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15090057CITY OF CUPERTINO BUILDING PERMIT 13UILDING ADDRESS: 19732 STEVENS CREEK BLVD CONTRACTOR: ALLEN SIGNS INC PERMIT NO: 15090057 OWNER'S NAME: EVERSHINE VI, LP/ KCR MNGMNT 1982 STONE AVE DATE ISSUED: 09/09/2015 OW R'S PHONE: 4088074618 SAN JOSE, CA 95125 PHONE NO: (408)280-6500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ LEGENDS - INSTALL 1 (N) ILLUMINATED WALL SIGN TO (E) BRANCH CIRCUITS License Class # � o " /�Liye.. Contractor /"1 /1 (_ + 1_ Date (/f ( 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. Sq. Ft Floor Area: Valuation: $2700 I hereby affirm under penalty of perjury one of the following two declarations: t. I have and will maintain a certificate of consent to self -insure for Worker's APN Number: 36906012.19732 Occupancy Typc: Compensation, as provided for by Section 3700 of the Labor Code, for the .performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D PERMIT ISSUANCE OR APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is 180 Ate$ + ALLED INSPECTION. 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 Iss y: te: 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 ROOFS: all non -point source regulations per pwtino Municipal Code, Section 9.1 All roofs shall be inspected prior to anyy roofing material being installed. If a roof is Signature Date installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: Cl OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain construct the project (Sec.7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should I use equipment or devices which emit hazardous air 1 I have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Owner or autho ' gent, Section 3700 of the Labor Code, for the performance of the work for which this Date: a permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY 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 1 hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional 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. Signature Date CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.org S -D ? 00 .�_ 3 S PROJECT ADDRESS jjq 7; /�1 ("APnN # —OWNER NAME (S^ / /J PHO*0' o � (/� [ 1 Cj E-MAIL STREET ADDRESS V ✓,— MIITI� STATE, ZIP U �/-(-vQ (�FAX CONTACT NAME PHONE 1 E-MAIL Allen Signs, Inc 408-280-6500 allensigns@)fahoo.com STREET ADDRESS 1982 Stone Ave CITY, STATE, ZIP FAX San Jose, CA 95125 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LI BER LICE E BUS. LIC # Allen Ling' - 22174 COMPANY NAME E-MAIL FAX Allen Signs, Inc allensi ns@ ahoo.com STREET ADDRESS CITY, STATE, ZIP PHONE 1982 Stone Ave San lose, CA 95125 408-280-6500 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK fie, t1 ; h'PI YV� Q e%_ t f) L N L na IUSE OF H SFD or Duplex STRUCTURE: commercial SIGN TYPE CODES: B - BANNER SIGN BL - BLADE SIGN D - DEVELOPMENT ID SIGN DI - DIRECTIONAL SIGN E - ELECTRONIC READERBOARD M - MONUMENT (GROUND) SIGN P - PROJECTING SIGN SP - SPECIAL EVENT BANNER T - TEMPORARY W - WALL SIGN - WINDOW SIGN By my signature below, I certify to each of the following: I am the1r�__ application and the information I have provided is correct. I have read the Descril ordinances and state laws relating to building constru authorize represent Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED Site Plan Elevations Sign Details - including UL listing(s) applicable Structural Calculations (if applicable) _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. r/ov, - ize proper�r s behalf. I have rdad this veri s accurate. I agree to co with all applicable local o enter the above -identified prope or inspection purposes. Date: —1 ■ OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW ❑ EXPRESS ❑ PLANNING PLAN REVIEW ❑ STANDARD ❑ OTHER: ❑ LARGE ❑ MAJOR SignApp_2011.doe revised 03/31/11 ILLUMINATED (Y / N) SIGN TYPE (CODE) NO. OF SIGNS SIGN AREA VALUATION (SQ. FT.) ($) Ci. / 0 0( By my signature below, I certify to each of