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B-2016-1659 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1659 10475 S DE ANZA BLVD CUPERTINO,CA 95014-3011(359 17 019) SUCCESS GRAPHIC SIGNS SAN JOSE,CA 95132 OWNER'S NAME: BDC HAYWARD LP DATE ISSUED:03/30/2016 OWNER'S PHONE:925-588-2237 PHONE NO:(408)667-1777 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ELECTRICAL SIGNS Lie.#896458 Contractor SUCCESS GRAPHIC SIGNS Date 05/31/2017 X BLDG _ELECT —PLUMB MECH RESIDENTIAL X COMMERCIAL 1 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. JOB DESCRIPTION: ACUPUNCTURE I(N)ILLUMINATED WALL SIGN 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 kzCompensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 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. Sq.Ft Floor Area: Valuation:$2000.00 APPLICANT CERTIFICATION 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 59 Number: Occupancy Type: 3 and state laws relating to building construction,and hereby authorize 359 17 019 A(Tenant Improvements) representatives of this city to enter upon the above mentioned property for I inspection purposes, (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said m� nsequence of the granting of this permit. Additionally,the app/' nt under tands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulatio per the C�ertino^Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. i;Signature_ — Date 3/30/2016 Issued by:ABBY AYENDE Ca r Date:3/30/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF-ROOFS: i following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is i. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for inspection. 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 Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: / 03 3 /2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 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. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. 1 certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 5 5,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. owner or authorized agent: APPLICANT CERTIFICATION Date:3/301201 I certifythat I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is correct.I agree to comply with all city and county ordinances and state laws i construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shalt be used as public records. Code,Section 9.18. Licensed Signature Date 3/30/2016 Professional i SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 0UPERTIN (408)777-3228• FAX(408)777-3333•buildinaQcupertino.orgCO t�QS"1 PROJECT ADDRESS { "T� ;u APN# OWNER NAME v PHONE �r� E-MAIL STREET ADDRESS �,. r f� Cr*, STATE,ZIP j jy +- r AX CONTACT NAME (/ PHONE (/ E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑. DEVELOPER ❑TENANT I CONTRACTOR NANM LICENSE NUMBER f� �i G LICENSE TYPE US.LIC# COMPANY NAME E-MAIL © L� FAX "� 4 �q STREET ADDRESS fI CITY,STATE,ZIP �q�.Y � ,�!p�y"�r- �//►_ PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE I DESCRIPTION OF WORK 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: - 1 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 00 0 LREGEI DBY 11 VWIA TlVALUATION: By my signature below,I certify to each of the following: e proue6 owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is col I have rea b,Description of Work and verify it is accurate. I agree to comp with all appl' able local ordinances and state laws relating to building c ction. I authorize re re entatives of Cupe o to enter the above-ide d prop, f�sp cti pure ses. S i gnature of App]icant/Agent: Date: C SUPPLEMENTAL INFORMA REQUIRED zoFl i ^TIs�oNlA _ � Site Plan PLAN cHECI�GYPE� RouTm sLIP a� „: Elevations - ` �BUILDING��"AN.RE � Sign Details-including UL listing(s)applicable ❑ sz�NnnRb rLArrNatGLA�REVS1wL Structural Calculations(if applicable) ❑ tGE zb oTix k Copy of Planning Approval Letter or Meeting with Planning prior to ❑ NL4�o i submittal of Building Permit application. - - Sigm4pp_2011.doc revised 03/16/11 I SIM; UGHTING CALIFORNIA ENERGY COMMISSION CEC-NkCC-LTS-01-E Revised 05/15) NRCC-LTS-01-E CERTIFICATE OF COMPLIANCE [� q`(Page 1 of 5) Sign Lighting_ .. Acupuncture - _ - - Date Prepared:.. Q3-29_16... Project Ramei- Acu uncture : rA. General Information ect Address:tion of Sign l4 Outdoor Signs 0 Indoor Signs Phase of Sign Construction P New Signs ( Sign Alterations pe of Lighting Control ❑New Lighting Controls Replaced Lighting.Controls 0 Not Installing Lighting Controls Ty This Certificate of Compliance includes the following components(check all that apply) Mandatory Measures(Lighting Controls) p Maximum Allowed Lighting Power ❑Specific Lighting Sources 1. Mandatory Sign Lighting Controls j NOTES: 1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible j 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. 1a. 