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15030104
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20686 HOMESTEAD RD A ''TOR: Ti _ PERMIT NO: 15030104 OWNER'S NAME: SOBRATO INTERESTS 1 ETAL I t%A10 1''. //.. hn h /,-, ,,I I DATE ISSUED: 06/03/2015 1 OWNER'S PHONE: 4084460700 PQ LICENSED CONTRACTOR'S DECLARATION License Class O Lic. # �� L ! / Contractor ST /I- A d '^ N LA ('G, r, "97ate 6 W/ S 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. 71 hereby affirm under penalty of perjury one of the following two declarations: '1 have and will maintain a certificate of consent to self- insure for Workers Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 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 permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. l 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 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 perm . Additionally, the applicant understands and will comply with all non -poi ou cc regulatio s er the Cu ertino Municipal Code, Section 9.18. Signature Date 61J11 ❑ -OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 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 permit is issued. I certify that in the performance of the work for which this permit is issued, l 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, 1 become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked, APPLICANT CERTIFICATION 1 certify that 1 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 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. � G)aZU %� 1 PHONE NO: e�& JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL GREAT CLIPS - T.I. (1683 S.F.) Sq. Ft Floor Area: Valuation: $60000 APN Number: 32610066.20686 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 RMIT ISSUANCE OR 180 FROM LLED INSPECTION. — Date: 6 3 l p RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safe ty Code, Sections 25533 and 25534. Owner or authorized agent: V Date: .il CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional il CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20686 HOMESTEAD RD CONTRACTOR: STRAUWALD PERMIT NO: 15030104 CONSTRUCTION OWNER'S NAME: SOBRATO INTERESTS 1 ETAL 9449 CALLE DEL LAGO DATE ISSUED: 06/03/2015 OWNER'S PHONE: 4084460700 SANTEE, CA 92071 PHONE NO: (619) 885 -2710 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL 3 e 2 � 9 GREAT CLIPS - T.I. (1683 S.F.) License Class__ Lic. # Contractor � W ' t ' Revision #1 (6- 30 -15): Install roof top air conditioning and heating system; extend gas line to new unit. 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 Sq. Ft Floor Area: Valuation: $60000 rmance of the work for which this permit is issued. 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: 32610066.20686 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses whi may accrue against said City in consequence of the �� granting of this pe rmit. dditionally, the applicant understands and will comply �: Issued by: Date: with all non, -point source gulations per the Cupertino Municipal Code, Section 9.18. i RE- ROOFS: Signature Date 30 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OWNER - BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 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 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, 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the declarations: Health & Safety Code, Section 25532(x) shot Id l store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should 1 use quipm t or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the y Are it Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit the C pertin unicipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S ons 505, 55 3, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: i 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 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 CUPERTINO 1 n VFW CONRTRUCTION CONSTRUCTION PERMIT APPLICATION 0� IM CONMUNIIY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �� ffmiff 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX ((/408) 777 -3333 • building (d)cupertino.oro ADDITION Al ALTERATION' / Ti F7 REVIRION / DEFFRRED ORIGTNAT. PERMTT ii PR CT ADDRESS , �� APN k d O7 � _ ZQ 06k6 3Z6 pn rc��s 'y pv��� i O1tRJERNAME _ _ PHfQNE e' n /� �b �� �� E -MAIL STREET DDR.FSS / CITY, STATE, ZIP. (` FAX 00 �1 C�'F�h /(b CO-"Z NAME P ONE E -MAIL v 1 .S7A J--:0 a ,,S`7A A ow Ac ST DRE� CITY, STATE, ZIP FAX ❑ o A NER ❑ OWNER - BUILDER ❑ o AN'ER AGENT CONITiLAC T OR - ❑ CONTRACTOR AGEIrr ❑ ARCHITECT ❑ ENGINEER - ❑ DEVELOPER ❑ TENANT CONi�0RN N BER AME LICENSE UM„ �. LICENSE TYPE BUS. LIC4 -) 2'IZA y S i c,, r1Z —5, ; COMPANY NAME E-MAIL l)—AVw J :"l6 T? vW)'1G 6, 0 4tc�C��'i FAX STRE DDRESS CITY, STATE, ZIP r'I f'J T .: (,A - r )-6 PP ONE C ( L ARCHITECT NAMZIr ( LICENSE NUMBER l� BUS, LIC d t LEER W ( L � COMPANY NAME L M E -MAIL ILA !C1 Q7 e/tf `. C h -> .A ' FAX o STREET ADDRESS X86)( 2, r? �L�� frl��?6SD CITY, STATE, ZIP �rI<<'{J.C��- ��� ��� T"6 1 c� DESCRIPTION OF WORK �S>� Lti/1LC CL'o-) i1��cT'!G'a�.1Tn�'P �LstL1� pG���A IA. .L �Lj h�c�� L I G' C�, H,�, 1c, t, L -of, A ^,t-:1`, -) it -A crdyT EXISTING USE PROPOSED USE CONSTR. TYPE 4 STORIES l USE TYPE OCC. SQ.FT. VALUATION (S) AREANEW AREA E fL00R AREA DEMO AREA TOTAL NET AREA ���j s _ _� � /�,�,f/J� BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH.AREA DECK AREA TOTAL DECK )PORCH AREA GARAGE AREA: D TACH ❑ ATTACH T DWELLING UNUTS: IS A SECOND UNIT ❑ YES SECOND STORY DYES BEING ADDED? 13 NO ADDITION? ❑NO PRE-APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TQTAL VALIDATION: PLANNING APPLE ❑NO PLANNWG APPROVAL LETTER EICHLERHOME? ❑NO s�"'°' By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I haNft read this application and the information I have provided is ect. I have read the Description of ',Work and verify it is accurate. I agree to comply with all applicable local c . ordinances and state laws relating to building st ction. I authori represent ves of Cupertino to enter the above - identified property for inspection purposes. - % SigTatureofApplicant/Agent: Date: SUPPLEMEINTTAL INTF TION REQUIRED ^ ; =.44 t ' _� PI 1I�.CHECKTIPE .;�ROUT3I�GSLLP`' f ' -� 3 v Ar sWTi OVEiNTHE COUNTERBLIIDLNGPL43� f I2E }M}y New SFD or Multifamily dwellin gs:. pply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building s r " permit for new building. Eess`" a�� at an;,rnG PL`tzE��Et} _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1U raN ARD a � PU LIGtYORILS x form if any Hazardous Materials are being used as part of this project. A LARGEh { yIREDEPTs ` ° rte' 3 _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. �7 i OR " �t AI�ITARY SESi'ERDISTRIC Bldg4pp_2011. doc revised 06/21/11 y • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255"" - "4nN ..__ ...�. (408) 777 -3228 • FAX (408) 777 -3333 • building( cuueriino org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ' REVISION /DEFERRED ORIGINAL PERMIT n 4 C>�� PROJECT ADDRESS D APN 4 3 'T (0 I n ©� "7 (� OWNER NA ONE sava3re.4,i5 o� 4- D Gov E -MAIL ST1 E DKESS �^ CITY, ATE, ZIP ro, / �`. FAX OQ G � J CONTACT N V LO Z Z 2, — �$ '% E -MAIL r $ c Cj D, a� co / STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNTER- BUQ.DER ❑ OIAWHR AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGLNEER ❑ DEVELOPER ❑ TENANT CONTRA -CTOR 1. ME S C1 LICENSE NUMBER I LICENSE TYPE _ ^ BUS. LIC 9 COMPANY NAME E -MAIL FAX . ` STREET ADDRES CITY, STATE, I �.` �"� PP &�Z% , r ARCHITECT/ENGINEER NAME LICENSE N7JMBER BUS. LIC R COMPANY NAVE E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK S - n e yv cv of th EMS G USE PROPOSED USE CONSTR. TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EMSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET ARE.. BATHROOM KITCHEN OTY.F.R REMODEL AREA REMODEL AREA REMODEL AREA PORCH P.REA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: L DETACH ❑ ATTACH DWELLING UNITS: IS A SECOND UNIT ❑ Y'ES SECOND STORY ❑YES BETNGADDED? NO ADDITION? []NO PRE- ..PPLICATION ❑YES IF YES, PROVIDE COPY OF LNTNG APPL 4 ❑ NO PLA TNINTG APPROVAL LETTER PA*II IS THE BLDG AN ❑ YES EICHLER HONTE ❑ NO RECEI \T Bl - TO VALUATION: .. DOD _ - By my signature below, I certiWb,illd�in following: a the property owner or authorized agent to act on the property owner' behalf I have read this application and the information is correct. I h ve read the Description of Work and verify it is atit e. I agree to co ply with all applicable local ordinances and state laws relatin ctio I uthorize r Cupertino to enter the -i eop Inspection purposes. Si- nature ofApplicant/Agent: Date: SUPPLEMEN AL INFORMATION QUIRED rLav c�cx \� AouTLnG.s%� -' t0 \-ER TH�COUhTER �BUI[,DL'�G PL4NRE \7EYV -_- _ New SFD or Multifamily dYvellings: Apply for demolition permit for ding existing building(s). Demolition permit is required prior to issuance of buil F _ u permit for new building. EXPRESS '� PLAr�T,II.GPLA -n IzEV1EW;__ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Ir srAJ.