the following: I am the1r�__ application and the information I have provided is correct. I have read the Descril ordinances and state laws relating to building constru authorize represent Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED Site Plan Elevations Sign Details - including UL listing(s) applicable Structural Calculations (if applicable) _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. r/ov, - ize proper�r s behalf. I have rdad this veri s accurate. I agree to co with all applicable local o enter the above -identified prope or inspection purposes. Date: —1 ■ OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW ❑ EXPRESS ❑ PLANNING PLAN REVIEW ❑ STANDARD ❑ OTHER: ❑ LARGE ❑ MAJOR SignApp_2011.doe revised 03/31/11 CITY OF CUPERTINO IJ�I FEE ESTIMATOR - BUILDING DIVISION 19, ADDRESS: 19732 STEVENS CREEK BLVD DATE: 09/09/2015 REVIEWED BY: MELISSA -71it 1'1'C. APN: 36906012 BP#: EVALUATION: $2,700 'PERMIT TYPE: Building Permit PL 4N CHECK 7')'PE: PRIMARY USE: Sign I'tumb. In.�7� ,l���t�� PENTAMATION PERMIT TYPE: 10EAP5 WORK LEGENDS - INSTALL 1 N ILLUMINATED WALL SIGN TOE BRANCH CIRCUITS SCOPE Suppl. Insp. Fee:Q Reg. Q OT SIGN TYPE FEE ID 'himb. Ilan Check QTY -71it 1'1'C. SIGN FEE IESIGN Elec. Permit Fee: IEPERMIT Wall Sign, Electric 1SIGNWELEC Other Elea Insp. 0.0 $48.00 1 I'tumb. In.�7� ,l���t�� $286 Permit Fee: $286.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: -41ministrative Fee: Work Without Permit? 0 Yes Q No $0.00 TOTALS: $0.00 Travel Documentation Fee: ITR,4VDOC $286.00 Strong Motion Fee: IBSEISMICO 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 Eff 7/1113) ,11ech. Plan CH111"'11 'himb. Ilan Check # Branch Circuits 1 $48.00 -71it 1'1'C. Plumb. Permit Fee: IESIGN Elec. Permit Fee: IEPERMIT t)therMech_ Insp. —L] Other.Plunib lap. Other Elea Insp. 0.0 $48.00 tlech. Insp. Fc(- I'tumb. In.�7� ,l���t�� ��� !,�� 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 Eff 7/1113) FEE QTY/FEE MISC ITEMS Plan C:heckFee: Suppl. PC Fee: Q Reg. () OT 0.0 hrs $0.00 I'himb./Afech./Elec Permit Fee: $286.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: -41ministrative Fee: Work Without Permit? 0 Yes Q No $0.00 Sign Master Plan: © Yes (F) No $0.00 Travel Documentation Fee: ITR,4VDOC $48.00 Strong Motion Fee: IBSEISMICO $0.76 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $431.76 $0.00 TOTAL FEE: $431.76 Revised: 07/02/2015 LEGEND PIZZA BUILDING SIGN ELEVATION: 19732 STEVENS CREEK BLVD. CITY OF CUPERTINO 5' THICK INDIVIDUAL CHANNEL L 3/4" BLACK COLOR. BUILDING ELEVATION: r 0 ��OOR INTERNALLY ILLUMINATION. HINTED BLACK COLOR. WILL BE RED ,p,e te. a*Nie ,' o any unoaov to dd • Cp'\C\a�. n. at NQS T' +AXP' 250 foot-lambert = 80 candela/foot/ / Sign area =1.5'x20.5' = 30.75 rquare feet 9 LED per letter x 20 lumeker LED =180 lumen x 13 = 2,340 lumen/30.75 = 76.1 candela/foot2 R OPLOT CH QKED BY EX15TING WOOD BEAM SHEET METAL RACEWAY FOR ELECTRICAL WIKEING 1/4"x2" LAG SCREW INTO WOOD BEAM TOP & BOTTOM @ 4'-0" O.C. D15CONNECTED SWITCH #10x1" 5CREW MIN.3 PER LETTER TRAN5FOKMER 13OX #10x1/2" SCREW FOR RACEWAY COVER LED CHANNEL LETTER INSTALLATION DETAIL DATE PPA DE 7 CUPE RTINQO � G�VO Pa�e�t +�uildtn9 ' � CEp 0 91015 �c� R CpDE CC�p��P _. Reviewed 61 Legend Pizza 3 t M cus�au rr«wc wr�� s,eR.s cau wu«vw N �► JAM• 1982 Stone Ave San Jose, Ca. 95125 All designs & art works belong to E-mail: allensigns@yahoo.com �L 408 280 6500 fAX 405 280 6700 Allen Signs Inc any duplication State Contractor License # 834580 is prohibited — Copy right 2015 20'-6" RACEWAY PAINTED TO MATCH BACK WALL COLOR - 5' THICK INDIVIDUAL CHANNEL L 3/4" BLACK COLOR. BUILDING ELEVATION: r 0 ��OOR INTERNALLY ILLUMINATION. HINTED BLACK COLOR. WILL BE RED ,p,e te. a*Nie ,' o any unoaov to dd • Cp'\C\a�. n. at NQS T' +AXP' 250 foot-lambert = 80 candela/foot/ / Sign area =1.5'x20.5' = 30.75 rquare feet 9 LED per letter x 20 lumeker LED =180 lumen x 13 = 2,340 lumen/30.75 = 76.1 candela/foot2 R OPLOT CH QKED