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15100096CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19634 STEVENS CREEK BLVD I CONTRACTOR: ACTIVE SIGN CO PERMIT NO: 15100096 OWNER'S NAME: EVERSHINE VI, LP 11365 E TAYLOR ST 1 DATE ISSUED: 10/13/2015 OWNER'S PHONE: 4082092974 91 LICENSED CONTRACTORS DECLARATION License Class C /0 , Lic. # [ :Z x0;? -/ Contractor l Va S Z� t Dae �/,3Z15 1 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: 1. 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 t6ection 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 ent upon the above mentioned property for inspection purposes. (We) agr ave 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 nderstands and will comply with all non -point source regulati e CVerti unicipal Code, Section 9.18. Signature Date /d> ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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. Signature Date SAN JOSE, CA 95133 PHONE NO: (408)297-6640 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ LAN'S GARDEN - INSTALL 3 (N) ILLUMINATED WALL SIGNS TO (E) BRANCH CIRCUITS Sq. Ft Floor Area: Valuation: $5300 APN Number: 36906012.19634 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 ALLED INSPECTION. 111-0// .2 /i)1 - 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(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 & Safety Code, Sections 25505, 25533, and 25534. Owner or author' agent: 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • buildinp(c1cupertino.org CUPERi iNa i /5 PROJECT ADDRESS / 3 '-ev erI s c ki vd . APN I - 1 3 OWNER NAME u w PHONE o E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAMEL / U 4��A PHONE � � _ � E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENS PE BUS. LIC # COMPANY NAME V, E-MAIL w c�o �Cc, Ccm FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITfiCT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS I CITY. STATE, ZIP PHONE DESCRIP'T'ION OF WORK � J AqfernLI& Aumirla+ed Indiy;Aa f IS4anni I lEfr- W r6r-.ewrCy 3 !�,4 _ USE OF ❑ SFD or Duplex ❑ Multi -Family ILLUMINATED SIGN TYPE NO. OF SIGN AREA VALUATION STRUCTURE: ® Commercial (Y / N) (CODE) SIGNS (SQ. FT.) (S) SIGN TYPE CODES: V V > , q q �, 3(PD B - BANNER SIGN M - MONUMENT (GROUIv'D) SIGN` BL - BLADE SIGN P PROJECTINGSIGN % Oro D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY - E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN TOT A14�0 By my signature below, I certify to each of the following: I am the property o or authorized aa t to a on the property owner's behalf- ve read this application and the information I have provided is correct. I have read the Description of Work v it is accurate. I agree to comply with al applicable local ordinances and state laws relating to building construction. I thorize rep r entatives of Cu to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: %%f�' / SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY PLA\ CHECK TYPE ROUTING SLIP Site Plan ❑ EXPRESS I3ULLDLNG PLAN 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 ❑ Olz submittal of Building Permit application. SignApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 19634 STEVENS CREEK BLVD DATE: 10/13/2015 REVIEWED BY: MELISSA APN: 36906012.19634 1 BP#: *VALUATION: 1$5,300 *PERMIT TYPE: Building Permit PLAN CHECK C'YPE: PRIMARY PENTAMATION USE: Sign PERMIT TYPE: 1 CEAP5 WORK LAN'S GARDEN - INSTALL 3 N ILLUMINATED WALL SIGNS TOE BRANCH CIRCUITS SCOPE SIGN TYPE FEE ID QTY/FEE7 QTY Wech. Permit Fee: SIGN FEE IESIGN Elec. Permit Fee: IEPERMIT Wall Sign, Electric 1 SIGNWELEC Other Elec. Insp. 0.0 $48.00 3 $858 Permit Fee: $858.00 Suppl. Insp. Fee: Reg. OT 0.0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 ytlid:S'l1"t?c°ttrlt? �tt�:.