�nRD ❑ ruBLlevvoRlcs } form if any Hazardous Materials are being used as part of this project. Q LtiRG' ❑�FIREDEPC Copy of Planning Approval Letter or Meeting with Planning prior to ❑$AI�TLARY -,. submittal of Building Permit application. 3�LA70R- SEVI'ER DISTRICT _ ��El \'VIRON?+1E1\T4L ^FIEALTH,, : :F B!d,aApp_2011.doc revised 06/11/11 U CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 20686 HOMESTEAD RD DATE: 0311712015 REVIEWED BY: MELISSA PC FEE ID APN: 32610066.20686 BP #: VALUATION: $60,000 PERMIT TYPE: Building Permit PLAN CHECK TYP : Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAMATION 1 B TI PERMIT TYPE: WORK GREAT CLIPS - T.I. 1683 S.F. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II- B,111- B,IV,V -B 1,683 $2,189.92 IBTIPLNCK $1,569.62 IBTII_NSP $0.00 PME Plan Check: $0.00 Pen-nit Fee: $1,569.62 Suppl. Insp. Fee: Reg. OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 1,683 $2,189.92 $1,569.62 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ etc_)_ Thoco feeo aro hncod nn the nroliminary information availahle and are nnlv an estimate. Contact the Dent far addn'l info_ FEE ITEMS (Fee Resolution 11 -053 Eff. 7/1/133 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,189.92 Select a Misc Bldg /Structure or Element of a Building Suppl. PC Fee: (E) Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 Pen-nit Fee: $1,569.62 Suppl. Insp. Fee: Reg. OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 G Work Without Pen-nit? 0 Yes (j) No $0.00 Advanced PlanninK Fee: $0.00 Select a Non - Residential Building or Structure 0 A Strom Motion Fee: IBSEISMICO $16.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $3,779.34 $0.00 TOTAL FEE: F $3,779.34 Revised: 02/14/2015 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Elf.' 711!13) ADDRESS: 20686 Homestead Rd DATE: 06/30/2015 REVIEWED BY: Sean APN: BP #: 'VALUATION: 1$8,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? ©Yes 0 No PENTAMATION PERMIT TYPE: FURN /AC WORK Revision #1 (6-30-15): Install roof top air conditioning and heating system; extend gas line to new unit. SCOPE 1 # $143.00 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Elf.' 711!13) Mech, Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp. E rs $48.00 Plumb. Plan Check 0.0 1 hrs $0.00 Plumb. Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $48.00 E3 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Elf.' 711!13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 = # $143.00 Mechanical IMCRAA Heating System Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 # $143.00 Mechanical IMCRAA Cooling System Permit Fee: $0.00 Suppl. Insp. Fee.S Reg. Q OT 0.0 hrs $0.00 0 # Plumbing $72.00 IPGASRES Piping, Gas < =4 Outlets PME Unit Fee: $0.00 PME Permit Fee: $96.00 Construction Tax: IBCONSTAXC $0.00 Administrative Fee: IADMIN $45.00 0 0 Work Without Permit? C) Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICO $2.24 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $192.24 $358.00 TOTAL FEE: $550.24 Revised: 05/07/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408- 777 -3333 JOB ADDRESS: Xo 6 j-4 1y &rr U ur Tai A A. it. PERMIT # /.-CJ 3 04, 0!!6 OWNER'S NAME: /y)q /c RACtr — &/Lk-sxlT C.(. /p.3 PHONE# 61 Z GENERAL CONTRACTOR: ,,f jq 0jo 41-j ? 4 0c 7 -taMUSINESS LICENSE # 36 z-f �r ADDRESS: - ae� a Au;'zr A, CITY /ZIPCODE: 9S '! *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors. Signature Please check applicable subcontractors and complete the following information: Date Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & �llwor f ?A. quWAC ('vnrsrn (, Ct /a 3 6 Y 1 �' Cement Finishing % t9 U LJ F C C 0:-' rJ'n LC-'1 1?C K 1 Electrical 3,6 Y Z Excavation /V /,Q Fencing N Flooring/ Carpeting o 2/ } o f —[t,, o n t-e; A h L'' A! 6q -Lr t I A i Linoleum / Wood sp /I h Glass / Glazing IVA Heating �evTheL Lai sf� w °, OF jai.