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15090161CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19720 STEVENS CREEK BLVD CONTRACTOR: SUCCESS GRAPHIC PERMIT NO: 15090161 SIGNS OWNER'S NAME: EVERSHINE VI LP 11744 QUEENS CROSSING DR I DATE ISSUED: 09/23/2015 1 OWNER'S PHONE: 4088637346 1 SAN JOSE, CA 95132 1 PHONE NO: (408) 667-1777 ;H—/ LICENSED CONTRACTOR'S DECLARATION License Class 0-0 � Lic. # Contractor �h % til Date Y 7 I hereby affirm that I am licensed under the provisions of dhapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. IUeyCbyafiirm under penalty of perjury one of the following two declarations: 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. 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. APPLICANT CERTIFICATION 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 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. Addi ' , the applicant understands andwill co ply9.1with all non -point source re ions p he^Cupertino Municipal Code, Secti 8 Signature ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. 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. 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. 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. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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. Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ KARATE - INSTALL 1 (N) ILLUMINATED WALL SIGN TO (E) BRANCH CIRCUITS Sq. Ft Floor Area: Valuation: $1500 AI'NNumber: "_3(,,J 0 0I.A, 00 IOccupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS ON. RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: 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 9.12 and the Health & Safety Code, Section 25532(x) 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 & Safety Code, 'ons 25505, 25533, and 25534. n / Owner or auth ed ge Date: 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 I understand my plans shall be used as public records. Licensed Professional CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(@cupegtLgrg j_5-0 �V/ KI �10 PROJECT ADDRESS "la �ce � ew APN # OWNER NAME /✓A V___7 4.-�ePHO SSV ` 6; ) / E-MAIL D 3-22 4 STREET ADDRESS 6 2v cr •1� CITY, ST ZIP 9�i1/ FAX CONTACT NAME `vy� 1 I ) / /T "J V�� PHONE 10 E-MAIL STREET ADDRESS ITY, STATE, ZIP 1 `7A C,EC S �5SA! 9i_f1; FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT COCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME L4 LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME �C- E-MAILA - \ N Cj / ( j _ FAX STREET ADDRESS �„7�v./ st/ /1 CITY, STATE, ZI v ® `X CA PHO qq ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK <a/W74,11 (/ �• �— /�,11A J� /' yam c . � Q� �} JG' C�r7 Cil. C- ,t. l •v" 1 7r USE OF ❑ SFD or Duplex ❑ Multi -Family ILLUMINATED SIGNTYPE NO.OF SIGN AREA VALUATION STRUCTURE: ❑ Commercial (Y / N) (CODE) SIGNS (SQ. FT.) (S) �� ! SIGN TYPE CODES: B - BANNER SIGN M - MONUMENT (GROUND) SIGN BL - BLADE SIGN P - PROJECTING SIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN RECEI TOTI VA OIC: By my signature below, I certify to each of the following: I am the property owirMT75 authorized agent to act on the property owners 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 a licable local ordinances and state laws relating to buil ' g nstruction, aut rize representatives of Cupertino to enter the above -identified roperty for inspection p rposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Site Plan ❑ EXPRESS ❑ BUILDING PLAIN REVIEW Elevations Sign Details - including UL listing(s) applicable ❑ STANDARD ❑ PLANNING PLAN REVIEW Structural Calculations (if applicable) ❑ LARGE ' ❑ OTHER: _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ NLA.IOx submittal of Building Permit application. SignApp_2011.doc revised 03/16/11 �,,���,,��� CITY OF CUPERTINO I w/ll FEE ESTIMATOR - BUILDING DIVISION kalADDRESS: 19720 STEVENS CREEK BLVD DATE: 09/23/2015 REVIEWED BY: MELISSA 44ech. Permit Fee: APN: 316 06 012 BP#: "VALUATION: 1$1,500 *PERMIT TYPE: Building Permit Other Elea Insp. 0.0 $48.00 PRIMARY Sign rhumb_ Insp. Fee_ PENTAMATION 1 CEAP USE: Permit Fee: PERMIT TYPE: WORK KARATE - INSTALL 1 N ILLUMINATED WALL SIGN TOE BRANCH CIRCUITS hrs $0.00 SCOPE PME Unit Fee: SIGN TYPE FEE ID 7ifmb. Plan Check QTY 44ech. Permit Fee: SIGN FEE IESIGN Elec. Permit Fee: IEPERMIT Wall Sign, Electric 1SIGNWELEC Other Elea Insp. 0.0 $48.00 1 rhumb_ Insp. Fee_ $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 i onstruelion Tax: Ic(ministralive Fee: Work Without Permit? © Yes (j) No $0.00 TOTALS: $0.00 Travel Documentation Fee: ITRA VDOC $286.00 Strong Motion Fee: IBSEISMICG NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nivtrht_ etc)_ Thvcv, feet are