` Work Without Permit? Yes No $0.00 TOTALS: $0.00 Travel Documentation Fee: ITRA VDOC $858.00 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 Dictrirt_ etr )_ Thece feec are haced nn the nroliminary infnrmatinn availahle and are nnly an octimnto_ C'nntart the Dont fnr addn'l info_ FEE ITEMS (Fee Resolution I1-053 Ef': 7f /1/1 jj Alech, Plan C.'hc�ctc QTY/FEE7 #Branch Circuits 1 $48.00 Wech. Permit Fee: Plumb. Permit Fee: IESIGN Elec. Permit Fee: IEPERMIT Other .A4ech..In p. 01her.Pluinh .hasp. Other Elec. Insp. 0.0 $48.00 $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ etr )_ Thece feec are haced nn the nroliminary infnrmatinn availahle and are nnly an octimnto_ C'nntart the Dont fnr addn'l info_ FEE ITEMS (Fee Resolution I1-053 Ef': 7f /1/1 jj FEE QTY/FEE7 MISC ITEMS 11(in t.;"heek.Fee: Suppl. PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 Permit Fee: $858.00 Suppl. Insp. Fee: Reg. OT 0.0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 ytlid:S'l1"t?c°ttrlt? �tt�:.` Work Without Permit? Yes No $0.00 Sign Master Plan: 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICO $1.48 Select an Administrative Item Bldg-Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $11004.48 $0.00 TOTAL FEE: $1,004.48 Revised: 10/01/2015 Project descripton Project informaton: Total Page.- 8 pages Signage plans for: OFIZ Ic co Lan's Garden P Genaral Information of signage: Marketplace plaza Front lit - internallyminate 19634 Stevens Creek Blve. aluminum channer$ f w/ raceway Cupertino, CA 95014 Total set of s i g n,s :its49, �,0 South elevation:-\x'74-i'pqsf East elevation: 417 4415 Landlord. aM"UN�Q�,�Lop ME West elevation: 41.7 � °�� BULDrNG s; NT QEPART 94 KC R Development �P °N' CUFtRVN0 ENT 'lr'�ti This�etofPlans �� .040 Bronze aluminum return �� and s R 408)343-1800'o�sito��.r.n-- ��n�trp�c'6n,`cat'°"�nAv k� 1" Dark bronze trim c It is unlawfulST be pt at t cap 19620 Stevens Creek Blvd. Suit(~ a n same,orttoMakean » J app�-o to deviat vaifro 8 3/16 White acrylic w/ red vinyls � stagy m the n Cupertino, CA 95041 �,� �"-,ng of this ,n G Building official. "� +o �- p nay a'• UL approve white LED module p � n;;t or t� � ,-,oacifications ;s:7 �� an aoro�a; of ihSHALL atioN07 n e or State Law. �..! _ JOB SITE Contact: Tenant: Rita Wu( Hongling Wu ) 408)209-2974 ritawuhongling@yahoo.com l�ld'o CD CO -I MN0 0 Q TC 2 _ IN 20N 4' it ❑ a o ❑ ❑ a > S S S S S C C C C C ❑ I D 1 W 1 A3 Cl G S S C ❑1 16 I S S C C ` E14 C qD °3101S 5 S S C 1 W�, , ,. S S C C4 E !A N C::.- _ i rj - s S 3 � ❑ rt3d0 000 O❑ S s c s H -- 1 S 2 S. 2 S S S ❑a � ° S S❑❑ 3SW c ❑ 5 E B - S S S c S S s c c c - 4W c ❑ S s s •5 A C S S s S s s C C G ❑ 1 5W • 16 C s s s c DA4 S s S G c c 0 13 0 ° DL2 ED ® S s S s s 5S 7 r M Master Installation Site Plan The Market place, Cupertino Master Sign Program �ulldlng A.- Enlarged SPlan February 6, 2008 2 Development O E M 2 M V ding A: South Elevation 3 4 4.5) ( 5 Suildino Dept OCr 3 2015 rtnent 'REvIEIVEC Fobs Rein d DE COA-4PL14NC&(8 0 Master Installation Site Plan The Market place, Cupertino Master Sign Program February 6, 2008 ERTW r4 p., 3ui ding A: East Elevation Master Installation Site Plan The Market place, Cupertino Master Sign Program February 6, 2008 C�evarfi�is Master Installation Site Plan The Market place, Cupertino Master Sign Program Building A: West Elevation February 6, 2008 W!9 492" CAPITAL ELI gLUMINUM CHANNEL LETTER w/ RACEWAY ALUM. BRONZE RETURN I Acrylic Face w/ Red Vinyl CUPERTINII Building Departrn Sign Location: 5W OCT 13 2015 EvvED FOR CODE COMPLIAN :eviewed By, - PROJECT: BUSINESS ID SIGN, CHANNEL LETTER SIGN PREPARED BY; Daniel Cho SCALE: N/A BUSINESS APPROVAL: CAPITAL ELECTRIC & SIGN / ACTIVE 990 HELEN AVE. UNIT 1 DATE: LANDLORD APPROVAL: Washer SUNNYVALE, CA 94086 TEL 408-892-6744 PROJECT ADDRESS: Lan's Garden 19634 Stevens Creek Blvd.FAX- 408-260-7028 E-MAIL: capitalelectricnsign@gmai1.com Cupertino, CA 95014 LIC#622021 1" Dark Bronze Trim Cap INSTALLATION DETP =. _76.,n.. 4CHEC TING ELEVATION PLIOT PECKED BY DATE PLANNING DE T 4ff CUPERTINO 5" Wood 3/8"O. D. x 2" Frame Lag screw w/ 12v Low Washer Voltage Rated Wire Existing power Red UL source approved LED Module i 1/2" Self I Driling Screw 120v / 12v LED Power Supply w/ 2 Toggle S/W Raceyway Drawing# 116: Capital Signs =. _76.,n.. 4CHEC TING ELEVATION PLIOT PECKED BY DATE PLANNING DE T 4ff CUPERTINO Lr*lj I 101- 24 x 107.87" - 17.99sf FRONT ELEVATION Sign Location: 5S PROJECT- BUSINESS ID SIGN, CHANNEL LETTER SIGN PREPARED BY: Daniel Cho SCALE: N/A BUSINESS APPROVAL: CAPITAL ELECTRIC & SIGN / ACTIVE 990 