(�O,.ai 0 ?1P Insulation ,q Landscaping N -P, Lathing W4 Masonry IV A Painting / Wallpaper C' - A { t+/ B l A. C- �f Paving pi /A Plastering Plumbing 3C Ya--c ' Roofing S" TA i Y W t d L IL(-' e F I XL - L `® T Septic Tank /V /4. Sheet Metal %Q Sheet Rock f 9.., y I'V ' .,(_ , f Fi AV C. &, Arll- F,nLir Pt'j-e-cTj6'j 2-S 1 G CS Owner / Contractor Signature Date CUPERTINO CALGREEN NON - RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • bu' n o.or PURPOSE: J The non - residential provisions of the 2013 CalGreen Code outline planni ,, de a e to methods that include environmentally responsible site selection, building design, building siting Pd n protect, restore and enhance the environmental quality of the site and respect the integrity of adjacent properties; establishes the means of conserving water used indoors, outdoors and in wastewater conveyance; outlines means of achieving material conservation and resource efficiency; and outlines means of reducing the quantity of air contaminants. Project Name: GREAT CLIPS Project Address: 20686 HOMESTEAD RD. Project Description: BARBER SHOP Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013 California Green Building Standards Codes to verify and assure that all uired work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design pr "o %l initial Column 2 of this checklist, sign and date Section 1 - Design Verificat,,t the e s checklist and have the checklist printed on the approved plans for the project. ' 3. Prior to final inspection by the Building Department, the lic nsed profossional Akbmplete Column 3 and sign and date Section 2 - Implementation Verification at the of this checklist and submit the completed form to the Building Inspector. Page 1 of 9 CalGreen Non -Res Checklist. doc revised 01123114 5.106.4 Bicycle parking. Comply with Sections 5.106.4.1 and 5.106.4.2; or meet local ordinance, whichever is stricter. X❑ ❑ 5.106.4.1.1 Short-Term bicycle parking. If the qualified project is anticipated to generate visitor traffic, provide permanently anchored bicycle racks within 200 feet of the visitors' entrance, readily visible to passers -by, X❑ ❑ for 5 percent of visitor motorized vehicle parking spaces being added, with a minimum of one two -bike capacity rack. 5.106.4.1.2 Long -Term bicycle parking. For qualified buildings with over ❑ ❑ 10 tenant - occupants, provide secure bicycle parking for 5 percent of tenant vehicle parking spaces being added, with a minimum of one space. 5.106.5.2 Designated parking. Provide designated parking for any combination of low- emitting, fuel - efficient and carpool /van pool vehicles as ® ❑ shown in Table 5.106.5.2. 5.106.8 Light pollution reduction. Outdoor lighting systems shall be ❑ ❑ designed and installed to comply with the following: 1. The minimum requirements in the California Energy Code for lighting zones 1 — 4 as defined in Chapter 10 of the California Administrative Code; and © ❑ 2. Backlight, Uplight and Glare (BUG) ratings as defined in IES TM- 15 -11; and ® ❑ 3. Allowable BUG rating not exceeding those shown in Table 5.106.8, or ❑ ❑ Comply with a local ordinance lawfully enacted pursuant to Section 101.7, whichever is more stringent. 5.106.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how ❑X ❑ site grading or a drainage system will manage all surface water flows. 5.201.1 Scope. The California Energy Commission will continue to adopt ❑ ❑ mandatory building standards. 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 and 503.1.2. 5.303.1.1 New building or additions in excess of 50,000 square feet. ❑ ❑ Separate submeters shall be installed as follows: 1. For each individual leased, rented or other tenant space within the ❑ ❑ building projected to consume more than 100 gal /day. 2. Where separate submeters are unfeasible, for water supplied to the following systems: a. Makeup water for cooling towers where flow through is greater ❑ ❑ than 500 gpm. b. Makeup water for evaporative coolers greater than 6 gpm. c. Steam and hot -water boilers with energy input > 500,000 Btu /h. Page 2 of 9 CalGreen Non -Res Checklist.doc revised 01123114 5.303.1.2 Excess consumption. A separate submeter shall be provided for any tenant within a new building or within an addition that is projected ❑ 1:1 to consume > 1,000 gal /day. 5.303.2 Water reduction. Plumbing fixtures shall meet the maximum flow rate values shown in Table 5.303.2.3. ❑X ❑ Exception: Building that demonstrate 20- percent overall water use reduction. 