15060121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10057 SAICH WAY CONTRACTOR:NORTHWEST SIGNS PERMIT NO: 15060121
OWNER'S NAME: DIANA TAYLOR TRUSTEE 22695 E CLIFF DR DATE ISSUED:06/17/2015
OWNER'S PHONE: 4085217110 SANTA CRUZ,CA 95062 PHONE NO:(831)462-51 13
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMMERCIAL �
_ INSTALLATION OF(2) ILLUMINATED WALL SIGNS(THE
�icense Class C `�� Lic.# �� � ���J CODER SCHOOL).
Contractor �C�1,�UU-Qp� �l Q�S Date �D �7 .�
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 hvo 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:$8500
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:32632041.10057 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 FROM 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 r� � / ��� -7_� �
granting of this permit. Additionally,the applicant understands and will comply Issued by��G�� �1 ctT Date: l �
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
� �.� /S RE-ROOFS:
Signature � T Date 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
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)
l,as owner of the property,am exclusively contracting with licensed contractors to HA7,ARDOIJS 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 Rl 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
1 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 1
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,Sectio s 25505,2553�qnd 2553 .
J
Section 3700 of the Labor Code,for the performance of the work for which this � � I��
permit is issued. Owner or authorized agent: � Date:
1 certify that in the performance of the work for which this permit is issued,1 shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for[he 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.1 agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize represen[atives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless[he City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 I` / �/�
CUP�RTiN� (408)777-3228 • FAX (408)777-3333•buildinp(c�cupertino.orq j �0(� f
PROJECT ADDRBSS �'.�V�� S�IC�� �� APN# ��� �� � f � -i �'��
OWNER NAME ` � ' � �� �� PHONE � � O E-MA1L
i�
STREET ADDRESS �O�� � �k�C � �� �IIy CITY, ST�,ZIP�nS R�I�� I FA3C
f I W ri
COM'ACT NANIE � r, � �� PHONE �� � (}-1 dl� E-MAIL
(�� 2S!�/
STREET ADDRE55 I� �� �� C STATE, IP �,I�,v7 �7 `'7'1/� FAX
v c� `f����J
� OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT '�CONTI2ACTOR ❑CONTfWCTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �� ��� I/� LICENSE NUMB�R LICENS,E TYPS BUS.LIC#Z� S
r
COMPANYNAME �h 1�`���J � ` �( E-MAIL F.4X ��/ wL/�ry" ����
U l � �f
STREET ADDRESS �� �I�C�^ a{ , ' GTY.STATE.ZIP_ �UZ G� �J VV D PHONE �2 I �/n��
�1 (� l � � (/�.
ARCHITECT/ENGIIv'EER NAME LICENSE i�IU�fBER BUS.LIC�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE �
DESCRIPTION OF WORK
) /nla � l��VinlnafP � �c - � 5 �►/
USE OF ❑ SFD or Duplex � MUItI-F3rilllY Q,LUMINATED SIGN TYPE N0.OF SIGN AREA VALUATION
STRUC"I'URE: � COr17II101'C131 (y/M (CODE) SIGNS (SQ FT.) ($)
SIGN TYPE CODES: �V Z �W.L� � � Q O
B - BANNER SIGN '.�( - MONUMENT(GROUND)SIGN
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIItECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WItv'DOW SIGN
RECEI�'ED IIY: r TO AL V liAI'ION'
��� � ���
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the properry 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 buildin cons ction. I au onz epresenta ves of Cupertino to enter the above-i entified properry for inspection purposes.
Signature of ApplicanUAgent: ��J�.��►'\�-- �/�✓���`^^ Date: �' �/ 7 f! ���
SUPPLEIVIENTAL INFOR�'VIATION REQUIRED � � oFFicE�sE o�Lr �
SltO PI3R PLAN CF3ECEi T'1'PE �ROliTI�'G SLIP
_E10V3t10riS �E\PRESS � � � �Bti7LDL'�G PLA:�REVIER'
_Sign Details-including UL listing(s)applicable sr:�tiU.axD �f LA�vtv�Y[,:�v xt>v[Ew
Structural Calculations(if applicable) ❑ L:�RGE ❑ oTAER:
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ �r_�Jort
submittal of Building Permit application.
