(Fee Resolution I1-053 E . 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC Fee: C) Reg. ® OT 0.0 hrs $0.00
Plumh.;t tech./lslec;
Permit Fee: $286.00
Suppl. Insp. Fee-0 Reg. ® OT0 0 hrs $0.00
PME Unit Fee: $48.00
PME Permit Fee: $48.00
("'onslr uciion Tax:
,ldInini.s-trative Foe:
Work Without Permit? ®Yes (j) No $0.00
Sign Master Plan: ® Yes (E) No $0.00
Travel Documentation Fee: ITRAVDOC $48.00
Strom Motion Fee: 1BSEISMICO $0.50 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
r w
$431.50s' TO iL FEE: ` $431.50
Revised: 02/14/2015
PROJECT APPLICANT
20" HIGH ILLUMINATED LED CHANNEL LETTER SIGN 11 SAFARI KID " name:
address:
-T 114" I phone:
COLORS AND MATERIAL: contectperson:
SIGN FACE:WHITE TRANSLUCENT PLEX SHEET WITH date:
BLUEIGREEN/REDVINYLE 20v
SIGN BODY:BRONZE PAINT --- ---
TRIM CAP:3/4"BROWNZTRIM CAP. BUSINESS owNER(sign location
ALL SIGNS ARE UL LISTED. t 6 tib ( , address: 20100
60 CStevens
p tllnoCreekBNd
� SCALE:1"=18"
286' SIGN AREA:11420"/144=15.83SQFT Phone:
contact;
ho Ba.
Frontage Company:
PEGGED OUT FROM BLDG.
------------- -----------------
SILICONE SEALED date:
— BLDG.WALL(STUCCO)
L.E.D.UNITS SEALALL BUILDING PENETRATIONS APPROVAL BY PROPERTY OWNER
SPLICE CONNECTORS am address:
=+ 0f8ef Y4444" TRANSLUCENT PLEX FACE phone:
POWER SUPPLY
11 1Wx2"ANCHOR BOLTS ENCLOSURE signature:
E (3 MW(LETTER) jPRIIMAARYCIRCUIT
date:
n 1
1 LOW VOLTAGE SECONDARY WIRING _ IN tlY MC
DISCONNECT
3/4'TRIM CAP «--•- SWITCH
0 44h
PROPOSED SIGN (NTS) TRANSFORMER
1/4" DRAIN HOLE CLASS 2 POWER SUPPLY
GROUNDING WIRE((AW 14)FROM TERMINAL LUG
(PAINT GREEN)TO NCL SURE
286' LED LETTER SECTION
Frontage
Steven Creek HI,d W
1kR
3:vd SUrvens Creek R vd Sleveis CreeK 5ivd
Customer Signature and Date:
^t p - e This rendering is computer generated
,,nni tii F £� �>h tlx Modest caddese Drawings are to scale using actual cam
p' 44" ,n aces aarei onyoumr�monftoro P�rinterdependmg t
I Liidr tree Whneua New sign T hbnresson Prescho on the model We have made every effort
m make this toyaursPcdons,ficatlbut
20100 Stevens please take a moment and make sure
spatsemuua, .Creek Blvd we have it right This isanart proof that
II
AIM, Is designed to meet the approval ofthe
—1- a customer,once a pprovalisgramed,we
C U P E RT I N O f
are no bngen able for typographical
and/or design layout errors.
+- j 6 Please do notglve approval
90ding DEhpartment until It Meets your requirements.
® foP this
when we your
i ncWlly responsible
e e ro
EX NGSIGN
P s C CKE R orderve ou
TOP VIEW
REVIEt R CODE COMPLIANCE
_. .
P N I G DEPT
;evlew c, v CUPERT
l `-1 INO
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 1 of 5)
Project Name: Date Prepared: {—
ra
Project Address: �p,, /, `
12 ,
Location of Sign Outdoor Signs ❑Indoor Signs
Phase of Sign Construction QMew Signs ❑Sign Alterations
Type of Lighting Control ❑New Lighting Controls X Replaced Lighting Controls ❑Not Installing Lighting Controls
This Certificate of Compliance includes the following components(check all that apply)
Mandatory Measures(Lighting Controls) ❑Maximum Allowed Lighting Power ❑Specific Lighting Sources
1.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.
la. Statements of Responsibility:Any person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E
shall complete Part 1a.Check Yes or No for all of the following statements:
1 1 have responsibility for installing the sign lighting controls
❑Yes,complete parts 1a and 1b of this form 4 No,complete part 1a of this form
2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls
❑Yes [9 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 EIINo
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 A No
1' ... F COIN?
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance "f ��''� June 2014
STATE OF CALIFORNIA
SIGN LIGHTING
CEGNROC-LTS-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 2 of 5)
Project Name: SA '!� - � Date Prepared:
K. � 1
1b.Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E 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. ❑ ❑ [11
§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. l?- ❑ ❑
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. ❑ 1
§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 ❑ ❑ K
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. ❑ I it
§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 2014
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NROC-LTS-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 3 of 5)
Project Name: 136J_46 V 7 t � Date Prepared: .�
2 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 3 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
y Description of the Sign Verified Label(see Allotted Watts Design Watts YEN Check that sign
Or Code instructions below) complies
V
VI
J \ f0
0 3 3 3 LL N o
d c c E 3 � N °' � N v_
0 y v ° I u o ;° m °'
y E w = Q Q F 3 0
❑ 701-1
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
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 forthis 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 V through T 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"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(LPD=watts)in column F.
H Show the total installed watts in the sign,as determined according to the applicable provisions of§130(c).
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 afield inspection checklist.
Field Inspector Notes.
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
SIGN LIGHTING
CEGNRCC-LTS-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 4 of 5)
Project Name: n A 7 !7o Date Prepared: `
3.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 2 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
or Description label Shall include only lighting Check that Sign
Code (see instructions technologies listed below Complies
below) List all that apply
Lis, 2
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 9)that apply in column D above for each row.
1 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 Compact fluorescent lamps that do not contain a medium screw base sockets(E24/E26).
E This page doubles as afield inspection checklist.
Field Inspector Notes:
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 5 of 5)
Project Name: A R,.1 ffJ--y Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: r f V^ Documentation Author Signature: �\
Company: — ' - Signature Date:
Address: V CEA/HERS Certification Identification(if applicable):
2'6 o f.WoVIVIX rW OT .
City/State/Zip: V
Phone: (� s vJ Y
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury,underthe 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.
5. 1 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.
Responsible Designer Name: Responsible Designer Signature:
Company: / -0 n, C WADate Signed: y
v '
Address: -4v oow V cy, License:
City/state/Zip: Phone:
ex
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2014