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: I have responsibility for installing the sign lighting controls 1 ❑Yes,complete parts 1a and 1b of this.form [X No,complete part 1a of this form There are no existing sign lighting controls and I will be installing compliant sign lighting controls 2 ❑Yes J0 No There are no existing sign lighting controls and someone else will be responsible to install compliant sign ligh 'ng controls 3 Q Yes M 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 ins In ompliant sign lighting controls es There ar xisting signlighting controls that do not comply with the applicable provision of§110.9 and§130.3 and someone I I be responsible to install compliant sign lighting controls 0 Yes IX No PY t L ('"OFFICE CUAYId III! h i May 2015 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance SiPN UGHTiNG CALIFORNIA ENERGY COMMISSION CEC-NRCC-LTS-01-E Revised 05/15 NRCC-LTS-01-E CERTIFICATE OF COMPLIANCE (Page 2 of 5) Sign Lighting Project Name: Acu uncture Date Prepared: 03_29-16 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- N❑ NA 1 switch control. §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- YY N❑ N 2 switch control,or an astronomical time-switch control. EXCEPTION to Section 130.3(a)2A:Outdoor signs in tunnels,and signs in large permanently covered outdoor Y❑ NSA 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 3 Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ ❑ 0 day and night. EXCEPTION to Section 130.3(a)2B:Outdoor signs in tunnels and large covered areas that are intended to be Y❑ NSA 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 ❑ ❑ M 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 NA ordinance,or regulation to'be reduced by 30 percent. I Field'Inspector Notes: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 STATE OF CALI�PRNIA SIGN LIGHTING CALIFORNIA ENERGY COMMISSION CEC-NRCC-LTS-01-E Revised 05/15 - - NRCC-LTS-01-E CERTIFICATE OF COMPLIANCE ' (Page 3 of 5) Sign Lighting - Date Prepared: 03_29_16 Project Name: Acupuncture 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) C p E F G R I 1. Filed Symbol OPTIONAL—Energy Design Complies Inspector or Description of the Sign Verified Label(see Allotted Watts Watts Y/N Check that Code instructions below) sign complies VI N Q W �.NN V•y y Y• . N T C X C. Yom-• N C L 3 o-1 N. n — A c +� l u o o m N w = ¢ a 3 0 v INTERNALLY CHANNEL LETTER (]: 12 1 12 14.4 60 ❑ 0 El ❑ J 0 o 13 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. 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 C 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 1 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: rn ru fli ling Fnerev Efficiencv Standards-2013 Nonresidential Comoliance Mav 2015 I SIGN LIGHTING GEC-NRCC-LTS701-E Revised 05/15 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE I (Pag T4 of 5) Sign Lighting. (Page 4 of 5) Project Name: Date Prepared: 03-2916 Acupuncture 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. 13 C Q OPTIONAL Specific light source used for 3 Symbol ENERGY VERIFIED compliance lei to label Shall include only lighting or Description Code(see instructions technologies listed below below) List all that apply ;<<F INTERNALLY CHANNEL LETTER y x 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 3 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 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 I 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): gThisompact fluorescent lamps that do not contain a medium screw base sockets(E24/E26). age doublesasa field inspection checklist. ector Notes; CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 SIGN LIGHTING CEC NRCC-LTS-01-E Revised 05/15 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 5 of 5) Project Name: Acupuncture uncture Date Prepared: 03-29-16 G. DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Company: 1 Signature Date: Addres . CEA Certification Identification(if applicable): City/State/Zips J �- Phone: RESPONSIBLE PERSON'S DECO RATION 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 signedcopy of this Certificate of Compliance shall be made ayag, ble with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections.I de tand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the buil r pr vides to the building owner at occupancy. Responsible Designer Name: SEAN WU Responsible De i ner atur - i Company: SUCCESS GRAPHIC SIGNS Date Signed: 03-2 W6 Address: 1744 QUEENS CROSSING DRIVE License; 896458 City/State/Zip: SAN JOSE CA 95132 Phone: 408.667.1777 i CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 C i N -o R m Q I V1 I V CL CN LO � Q 1 G co 9) co o rn � o z, o U � j y CO ami ai c 0 i i .r y �+ —23.03 ien OL ao V y WOE .-..V's, <'zi IA cis d LAI' ori o n 1 9%- rn m• 9 ► N ",CA • v low � J N V � O • N • fD y m o 3 `� � 3x D oNi Fcp3 �' • to 0. j � C N � W o c n < co �_ m '• j r r cn A 5. Q fD �• Dm N cD W 0 3 n (� COD rD d .Z7 T -L ID) co � D T a 0 r O B k ac A m m v 3 oc =r � m - r nF �cy '0c Ll • 330 " 0� C — -- A n. C Z (D A n O 3. 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