HELEN AVE. UNIT 1 SUNNYVALE, CA 94086 TEL: 408-892-6744 DATE: LANDLORD APPROVAL: PROJECT ADDRESS: Lan's Garden 19634 Stevens Creek Blvd.FAX- 408-260-7028 E-MAIL: capitalelectricnsign@gmail.com Cupertino, CA 95014 LIC#622021 ALUMINUM CHANNEL LETTER w/ RACEWAY INSTALLATION DETAII ALUM. BRONZE RETURN I gTUD 000 0 �5"� 3/8°O.D. x 2" 0 0 12v Low Lag screw w/ 0 Voltage Washer Rated Wire White UL 3/8°O.D. x 2" approved Bolt w/ Washer LED Module &Nuts F 120v / 12v 1/2" Self LED Power Driling Screw Supply w/ 3/16" White Weep holes \ Toggle S/W Acrylic Face 1" Dark Bronze 3-1/2" w/ Red Vinyl Trim Cap Raceyway Drawing# 118 Capital Signs pwEXISTING ELEVATION UPERTINO El I'ing Dep,rtrnenf, OCT 13 2015 REVIEWED FOR Cosi CC��1 y �,F-t`j�4IyCE Reviewed `Z' FRONT ELEVATION L.X-A � 24" x 46.5" - 7.75sf Sign Location: 5EA LA NIDEN 23" x 212.84" - 34sf Q1qNW&MAr_W Total: 41.75sf PROJECT: BUSINESS ID SIGN, CHANNEL LETTER SIGN PREPARED BY: Daniel Cho SCALE: N/A BUSINESS APPROVAL: CAPITAL ELECTRIC & SIGN / ACTIVE Anchors w/ 990 HELEN AVE. UNIT 1 SUNNYVALE, CA 94086 TEL- 408-892-6744 DATE: LANDLORD APPROVAL: PROJECT ADDRESS: Lan's Garden 19634 Stevens Creek Blvd.FAK 408-260-7028 E-MAIL: capitalelectricnsign@gmail.com Cupertino, CA 95014 LIC#622021 ALUMINUM CHANNEL LETTER w/ RACEWAY INSTALLATION DETAIL ALUM. BRONZE RETURN WALL 3/8"O.D. x 3" 5" � Anchors w/ I Washer 12v Low Voltage 120v / 12v Rated Wire LED Power Supply w/ Red UL Toggle S/W approved LED Module ■ 1/2" Self J -Box Driling Screw I 3-1/2" 3/16" White weep holes Raceyway Acrylic Face 1" Dark Bronze 117 w/ Red Vinyl Trim Cap Drawing# Capital Signs EXISTING ELEVATION UC(JP :�.. j Depa �v��wEa 32015 Cp MP0ANCE Certificate of Compliance (Sign Lighting) NRCC-LTG-08-E Project Name: ��1 kf.��7 ) S C G:.�'(�ei1 Date: /0 ��•. � ��,-- Project Address: / 9 �3.4 _Sr+ewo , cre C Blvd, Location of Sign ® Outdoor Signs ❑ Indoor Signs Phase of Sign Construction ® New Signs ❑ Sign Alterations Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls 21 Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) 0 Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power ❑ Specific Lighting Sources 1. Certificate of Compliance Declaration Statement (this may be a Cl o, 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 1 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:Signature �- r, el co o enforcement agency. Company Phone Address:_ // License number (may be contractor's lic #) 13 Company Name- City/State/Zip: Date 2. Installation Certificate (to be signed by responsible person after installation) Permit number Checked by/Date (Enforcement Agency Use (Enforcement Agency Use ) Installation Declaration statement 0 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. • 1 will ensure that a completed, signed copy of this Installation Certificate 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 signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name- C 1! e 34y) Responsible Person's Name: VResponsible Person's Signatur�,� License number (may be contractor's lic #) Date Signed: Position With Company- ompany:022 01Z24 ZI 1Q �, % Hae? G- e -i— 2013 Nom-esidential Compliance F07 -177S February 2013 Certificate of Compliance (Sign Lighting) NRCC-LTG-08-E Project Name: ot..n � 5 1. 4x6441 Date: _ 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 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,- esponsible;alternatively, 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 ❑ ❑ Yes, complete parts 3a and 3b of this form R No, complete part 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls Y ❑ Yes IZ No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls switch control, or an astronomical time -switch control. ❑ Yes 16 No ❑ 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 Y Yes ❑ No 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 ❑ Yes 0 No 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page I of 4 of this SLTG-1C is responsible for -complyingwith the sign lighting control requirements, that person shall answer all ofthe following questions: If there are construction documents, indicate where on the building plans the ma datory measures (sign lighting control) note block can be located: 1 §130.3(a)l. All indoor sign lighting is controlled with an automatic time switch control or astronomical time Y N NA switch control that complies with the applicable requirements of § 110.9. ❑ ❑ in §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 ❑ ❑ 2 EXCEPTION to Section 130.3(a)2A: Outdoor signs in tunnels, and signs in large permanently covered Y NA outdoor areas that are intended to be continuously lit, 24 hours per day and 365 days per year. ❑ �1 §130.3(a)2B. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides the ability to automatically reduce sign lighting power by a minimum of 65 percent during Y N NA 3 nighttime hours. Signs that are illuminated at night and for more than I hour during daylight hours shall be ❑ ❑ V considered ON both day and night. EXCEPTION to Section 130.3(a)2B: Outdoor signs in tunnels and large covered areas that are intended to Y NA be illuminated both day and night. ❑ J?] §130.3(x)3. Demand Responsive Electronic Message Center Control. An Electronic Message Center (EMC) having a new connected lighting power load greater than 15 kW has a control installed that is capable Y N N/A 4 of reducing the I ighting power by a minimum of 30 percent when receivi . ng a demand response signal. ❑ ❑ EXCEPTION to Section 130.3(x)3: Lighting for EMCs that is not permitted by a health or life safety Y NA statute, ordinance, or regulation to be reduced by 30 percent. ❑ Field Inspector Notes: 2013 Nonresidential Compliance Forms Febritary 2013 Certificate of Compliance (Sign Lighting) NRCC-LTG-08-E Project Name: "t+ 75 %1a Date: I C' /131 /S"' 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 lighting ower method of compliance) A B C D E OPTIONAL Specific light source used for Field Symbol ENERGY compliance Inspector or Description VERIFIED Shall include only lighting Check that Code label (see instructions technologies listed below Sign Complies 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 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: List all applicable numbers (1 through 10) that apply in column D above for each row. I 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 watta e 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 3 served by a ballast that has a minimum efficiency of 80 percent. Ballast efficiency is the measured output wattage to the lamp divided by the measured operating input wattage when tested according to ANSI C82.6-2005. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 D 4 percent 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 S percent when the transformer or power supply rated output current is 50 mA or greater. The ratio of the output wattage to the in ut watta e is at 100 percent tubing load. 6 Fluorescent h-liting systems meeting one of the following requirements: A. Use only lamps with a minimum color rendering index (CRI) of 80; or B. Use only electronic ballasts with a fundamental output frequency not less than 20 kHz. 7 Light emitting diodes (LEDs) with a power supply having an efficiency of 80 percent or greater; Single voltage external power supplies that are designed to convert 120 volt AC input into lower voltage DC or AC output, and 8 have a 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 a -e doubles as a field inspection checklist. Field Inspector Notes: 2013 Nonresidential Compliance Forms February 2013 Certificate of Compliance (Sign Lighting) NRCC-LTG-08-E 4. Project Name: Date: )e9113 11-5- 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 Specific lighting sources method of compliance) A Symbol or code used on the plans (when plans are re uired) and other documents. B A narrative description of thesign, 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 C 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 I nspection 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 insquare feet. E List "I" if the sin is internally illuminated. List 'T" 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 sign does not comply. J This page doubles as a field inspection checklist. Field Inspector Notes: 2013 Nonresidential Compliance Forms February 2013