hated on the nreliminary information available and are oniv an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/132 le ch..Plan Check 7ifmb. Plan Check # Branch Circuits 1 $48.00 44ech. Permit Fee: Plug,; IESIGN Elec. Permit Fee: IEPERMIT Other Mech. 1np. �, aer Plxraah /rasp. Other Elea Insp. 0.0 $48.00 !,'c,,') Insp_ Fce: rhumb_ Insp. Fee_ NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nivtrht_ etc)_ Thvcv, feet are hated on the nreliminary information available and are oniv an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/132 FEE QTY/FEE MISC ITEMS Flan Check F�car: Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 P rimll.;"Wech l"FIec 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 i onstruelion Tax: Ic(ministralive Fee: Work Without Permit? © Yes (j) No $0.00 Sign Master Plan: Q Yes (j) No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICG $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $431.50 $0.00 TOTAL FEE: $431.50 Revised: 07/02/2015 STATE OF CALIFORNIA SIGN LIGHTING FA CAI IFORNIA FNFRGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting 1. (Page 1 of 5) Project Name: V'At-t Ilk -t The Mandatory Measures (sign lighting controls or compliance with the sign lighting Standards. If the person Date Prepared: responsible for installing the sign lighting power is not s resUnfor the sign lighting controls, then the owner of the sign, general contractor, or architect shall be responsible to have htin controls installed. shall and sign a Certificate of Project Address: � � � q __ V `v • / (`-- Location of Sign Phase of Sign Construction Type of Lighting Control ❑ Outdoor Signs ❑ New Signs ❑ New Lighting Controls El Indoor Signs ❑ Sign Alterations ❑ Replaced Lighting Controls ❑ Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) ❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power ❑ Specific Lighting Sources 1. Mandatory Sign Lighting Controls NOTES: 1. The same responsible person may install boththe, 'gn lighting power and the sign lighting controls, or a different responsible person may install the sign lighting controls I jle respWsible person installing the sign lighting power. 2. The Mandatory Measures (sign lighting controls or compliance with the sign lighting Standards. If the person responsible for installing the sign lighting power is not s resUnfor the sign lighting controls, then the owner of the sign, general contractor, or architect shall be responsible to have htin controls installed. shall and sign a Certificate of 3. If more than one person has responsibility for compliance, epq,!s person prepare Compliance and on Installation Certificate applicable to the portion of aotI(Ucti�bryor which they are responsible; alternatively, the person with chief responsibility for construction shall prepare and sign h Ce ifAte of Compliance Declaration Statement for the entire construction. 4� ;P 1a. Statements of Responsibility: Any person signing the Certificate of Compliance Declar' t on this NRCC-LTS-01-E shall complete Part 1a. Check Yes or No for all of the following statements: 1 have responsibility for installing the sign lighting controls 1 ❑ Yes, complete parts 1a and 1b of this form No, complete part 1a of this form There are no existing sign lighting controls and I will be in allirig compliant sign lighting controls 2 C3 Yes No There are no existing sign lighting controls and someone e will be responsible to install compliant sign lighting controls 3 ❑ Yes : N1c 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 P40, 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 con s ❑ Yes 2N o 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: ilk tZ— 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: §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time- Y N NA^ 1 switch control. 11❑ "j §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N N switch control, or an astronomical time -switch control. ❑ ❑ 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 N� Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ ❑ 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. ❑ §130.3(a)3. Demand Responsive Electronic Message Center Control. An Electronic Message Center (EMC) Y N N/A having a new connected lighting power load greater than 15 kW has a control installed that is capable of ❑ ❑ ,_,/ 4 reducing the lighting power by a minimum of 30 percent when receiving a demand response signal. � EXCEPTION to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, Y N 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 Revised 06/14 CALIFORNIA ENERGY CUMMISSIUN CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting ,(Page 3 of 5) Project Name: Date Prepared: 'I 2. Maximum Allowed Lighting Power Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 3 of this Certificate of Compliance if there are signs using the Specific lighting sources method of compliance) A B C D E F G H I J Symbol 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 ^ a in o io cy a m C E 3 v X 2 ° l u c w Q "� W -a x a o o v Q c on � N c 0 o° F 3 vi v — E 0 L-E(�w 1� ❑ '' GT o ❑ ❑ ❑ EI ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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). 