Si�nApp_Z011.doc revised 03/16/I1
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
.4DDRESS: 10057 Saich Way DATE: 06/17/2015 REVIEWED BY: Sean
� APN: BP#: *VALUATION: $8,500
�PERMIT TYPE: Building Permit
PRIMARY Si n PENTAMATION 1 CEAP5
USE: g PERMIT TYPE: �
WORK Installation of 2 illuminated wall si ns the coder school .
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign, Electric 1SIGNWELEC 2 $572
TOTALS: $572.00
#Branch Circuits 1 $48.00
JESIGN Elec. Permit Fee: IEPERM/T
. ��; �, Other Elec.Insp. 0.0 $48.00
rz Ir;r. ���
NOTE: This estimate does not include fees due to other Departments('�.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the relimina in ormation available and are onl an estimat� Contact the De t or addn'1 in o.
FEE ITEMS�Fee IZesolution 11-053 Gff i.'1%731 FEE QTY/FEE MISC ITEMS
Suppl. PC Fee: O Reg. � OT p.p hrs $0.00
Permit Fee: $572.00
Suppl. Insp. Fee:� Reg. Q OT p.p hrs $0.00
PME Unit Fee: $48.00
PME Permit Fee: $48.00
Work Without Permit? o Yes � No $0.00
Sign Master Plan: � Yes � No $0.00
Travel Documentation Fee: �Tn�t vDOC $48.00 �
Stron,� Motion Fee: 1BSEISMICO $2.38 Select an Administrative Item
F31d� Stds Commission Fee: 1BCBSC' $1.00
SUBTOTALs: $719.38 $0.00 TOTAL FEE: $719.38
Revised: 05/07/2015
PRE-APPLICATION FORM
Community Development Department
10300 Torre Avenue (408)777-3308/ Fax (408) 777-3333
Cupertino,CA 95014 planning@cupertino.org
G U P E RT 1 N O http://www.cupertino.org/planning
PLEASE NOTE:
A pre-application conference is required prior to submittal on all
applications. The purpose of the pre-application conference is to
determine if the application is ready for submittal. Application fees
are nonrefundable.
Please call your project manager to schedule a time for the review of
your application materials. We suggest you allow enough time prior
to the application deadline to prepare additional information or make
changes in case any are needed.
Please bring this form to the pre-application meeting for a signature.
Include this orm in e o��plication submittal.
Application Request:
Comments:
❑ Public Works Confirmation form?
Signed (planner) Date
As a part of the application review process, Cih�of Cupertino employees may visit yoicr site iri order to take
photographs,slides and/or videotape. These materials may be shown at a cih�meeting.
slreer 1 of 11
Ayp2014-15.doc reaised 7/7/14
APPLICATION F�RM
Community Development Departynent
103(?Q Torre Aveirue (408)T77-3308/Fax(408)777�333
Cuper�ino,CA 95014 planziing�cupertino.org
C LJ���t�'6 8V O httP://www.cupertino.org/Planning
Pr Owner ( ) \(h?
X �t � �J V`�c �� Phone w ' ��/ ''///W
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City,State, p Code �Ma�
SQ��Q �Y'[YZ 1 �-� ����a� r'p�`c o lW ��i��t,J�SfQr1S. C0�/h
Project Addre� APN(s)
_ to45? 5a�c� il��l �.v �Qr�,r�c�, �R `32� - 32 -a��
sri,ef Projecf nesc�3 on
sci
"�'w� (� a� S�e�S �a�o - I.-ti � G�J m C�c����.� Lf`��r�
U� i� 1.�1J 9 ���m�n�.�'t on
!certzf y' that the foregoing staixmercts c�re true ared rnrrect to the bsst of�cy knarnledge. I understand that a rnisrepreserctation of any
sttbmitted t�uta may in�lidahe an appraoaI by the Di�ector of Cnmmtenity Deaeloprnent, Design Reoiew Committee, Ptanning
Cmrmzission or City Counctl of this applicatiort. I understand that the app�fcafion rnay be zoithdrnwn if tny authorized
representative or I is not preseret at the sc�redufed r►reefing{s)unless a writEen requesE for pastponernent has been presented fo fhe
applicnbte revieiv 6ndy_ I have discussed this apptication urith the Public Works stafJ`and I undersnmd fhe public irnproaetrsent
reqecirements nssociafed unth fhis proposal. I understand appiicatforz jees are nmsrefundubTe.