5.303.2.1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission, as specified in Section 103, the provisions of Section 5.303.2 and Section 5.303.3 shall ❑X ❑ apply to new fixtures in additions or areas of alterations to the buildings. 5.303.4 Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: 1. The installation of water - conserving fixtures or ® ❑ 2. Utilizing non - potable water systems. ❑ ❑ 5.303.6 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code ❑ E] (CPC), and shall meet the applicable standards referenced in CPC Table 1401.1 and CalGreen Chapter 6. 5.304.1 Water budget. A water budget shall be developed for landscape ® 11 irrigation use. 5.304.2 Outdoor potable water use. For new water service or for addition or alteration requiring upgraded water service for landscaped areas of at least ® ❑ 1,000 sq.ft. but not more than 5,000 sq.ft., separate submeters or metering devices shall be installed for outdoor potable water use. 5.304.3 Irrigation design. In new nonresidential construction or building addition or alteration with at least 1,000 but not more than 2,500 sq.ft. of cumulative landscaped area, install irrigation controllers and sensors which ❑ include the following criteria, and meet manufacturer's recommendations. 5.304.3.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as X❑ ❑ weather conditions change. 2. Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicates ❑ with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. 5.407.1 Weather protection. Provide a weather - resistant exterior wall and foundation envelope as required by California Building Code Section 1403.2 ❑ and California Energy Code Section 150, manufacturer's installation instructions or local ordinance, whichever is more stringent.' Page 3 of 9 CalGreen Non -Res Checklist. doc revised 01123114 5.407.2 Moisture control. Employ moisture control measures by the following methods; 5.407.2.1 Sprinklers. Prevent irrigation spray on structures. ❑X ❑ 5.407.2.2 Entries and openings. Design exterior entries and/or openings ❑ ❑ to prevent water intrusion into buildings. 5.407.2.2.1 Exterior door protection. Primary exterior entries shall be covered to prevent water intrusion by using nonabsorbent floor and ❑ ❑ wall finishes within at least 2 ft around and perpendicular to such openings plus at least one of the following: 1. An installed awning at least 4 ft in depth. 2. The door is protected by a roof overhang at least 4 ft in depth. 3. The door is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5.407.2.2.2 Flashing. Install flashings integrated with a drainage © ❑ plane. 5.408.1 Construction waste management. Recycle and /or salvage for reuse a minimum of 50 percent of the nonhazardous construction and demolition waste in accordance with Section 5.408.1.1, 5.408.1.2, or 5.408.1.3; or meet a ❑X ❑ local construction and demolition waste management ordinance, whichever is more stringent. 5.408.1.1 Construction waste management plan. Submit plan per this ❑ ❑ section to enforcement authority. 5.408.1.2 Waste management company. Utilize a waste management company that can provide verifiable documentation that the percentage of ❑ ❑ construction and demolition waste material diverted from the landfill complies with CalGreen Section 5.408. 5.408.1.3 Waste stream reduction alternative. The combined weight of new construction disposal that does not exceed two pounds per square ❑ ❑ foot of building area may be deemed to meet the 50 percent minimum requirement as approved by the enforcing agency. 5.408.1.4 Documentation. Provide documentation of the waste ❑ ❑ management plan that meets the requirements listed in Section 5.408.1.1 through 5.408.1.3. 5.408.3 Excavated soil and land clearing debris. 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land ❑X ❑ clearing shall be reused or recycled. 5.410.1 Recycling by occupants. Provide readily accessible areas that serve the entire building and are identified for the depositing, storage and collection ❑X ❑ of nonhazardous materials for recycling. 5.410.2 Commissioning. For new buildings 10,000 square feet and over, building commissioning for all building systems covered by T24, Part 6, process systems and renewable energy systems shall be included in the ❑ ❑ design and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. Page 4 of 9 CalGreen Non -Res Checklist. doc revised 01 123114 5.410.2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the OPR shall include items listed in ❑ Section 5.410.4. 