B-2016-1179 ENERGY FORMSTATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING'
CECSLTGIC (Revised 10110) CALIFORNIA ENERGY COMMISSION L: '
Certificate of Compliance (Sip Lighting)
Page I of 4 SLTG-IC
ProjectName:
Timm
Project Address: p
Location of Sign ZCutdoor Signs ❑ Indoor Signs
Pbase cif Sip Construction El New Sigas - ❑ Sign Alterations -
T e of Li hfin Control ❑ New Li htin Controls [IReplaced Lighting Controls
❑ Not InstallingLighting 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. Certificate of Compliance Declaration Statement (thus maybe a CIO, 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, calculatio ,plans and specifications submitted to the
enforcement agency for approval with this building permit applicafto .
Name: 1,1''
vevIV\ V&i.VLct V\VrA' V
Signative
/
Company:
Phone
Address:
�25o Sw v. ftV4 S7 E ICqqAq
License number (may be contractor's lic T)
City/state/Zip: _ I
S �, . O%L eft- I r 11 a1
Date
iIX
2. Installation Certificate (to be signed by responsible person after instaltation)
Permtt number -
Clmr�catiymate
(EntoreemcrtAgen Use.) -
(HnforcementAgency,Use
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-ofthe Business and Professions -Code -toacce accept responsibility f n. u a ',�af t �u}r}�,orized-
P P REM �' r
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 tbisCertificate of Compliance have been met-
I that completed, signed copy of this Installation Certificate shall be posted, or madAQlable-with-the building
. will ensure a
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: /� /
51
Gts u�
Responsible Person' - me:
Responsible Persmis signature:
l� 1t 4 /AVl6kbl ,(l,6 ,
License numbber (may be contractor's lic N)
Date Signed:
si , p
2008 Nonresidential Compliance Fonns October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING'
CECSLTG-1C (Revised 10110) CALIFORNIA ENERGY COMMISSION t+ #r-
Certificate of Compliance (Sign Lighting) (Page 2 of 4 SLTG-IC
_
Project Name: pp��
;4�
Date:
3. Mandato!j Sign Lighting Controls
NOTES:
1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power.
2. The MondatoyMeasures (sign lighting controls) are required for compliance with tire 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 iinstalled.
3. If nrore than one person has responsibility for compliance, each responsible person shallprepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible;
altetnativelu the person with chief responsibility for constriction 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 I of
4 on this SLTG-IC shall complete Part 3a. Check Yes or No for all of the following statements:
I have responsibility for installing the sign lighting controls
1
❑ Yes, complete parts 3a and 3b of this form 15640, complete part 3a of this form
There are no existing sign lighting controls and I be stalling compliant sign lighting controls
2
❑ Yes 4KINO
There are no existing sign lighting controls and someone lse will be responsible to install compliant sign lighting controls
3
❑ Yes No
There are existing sign lighting controls that do not comp with the applicable provision of § 119 and § 133 and 1 willbe
4
installing compliant sign lighting controls
❑ Yes No
There are existing sign lighting controls that do not coo with the applicable provision of §119 and § 133 and someone else
5
wi be responsible to install compliant sign lighting controls
Yes ❑ No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-IC is responsible for
complying with the sign IiWiting control reciIiiiements, 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 he located:
§133(a)l. All indoor sign lighting is controlled with an automatic time switch control that complies with the
Y
N
39A.
1
applicable requirements of 119.
❑
❑ J
§133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo
Y
N
NA
-control,-or an -outdoor astronomicaltimeswitch, that comply -with -the -a licable requirements -of-- 119.. - -
- ---❑
--❑- -
2
Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during
Y
N
da li hibours.
❑
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce
Y
N
N
si power b a minimum of 65 percent duringnighttime hours.
❑
❑
-
Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours.
Y
11
NA
3
Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during
Y
N
da li t hours.
❑
Exception 3 to §133(a)3. Only metal halide, bigh pressure sodium; cold cathode, or neon lamps used for
Y
N
illuminatin signs or arts of signs.
❑
§133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than
Y
N
Nt
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 b the local utility.
Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including
Y
N
but not limited to exit signs and traffic si
Cl
Field Inspector Notes:
2008 Nonresidential Compliance Forotr October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEGSLTG-1C(Revlsed 10110) CALIFORNIA ENERGY COMMISSION 1+$'ri!•
Certificate of Compliance (Sign Lighting) (Page 3 of 4) SLTG-IC
Project Name: ��, /�)�Date:
C-1(Gj-"' - //// /('
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
f this Certificate of Compliance if there are signs using the Specific lie t nIg sources method of compliance)
A
B
C
D
E
F
G
H
I
Q
Allowed
Watts
Design
Complies?
-
w
-
Watts
Y/N
.
3
`
w
Field
_
VI
inspector
v
o
G ..
a
a
w
3
x
Check tliat
Sign:
a
w a
m
-ai G
o
3 N
x
°�' Q
i
Complies
01
O a
a+
O
U
Description
✓
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 signon 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 (IIL) or other Product Certification Body accredited to ISOAEC 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
-
method to validate compliance. An ENERGY VERIFIED label is not needed for compliance.
D
The sign area iu 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
Multi 1y the square footage in column D times the allowed Lighting Power Density (LPD —walls) in column F.
II
Show the total installed watts in the sign, as determined according to the applicable previsions of §130(d or 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: -
2008 Nonresidential Compliance Forms ' October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING tr
CECSLTG-1C(Revised 10110) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 4 of 4 SLTG-IC
ProjectName:
Date:
5. Specific Lighting Source Method of Compliance 7
r
Certificate of Compliance and Field.Inspection Energy Checklist Ill
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Cerocate of Compliance if there are signs using the maximum allowed litinn ower method of compliance)
A
B
C
D
OPTIONAL
'Field
ENERGY
Specific light source used for
Inspector
Symbol
VERIFIED
compliance
.
Check that
or
Description
label
Shall include only lighting
Sign
Code
(see instractiuns
below)
technologies listed below
Com hes ;
List all that apply
❑
o
❑
-o
A
Symbol or code used on the plans (when plans are required) and other documents.
B
A narrative description of the sign, or location of sign on the 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 t(tat
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/JEC Guide 65 by the American National Standards
Institute in accordance with ISOIIEC 1701L Surveillance by the Accredited Certification Body shall be an ongoing annual inspection
program carried out by a Type 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 sigu(s) identified above use only the following lighting technologies:
- -
-List a -I & linable nunnbcrs(l the h 10)-thrat a 1-tn-�otumif D above foi ea�li-row: - -- - — - - - - -- -
1
High pressure sodium lamps
2
Pulse start or ceramic metal halide lams served by a ballast with > 88% efficient
Pulse start metal halide lamps that are 5 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast
3
with> 80% efficiency
4
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 (CR) of 80
6
(Note: when using electronic ballasts for compliance, lamps with a CRI < 80 may 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
Com act fluorescent lams that do not contain a medium screw base sockets (E24/E26)
10
Electronic ballasts with a fundamental output frequency > 20 kHz
E
i This page doubles as afield ins ecfion checklist.
Field Inspector Notes:
2008 Nonresidential Cmnpllarrce Torras October 2010