(�„nk- � •1 S 15
Applirant' Sigftature Dafie
I dectare under pEnalt�J�l�fi��J that I am tlu oumer af s�id properti�or hazre Pou�er of Attarney{attnch copy)from said properfy
owner artd that I cansent to tl�e abooe-descrt�ed appiication attd I authorize City sfaff to visit the site in order to inke photographs,
sTides an or vedeot that may Iz s a cify meeting. I understand a�pticatian fees are nonr�fundabte.
x .� .s. � / �
I'ro wner's Signatnre Print Property Owner`s Name Dabe
Si-a,�use,Qnl��:
Applicatiota accepted Fn,/ on
Application hjps:
ForAntercdmenfs orModifccatians,list the originaI permit:
Slaeet�of Il
App201¢15.doc revised 7/7/14
.��,-----�
STATE OF Cf;LiFORN;A ��
S1GN LIGHTfh�G �
CEC-NP.CGLTS-0'1-E(Revised O6!14) CALIFOP.tvfA ENERGY COMNIISSIO� j �
CERTIFICATE OF COMPLIANCE NRCGLTS-0I-E
Sign Lighting (Page 1 of 5)
Proje�Name: � � _��� � �� Dzte Prep�red- �`
�J� � �
Projed Address:
��ds1 .��C� l� �{�C'�t►�b, �'�
Location of Sign �'Outaoor Signs ❑indoor Signs
Phase of Sign Construction �-Nev,�Signs ❑Sign Alte,ations
Type of Lighting Co�trol ❑New Lighting Controls ❑Replaced Lighting Controls ❑Not Installing Lighting Controls
This Certificate of Compiiance includes the foliowing components(check ail that apply)
�Mandatory fJleasures(Lighting Controls) � Maximurri Aliowed lighting Power �specific Lighting Sources
1.Mandatory Sign Lighting Controls
NOTES:
1. The same responsible person may ins�a/l both the siqn /ighting power and the sign lightino controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power_
2_ The Mandatory N,easures (sign lighting controls) are required for compliance ��iih the sign lighting Standards. !f the person
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the awner of the sign,
general contract�r,or architect shal!6e responsible to have the sign Iighting controls insta(led.
3. If more than one person has responsibility for compliance, each responsrble person shal!prepare and srgn a Certificate of
CompJiance and an Installation Cer'crficate applicable to the portion of construction for which they are respoRsible;a!"rernatively,
the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement
for the ertire construction.
la. Statements of Responsibi{ity:Any person signing the Certificate of Compiiance Declaration Statement on this NRCC-LTS-01-E
shafl compiete Part 1a.Check Yes or i�o for a11 of the folio�o�ing statements:
� I have responsibility for instaliing the sign lighting controls
❑Yes,compiete parts 1a and 1b of�his form No,complete part 1a afi this f�r�n
2 There are no existing sign lighting controls and I wiii be instaliing compiiant sign lighting controls
� Cl Yes 'o
3 There are no existing sign iighting controls ana someone else will be responsibie to instaif compliant sign {ighting controls
C�Yes [�'No
There are existing sign lighting controls that do not compiy with the appiicable pro��ision of§110.9 and§130.3 an�!wiii be
4 installin�com�liani sigr,lighting controls
C7 Yes �`�o
There are existing sign lighting controls that do not comply v.�ith the applicable provision of§110.9 and§130.3 and someone
5 else will be responsible to instal!compliant sign iighiing controls
❑Yes � �'o
�tq (,�� :������ I s b�A.����f��
� r.-�.�;i�-�r,� c�a�Q r�me
� nt
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�° �-�.3� _a�_t;�; `� f �s��� �
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�tr:i/�:�?L'Ni?(1 f�N ,��?,-•:' A�
t''�,i j1;
By
� � � � �
� �O �
�
CA 8uild+ng Energy E'fficiency Standards-2013 Nonresidentiai Compliance lune 2014
STATE OF CALIFORNiA
,.3�' .