5.410.2.2 Basis of Design (BOD). A written explanation of how the design of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems X❑ ❑ listed in Section 5.410.2.2. 5.410.2.3 Commissioning plan. A commissioning plan describing how the project will be commissioned shall be started during the design phase of ® ❑ the building project and shall include items listed in Section 5.410.2.3. 5.410.2.4 Functional performance testing. Functional performance testing shall demonstrate the correct installation and operation of each component, system and system -to- system interface in accordance with the ❑X ❑ approved plans and specifications. 5.410.2.5 Documentation and training. A Systems manual and systems operations training are required. ❑X ❑ 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall ❑X ❑ include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training. The training of the appropriate maintenance staff for each equipment type and /or system ❑ shall include items listed in Section 5.410.2.5.2. 5.410.2.6 Commissioning report. A complete report of commissioning process activities undertaken through the design, construction and ❑ reporting recommendations for post- construction phases of the building project shall be completed and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for buildings less than 10,000 square feet or new systems to serve an addition or alteration subject to Section 303.1. 5.410.4.2 Systems. Develop a written plan of procedures for testing and adjusting systems. Systems to be included for testing and adjusting shall include, as applicable to the project, the systems listed in Section © ❑ 5.410.3.2. 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards ❑ on each system. 5.410.4.3.1 HVAC balancing. Before a new space- conditioning system serving a building or space is operated for normal use, the system should be balanced in accordance with the procedures defined by Q ❑ national standards listed in Section 5.410.3.3.1. 5.410.4.4 Reporting. After completion of testing, adjusting and balancing, provide a final report of testing signed by the individual responsible for ® 1:1 performing these services. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of ❑ guaranties /warranties for each system prior to final inspection. 5.410.4.5.1 Inspections and reports. Include a copy of all inspection ❑ verifications and reports required by the enforcing agency. Page 5 of 9 CalGreen Non -Res Checklist. doc revised 01123114 5.503.1 Install only a direct -vent sealed- combustion gas or sealed wood - burning fireplace or a sealed woodstove and refer to residential requirements ❑ in the California Energy Code, Title 24, Part 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves. Woodstoves shall comply with US EPA Phase II emission limits. ❑X 1 ❑ 5.504.3 Covering of duct openings and protection of mechanical equipment during construction. At the time of rough installation or during storage on the construction site and until final startup of the heating and cooling equipment, all duct and other related air distribution component ❑X ❑ openings shall be covered with tape, plastic, sheet metal or other methods acceptable to the enforcing agency to reduce the amount of dust or debris which may collect in the system. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.4. 5.504.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the requirements of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or ❑ ❑ SCAQMD Rule 1168 VOC limits, as shown in Tables 5.504.4.1 and 5.504.4.2. 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds (in units of product, less packaging, which do not weigh more than one pound and do not consist of more than 16 fluid ounces) shall comply with statewide VOC standards and other ❑X ❑ requirements, including prohibitions on use of certain toxic compounds, of California Code of Regulations, Title 17, commencing with Section 94507. 5.504.4.3 Paints and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. ❑X ❑ 5.504.4.3.1 Aerosol paints and coatings. Aerosol paints and coatings shall meet the Product - Weighted MIR Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of ❑ ❑ certain toxic compounds and ozone depleting substances (CCR, Title 17, Section 94520 et seq). 