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 I^ 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 L�. UO- lT ❑ ❑ ❑ ❑ 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 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) Project Name: I l AV Date Prepared: A '7 , ( __- DOCUMENTATION AUTHOR'S DECLARATION STATEMENT • 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Company: Signature Date: Address: CEA/ HERS Certification Identification (if applicable): City/State/Zip: 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 kited signed cos of this Certificate of Compliance is required to be included with the documentation the builder provides e b f ing owner at occu Oncy. Responsible Designer Name: / ! Responsible Designer Signature: Company : 1 �V�77 �— Date Signed: / / Address 7 %'�5�' /} License: City/State/Zip Q - Phone((,,, Q- CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CFC-NRCI-I TS -M /Reviled 07/141 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTS-01-E Sign Lighting (Page 1 of 2) Project Name: V Enforcement Agency: .\ Permit Number: Project Address:- �- City: 677 M Zip Code: GENERAL INFORMATION DATE OF BUILDING PERMIT PERMIT# Location of Sign(s) El Outdoor Sign(s) ❑ Indoo ign(s) TYPE OF CONSTRUCTION ❑ New Sign(s) Sign Alteration SCOPE OF RESPONSIBILITY Enter the date of approval by enforcement agency of the Certificate of Compliance that provides Date: the specifications for the energy efficiency measures for the scope of responsibility for this Installation Certificate. In the table below identify all applicable construction documents that specify the requirements for the scope of responsibility reported by this Installation Certificate (continued). Date Approved By Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. I the Enforcement 2013 Nonresidential Compliance Forms July 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCI-LTS-01 (Revised 07/14) r:AI iFnRNiA 1=NPPr-'V r`nt,AhAICCInrl _ CERTIFICATE OF INSTALLATION NRCI-LTS-01-E Sign Lighting (Page 2 of 2) Project Name: Enforcement Agency: Permit Number: Project Address: - City: Zip Code: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Documentation Author Company Name: Date Signed: Address: CEA/ HERS Certification Identification (If applicable): City/State/Zip: 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 Installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 5. 1 will ensure that a completed signed copy of this Certificate of Installation shall be posted, or 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 Installation is required to be included with the documentati the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Sig Company Name: (Ins (ling Subcontractor or Gen Contractor wor` cn Position With Company (Title): Builder/Owner) Lxcc-t!5 j T {I G 7 Addre-1 Lti CSLB License: 7.� _ City/State/Z'I_� Phone �� Signed: o ✓ v Y -v 2013 Nonresidential Compliance Forms July 2014 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1C (Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTG-1C Project Name: karate Date: 09-16-15 Project Address: Title 24, Parts I and 6 of the California Code of Regulations. 19720 Stevens Creek Blvd., Cupertino this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the Location of Sign ❑ Outdoor Signs ❑ Indoor Signs Name: SEAN WU Phase of Sign Construction ❑ New Signs ® Sign Alterations Company: SUCCESS GRAPHIC SIGNS Type of Lighting Control ❑ New Li htin Controls ❑ Replaced Lighting Controls ❑ Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) City/State/Zip: SAN JOSE, CA 95132 ❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power ❑ Specific Lighting Sources 1. Certificate of Compliance Declaration Statement (this may be a C10, C45 or other eligible person) • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. • This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24, Parts I and 6 of the California Code of Regulations. • The design features represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: SEAN WU Signature Company: SUCCESS GRAPHIC SIGNS Phone 408.667.1777 Address: 1744 QUEENS CROSSING DRIVE License number 96458 be contractor's lic #) City/State/Zip: SAN JOSE, CA 95132 Date 2. Installation Certificate (to be signed by responsible person after installation) OrCItL.R'� Installation Declaration statement • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction. • I certify that the installed features, materials, components, or manufactured devices identified on this certificate conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I certify that the requirements detailed on this Certificate of Compliance have been met. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or mado av,Iailable with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable°in �pdctions. I understand that a signed copy of this Installation Certificate is required to be included with the documentatiol the builder provides to the building owner at occupancy. Company Name: SUCCESS GRAPHIC SIGNS Responsible Person's Name: Responsible Person's Signature: SEAN WU License number (may be contractor's lie #) Date Signed: Position With Company: owner 896458 2008 Nonresidential Compliance Forms October 2010 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1C (Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Compliance (Sign Lighting) (Page 2 of 4 SLTG-1C Project Name: karate Date: 09-16-15 3. Mandatory Sign Lighting Controls NOTES.- OTES:1. 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 lightingpower. 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 or the entire construction. 3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of 4 on this SLTG-1 C shall complete Part 3a. Check Yes or No for all of the following statements: 1 I have responsibility for installing the sign lighting controls §133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo ❑ Yes, complete parts 3a and 3b of this form Q No, complete part 3a of this form N There are no existing sign lighting controls and I will be installing compliant sign lighting controls 2 ❑ Yes El No 01 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls 3 ❑ Yes ® No Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and I will be 4 installing compliant sign lighting controls daylight hours. ❑ Yes KI No E There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and someone else 5 will be responsible to install compliant sign lighting controls N ❑ Yes P No 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1 C is responsible for complying with the sign lighting control requirements, that person shall answer all of the following uestions: If there are construction documents, indicate where on the building plans the mandatory measures sin lighting control note block can be located: §133(a)1. All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA 1 applicable requirements of § 119. ❑ ❑ 1❑ §133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA control, or an outdoor astronomical time switch, that comply with the applicable requirements of § 119. 01 ❑ Q 2 Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ E §133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA sign ower by a minimum of 65 percent during nighttime hours. ❑ ❑ Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours. Y 0 NA El 3 Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ 0 Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for Y NA illuminating signs or parts of signs. ❑ §133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than Y N N/A 15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ 4 receiving a demand response signal that is sent out by the local utility. Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including Y NA but not limited to exit signs and traffic signs. ❑ Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 STATE OF CALIFORNIA Ifialk CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CALIFORNIA ENERGY COMMISSION is CEC-SLTG-1C (Revised 10110) CT T!'1 .9 Certificate of Compliance (Sign Lighting) ra e . o1 ,4 3L 1L %ff_1%_ Project Name: � karate Date: 09-16-15 4. Maximum Allowed Lighting Power Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 5 of this Certificate of Compliance if there are signs using the S ecific lighting sources method of com liance A g C I D E F G H Allowed Watts Design Complies? A Watts Y/N W o �p.v p N ^ +- .-. ^N VI U o I v� � cCi • � � M b .� b�U v, E `�� Q_Cd U oAPsem'` Description I internally illuminated 13I 12 Q MR X r c• ° LE e 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. 