SIGN LIGHTiNG s;,��: ;
CEGNRCGLTS-01-E(Revised 06,'14} CHLIFORNIA ENERGY COMt�11S510N ' -
CERTIFICATE OF COMPLIANCE NRCGLTS-Ol-E
Sign Lighting (Page 2 of 5j
Proje�F:ame: �1,- •A � �� Daie Frzparec-
v� �c� '
1b. Mandatory Sign Lighting Controls
Ifithe person signing the Certificate of Compliance Declaration Statement on this NRCGLTS-01-E is responsibie for complyin
the sign lighting contro! requirements,that person shall ans�ver all of the follov:�ing quest�ons:
If there are construction documents,indicate vrhere on the buiiding plans the
mandatory measures(sign iighting control) note block can be located:
1 §130.3(a)1.All indoor sign lighting is controiled with an automatic time-switch contro►or nomical time- Y PJ NA
switch control. ❑ ❑ ❑
§130.3(a)2A. A11 outdoor sign lighting is controlled with a photocontrol in ad � � n to an automatic time- Y N NA
2 switch control,or an astronomical time-switch control. ❑ ❑ ❑
EKCEPTION to Section 130.3(a)2A:Outdoor signs in tunnels,and � s in large permanent)y covered outdoor Y NA
areas that are intended to be continuously lit,24 hours per y and 365 days per year. ❑ ❑
§130.3(a)2B. A11 outdoor sign lighting that is ON bot y and night is controiled v.�ith a dimmer that provides
the ability to automatically reduce sign fighting rer by a minimum of 65 percent during nighttime hours. Y N NA
3 Signs that are iiluminated at night and for e than 1 hour during daylight hours shall be considered ON both CI 0 ❑
day and night.
EXCEPTION to Section 130.3{a)2 . utdaor signs in tunnels and large covered areas that are intended to be Y N�,
illuminated both day and ni . ❑ ❑
§130.3(a)3. Demand ponsive Electr�nic Message Center Control.An Eiectronic Message Center(EMC)
having a new con ted lighting powe�load greater than 15 kW has a contro!installed ihat is capable of Y N N/A
4 reducfng the � ting power by a minimum of 30 percent when receiving a demand response signal. � � �
EXCEPTI to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safery statute, Y NA
ord� nce, or regulation to be reduced by 30 percent. Cr ❑
Field spector Notes:
��� C�{-�fl1� �y o�e�l (�
�
CA Suilding Energy Efficiency Standards-2013 Nonresidential Compliance June 2014
�
���
STATE OF CALIFORNIA
's�'
SIGN LIGHTING � �
CEGNRCGITS-01-E(Revised 06,�14) CALIFORNiA ENERG'f COMMISSIO� -
CERTIFICATE OF COMPLIANCE NRCGLTS-01-E
Sign Lighting (Page 3 of 5j
Projeci Name: � (� ,� A^ � Dzte Prepared: ` � �
W t, v
2. Maximum Allowed Lighting Power Method of Compliance
Certificate of Compliance and Field tnspection Energy Chetklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance.{Complete part f
this Certificate of Com.pliance if there are sigr+s using the Specific lightir�g sources metho�ofi compliance)
q B C D E F G H I J
OPTIONAL—Energy Co ies F��Ed Inspecrtor
Symbol Description of the Sign Verified Label(see Allotted V��atts Design Wztts Y�h Check that sign
Or Code instructions below) complies
`p w ��^ � � � v
w =`--'�QJ C ..= � � _ �� _
} �,, _t \ � ---� cC ,�
f° )'— rc � � � � O
N � � � Q� N m -O - C •� Q1
�
CD � X � O � N � � � � �
N r u � v � ~ � U !
� ~
� �
� �
� �
� �
�
�
� �
� �
� �
� �
❑ �
� � �
�
A Symbol or cozie�sed on the plans{when plans zre reauiredj and other documents.
B A c+escription o;ihe sign,or location of sign on ihe building;and the location o;sign on construction�ocuments.