5.504.4.3.2 Verification. Verification of compliance with this section shall be provided at the request of the enforcing agency. ❑X ❑ 5.504.4.4 Carpet systems. All carpet installed in the building interior shall meet the testing and product requirements of at least one of the standards ❑ ❑ listed in Section 5.504.4.4. 5.504.4.4.1 Carpet cushion. All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute ❑ ❑ Green Label program. 5.504.4.4.2 Carpet adhesive. All carpet adhesive shall meet the requirements of Table 5.504.4.1. X❑ ❑ Page 6 of 9 CalGreen Non -Res Checklist.doc revised 01123114 5.504.4.5 Composite wood products. Hardwood plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for formaldehyde as specified in Table 5.504.4.5. 5.504.4.5.3 Documentation. Verification of compliance with this section shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following standards listed in Section 5.504.5.3. 5.504.4.6 Resilient flooring systems. For 80 percent of floor area receiving resilient flooring, installed resilient flooring shall meet at least one of the following standards listed in Section 5.504.4.6. 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and return air prior to occupancy that provides at least a MERV of 8. 5.504.7 Environmental tobacco smoke (ETS) control. Prohibit smoking within 25 feet of building entries, outdoor air intakes and operable windows where outdoor areas are provided for smoking and in buildings; or as enforced by ordinances, regulations or policies of any city, county, city and county, California Community College, campus of the California State University or campus of the University of California, whichever are more stringent. 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of California Building Code, CCR, Title 24, Part 2, Sections 1203 and Chapter 14.1. 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the California Energy Code, CCR, Title 24, Part 6 and Chapter 4 of CCR, Title 8 or the applicable local code, whichever is more stringent.' 5.506.2 Carbon dioxide (CO2) monitoring. For buildings equipped with demand control ventilation, CO2 sensors and ventilation controls shall be specified and installed in accordance with the requirements of the latest edition of the California Energy Code, CCR, Title 24, Part 6, Section 121(c).1 5.507.4 Acoustical control. Employ building assemblies and components with STC values determined in accordance with ASTM E 90 and ASTM E 413 5.507.4.1 Exterior noise transmission. Wall and floor - ceiling assemblies making up the building envelope shall have an STC of at least 50 and exterior windows shall have a minimum STC of 30 for any of the building locations listed in Items 1 through 3 in Section 5.507.5.1. 5.507.4.2 Interior sound. Wall and floor - ceiling assemblies separating tenant spaces and tenant spaces and public places shall have an STC of at least 40. FE�Rnwml Enw■1 Page 7 of 9 CalGreen Non -Res Checklist.doc revised 01 123114 5.508.1 Ozone depletion and greenhouse gas reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. 5.508.1.1 Chlorofluorocarbons (CFCs). Install HVAC and refrigeration equipment that does not contain CFCs. 5.508.1.2 Halons. Install fire suppression equipment that does not contain El Halons. Page 8 of 9 CalCreen Non -Res Checklist. doc revised 01/23/14 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS GREAT CLIPS 20686 HOMESTEAD RD. BARBER SHOP SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adoptedAby the City of_Q.WVrtino. Y /020 nature I Date Owner�s Name (Please Print) 05/04/2015 Design Professional's Signature Date ERIC ENGELL De P essi n I's Name (Please Print) SSZa�S Signature of License Professional responsible for CalGreen compliance Date 1 C, EtJC� I.L 6C�6 364 - Z$ Name of License Professional responsible for CalGreen compliance (Please Print) Phone er-i L,iD e mreykcr ltv►(Wsrs _ calm Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 9 of 9 CalGreen Non -Res Checklist. doc revised 01,23114 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) PrcJef Nd11e Great Clips Date Prepared. 4-14-15 Project Address: Location of Sign UT Outdoor Signs ❑ Indoor Signs Phase of Sign Construction 0 New Signs ❑ Sign Alterations Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls [3 Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) ❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power 0 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 la. 