BY EX15TING WOOD BEAM SHEET METAL RACEWAY FOR ELECTRICAL WIKEING 1/4"x2" LAG SCREW INTO WOOD BEAM TOP & BOTTOM @ 4'-0" O.C. D15CONNECTED SWITCH #10x1" 5CREW MIN.3 PER LETTER TRAN5FOKMER 13OX #10x1/2" SCREW FOR RACEWAY COVER LED CHANNEL LETTER INSTALLATION DETAIL DATE PPA DE 7 CUPE RTINQO � G�VO Pa�e�t +�uildtn9 ' � CEp 0 91015 �c� R CpDE CC�p��P _. Reviewed 61 Legend Pizza 3 t M cus�au rr«wc wr�� s,eR.s cau wu«vw N �► JAM• 1982 Stone Ave San Jose, Ca. 95125 All designs & art works belong to E-mail: allensigns@yahoo.com �L 408 280 6500 fAX 405 280 6700 Allen Signs Inc any duplication State Contractor License # 834580 is prohibited — Copy right 2015 SKATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-o1-E Revised 06/14 CALIFORNIA ENERGY COM SSI CERTIFICATE OF COMPLIANCE MI ON NRCC-LTS-01-E Sign Lightin (Page 1 of 5) Project Name: ' Date Prepared: r person may install the sign lighting controls than the responsible person installing the sign lighting power. 2. Project Address: Location of Sign Phase of Sign Construction Type of Lighting Control A Outdoor Signs ❑ Indoor Signs A New Signs ❑ Sign Alterations ❑ New Lighting Controls ❑ 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 some 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 11 h e responsibility for installing the sign lighting controls d�'Yes, complete parts 1a and lb of this form ❑ No, complete part la of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls Q Yes ❑ No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls ❑ Yes ❑ No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and I will be 4 installing compliant sign lighting controls ❑ Yes ❑ No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and someone 5 else will be responsible to install compliant sign lighting controls ❑ Yes ❑ No 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 2 of 5) Project Name: Date Prepared: 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. ❑ ❑ §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. 1:1❑ 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. ❑ §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 ❑ ❑ 0/ 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 V illuminated both day and night. ❑ §130.3(a)3. Demand Responsive Electronic Message Center Control. An Electronic Message Center (EMC) Y N N/�j/ 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 A 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 77 CEC-NRCC-LTS-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION 4.,M ` CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) Project Name: Date Prepared: 2. Maximum Allowed Liehtine 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 Complies Y N Filed Inspector Check that sign complies ru Q OCO n vY MC C N +-' 7 c W — X33 m 3 .r -4-I I 11 Q =� N �LL Q N C No w F- 3 VI O v ✓ ✓ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 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 4 of 5) Project Name: 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 Field Inspector Symbol ENERGY VERIFIED compliance Check that Sign or Description label Shall include only lighting Complies Code (see instructions technologies listed below below) List all that apply 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 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 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 'TATE OF CALIFORNIA SIGN LIGHTING MY4141 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: Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT • 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Company: MICAS/1S �� Signature Date: Address: /,L � � a CEA/ HERS Certification Identification (if applicable): City/State/Zip: ^ (91 (9 Phone: 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. 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: sr Date Signed: E1 Address: o L J License: City/State/Zip: \ T Phone: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014