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 148 of the California 2008 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 C 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 An ENERGY VERIFIED label is not needed for compliance. method to validate 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(d or e). I Enter Y if the number in column H is less than orequal to the number in column G. Otherwise, the sin does not comply. J This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms vcrooer zvi v STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING r:FC-SI_TG-1C (Revised 10/10) CALIFORNIA ENERGY COMMISSION 0 Certificate of Compliance (Sign Lighting) (Page 4 of 4 SLTG-IC Project Name: karate Date: 09-16-15 5. Specific Lighting Source Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this Certificate of Compliance if there are signs using the maximum allowed li:,Yhting power method of compliance) A B C D E OPTIONAL ENERGY Specific light source used for Field Inspector Symbol VERIFIED compliance Check that or Description label Shall include only lighting Sign Code (see instructions technologies listed below Complies below) List all that apply ✓ internally illuminated channel letters ❑ 7 ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ A Symbol or code used on the plans (when plans are required) and other documents. A narrative description of the sign, or location of sign on the building; and the location of sign on construction documents B OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed ENERGY VERIFIED label, confirming that C this sign complies with the Section 148 of the California 2008 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: a licable numbers 1 throu h 10 that a 1 in column D above for each row. Hi h ressure sodium lam s Pulse start or ceramic metal halide lam s served b a ballast with >_ 88% efficiencPulse EI start metal halide lamps that are < 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast with > 80% efficienc Neon or cold cathode lamps with transformer or power supply efficiency>_ 75% with rated output current < 50 mA 5 Neon or cold cathode lamps with transformer or power supply efficiency > 68% with rated output current > 50 mA D Fluorescent lamps with a minimum color rendering index (CRI) of 80 6 (Note: when using electronic ballasts for compliance, lamps with a CRI < 80 in be used 7 Light emitting diodes LEDs with a power supply with >_ 80% efficiency Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC 8 output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as complying 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 10 1 Electronic ballasts with a fundamental output frequency > 20 kHz E This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms uctooer -lvi u Is SPALE Plywood Backing 5" Aluminium Return (.040) j #10 x 2" - 3 1/2" Drive Screws Minimum Three (3) per Letters or as required per field conditions w/sleeves for stand-off c �I Rubber Brushing Acrylic Face LED " Trim Cap 3/4"' 1/4" Drain Hole J. OFFICE COPY 'iucce"4� • 1744 Queens Crossing Drive - San Jose - CA 95132 T. (408) 667-1777 E-mail: swu1966@gmail.com Raceway ala Sign Type: (1) Intemally illuminated L.E.D individual Channel Letters Sign. Letter Face: 1/8" Thick acrylic face color as shown Letter Returns: 5" Black with .040 Aluminum Trim Cap: 3/4" Black 1 19720 Stevens Creek Blvd., Cupertino MON ECKED BY CUPERTINO "ilding Department, SEP 2 3 2015 REVIEWEO FOR CODE COMPLIANCE Reviewed By. QN J.INIu�� -me, a�pi4 - uol�elo!n ION llbHS o lene_ Sue ;o ol3L,ol�r��L o 'K10WO 6t,1 I�u� ue d st}lw�ad I 4�;0 6utuw }� x'41 n8 ey; Lu04 (1) CIRCUIT 120 V01 T/20 AMPS leneldde;no4),IlV► `lLol.t. ,a4; JO `awes 40 suolde1q�1210 �M 041 Me }daN a q _ t --Primary Electrical Source (supplies by Others) 1N3 0 Junction Box Class 2 Low Voltage Wiring Note: No conduit or flex required per class 2 low voltage wiring guideline Power Supply 1120-277 vac) Disconnected Switches 3/8" Lag Screws as Required. ala Sign Type: (1) Intemally illuminated L.E.D individual Channel Letters Sign. Letter Face: 1/8" Thick acrylic face color as shown Letter Returns: 5" Black with .040 Aluminum Trim Cap: 3/4" Black 1 19720 Stevens Creek Blvd., Cupertino MON ECKED BY CUPERTINO "ilding Department, SEP 2 3 2015 REVIEWEO FOR CODE COMPLIANCE Reviewed By. QN J.INIu�� -me, a�pi4 - uol�elo!n ION llbHS o lene_ Sue ;o ol3L,ol�r��L o 'K10WO 6t,1 I�u� ue d st}lw�ad I 4�;0 6utuw }� x'41 n8 ey; Lu04 e1elnap /SUe 6> vw O leneldde;no4),IlV► `lLol.t. ,a4; JO `awes 40 suolde1q�1210 �M 041 Me }daN a q s65upl vv s SI it '1101'{Jnl}sUOO bupin 10 5nY'J suol;eo,dloads '� tiffs c;ol PUL, sueld jo I' s14- G�A0 1N3 0 H3dnn - NOISUIIO 0N4011n8 d30 _LN3Ac'013P130 utNnvjVj00 Stevens Creek Blvd Authowed Orchard —�11 MetroPCS Dealer ley mMarkel Pl, 4W IL t BBOXiU4 IT" m— kc' ore It B" Ica pm ml Pau ORD LWU .41 LSPL I a b Pots, i M. L0.1 -A1 Isint - �]Q^: Mb+ ' t, t,, A- . alt4 _ VO 10 U!!L mu. I'A n6A7 UU Pacific Precious Met. ULA The.Ma(ketplace con Ur %. t qLatissene Bakery gal t a.- af� law "M304 AV Sg%o%Pa Project Location Approval 1744 Queens Crossing Drive --San Jose — CA 95132 — - 1 19720 Stevens Creek Blvd Cupertino