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 C No, complete part la of this form There are no existing sign lighting controls and I will be installing compliant sign lighting controls 2 ❑ Yes 1XNo ! There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls 3 (3Yes ❑ 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 CENo 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 lightin controls N El Yes No CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC- NRCC - LTS- 01- E(Reviswi 06114) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC - LTS -01 -E Sign Lighting (Page 2 of 5) P,o,ectName. Great Clips Date Prparcd4 -14 -15 lb. 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. ❑ ❑ CK §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N NA switch control, or an astronomical time- switch control. z ❑ ❑ 2 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. ❑ 13 §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 Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both f ❑ ❑ 3 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. ❑ 3 §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 reducin g the lighting g g power by a minimum of 30 percent when receiving a demand response signal. Y NA EXCEPTION to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, 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- NRCC- LTS -01 -E Revisw 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC- LTS -01 -E Sign Lighting Project name: (Page 3 of 5) Date preparetl: 2. Maximum Allowed Liahtina 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 Or Code Description of the Sign OPTIONAL— Energy Verified Label (see instructions below) Allotted Watts Design Watts Co �N es Filed Inspector Check that sign com lies P a Q C� On !Z- a > — T E c E 41 X 7 c w— �� � B w m 3 ry O I II a� w Y ZZ i n x 3 o p a v m c _ 2 Z t-° 3 l7 VI x a a E u ✓ ❑ ❑ ❑ ❑ Cl ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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. C 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 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 "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). 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 2014 STATF OF CAI IFOPNIA SIGN LIGHTING EMU CEC-NRCC- 1-TS -01 -E Revised 06/14 CALIFORNIA ENERGY COMMISSION Wr' CERTIFICATE OF COMPLIANCE NRCC- LTS -01 -E Sign Lighting (Page 4 of 5) Pmicc[ Name Date Prepared' Great Cli s 4 -14 -15 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 ENERGYVERIFIED 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 Wall Sign ❑ D -7 ❑ Wall Sign ❑ D -7 ❑ ❑ ❑ 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 '0' 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 a ballast that has a minimum efficiency of 80 percent. 3 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. Fluorescent lighting systems meeting one of the following requirements: A. Use only lamps with a minimum color rendering index (CRI) of 6 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 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) Protect Name: Great Clips - - Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Compliance documentation is accurate and complete. i Documentation Author Name: Cody Frank Documentation Author Signature: company: Northwest Signs Inc. Signature Date: Address: 120 Ene inal St CEA/ HERS Certification Identification (if applicable): City/State/Zip. Santa Cruz CA 95060 Phone: 831/469-8208 RESPONSIBLE PERSON'S DECLARATION STATEMENT I 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. (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. 1 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: Cody Frank Res ons" I De i ure- Company: Northwest Signs Inc. Date I n Address: 120 Eneinal St License: 786185 city /stater`'p: Santa Cruz CA 95060 Phone: 831/469 -8208 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 H Q W W Z Q Z 0 J H Z W ¢J 24C it OV J Z U Q 0 0 H N a) CL E O U m N 0i O Z m 0 t v Y u N uj W LuT m w c m m U ~ COM -PLIES th a) (larger of M or R, ai N/A for NOW y u N DDC) w m (CFM) c a W 0 m (20% DDC, N/A > E 3 c Lj > a NON -DDC) LL U (CFM) a E Y =o U- COM- PLIES? 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