OPTIONAI-Check this box only if this sign has a permanent,pre-prinied,factory-insialied,ENERGY VERIFIED label,conf�rming that the
sign complies with the Section 14Q.8 of the California 2013 Title 24,Part 6 Standaras,using the Maximum ANowed Lighting Power
method of compliance. The only labels that wi11 be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
� Undenvriters Laboratories(UL}or other Product Certification Body accredited to!SO/IEC Guide 55 by the Amzrican National Standards
Institute in accordance with I50/IEC 17011.Surveiliznce by the Accredited Certification Body shall be an ongoing annual inspedion
program carried out by a Type A Inspe�ion 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 VERlFIED label is an optiona!method to vaiidaie
compliance.An ENERGY VEft1FIED label is not needed for compliance.
D The sign area in square feet.
E List"!"if the sign is internally illuminated. List"E"if the sign is externally illuminated.
F Allowed watts per square foot. Enter 12 iT the sign is listed as'1"in column E.Enter 23 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 totai installed wattsrtn the sign,as determined according to the applicable provisions of§130(c).
1 Enter Y if the number in cofumn 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 fnergy Efficiency Standards-2013 Nonresidentiai Compliance June 2014
_�
STATE O�CALIFORNIA
SIGf� LIGHTING ;;� �
CEC-NRCG�TS-D1-E(Revised 06'14) CALIFORNfA ENERGY COMMISSI�N ���� ±
CERTIFICATE OF COMPLIANCE NRCGLTS-01-E
Sign Lighting (Page 4 of 5)
FrojeG Ivame- � � -^ �1 ��S Date Preparec: i / / ./
`LC J I i� �
3.Specific Li�htin�Source Method of Compliance
Certificate of Compliance and Fie1d 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 (ighting power method cf compliance)
A B C D E
OPTIONAL Specific light source used for Field Inspector
Symbol ENERGY VERIFIED compliance
or Description label Shall include only lighting Check that Sign
Code (see instructions technologies listed below �omplies
✓
below) List ail that appiy
LC� L�,r S � � o
❑ ❑
❑ ❑
❑ ❑
o ❑
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 b�ilding;and the location of sign on construction documents
C OPTIflNAL-Check this box only i1 this sign has a permanent,pre-printed,factory-insialled ENERGY VERIFIED label,confirming that this sign
complies with the Sedion 140.8 ot the Californi2 201?Ttle 24,Part 6 Standards,using the Specific Lighting Source Method of Compliance. The
only iabels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories(UL)or
other Product Certification Body accredited to ISOJlEC Guide 55 by the American Nationat 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 lnspection bo�y
in accordarce with 150/1EC 17020.For signs with such an ENERGY VERIFIED label,column`D'is not reGuired to be filled out.Note:Using an
ENERGY VER�RED label is an optional methad to valid�te compliance.An EfVER6Y VERIFIED label is not needed for compliance.
Specific Light Source Compliance Method. �he sign(s)iden#ifiied abave use only the following lighting technologies:
List all applicable numbers{1 through 9}that appiy in co(umn D above for each row.
1 High pressure sodium lamps
Metzl haiide iamps that are pulse start or ceramic served by a ballast that has a minimum ef�iciency of 88 percent or
2 greater. Ballast efficiency is the measured output wattage to the famp divided by the measured operating input wattage
when tested according#o AN51 C82.6-2005.
Metal hafide lamps that are pulse start that are 320 watts or smaller,are not 250 watt or i75 watt f�mps,and are served by
3 a baHast that has a minimum efficiency of 80 percent.
Ballast efficiency is the measured output wattage to the famp 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
� 4 wher the transformer or power supp!y rated output current is less than 50 mA.The ratio o{the outpui wattage to the input wattage is ai
100 percent tubing load.
Neon or cold cathode lamps with trarsformer or power supply efficiency greater than or eq�a1 to a minimum efficiency of 68 percent
� 5 when the transiormer or power supply rated output current is 50 mA or greater.The ratio of the output wattage to the input wa�tage 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;
Singie 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(Tit1e 2C).
9 Compad fluorescent lamps that do not contain a medium screw base sockets(E24/E26}.
E This page doubles as a fieid inspection checklist.
Field Inspector Notes:
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 20i4
�CEIVEI�
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