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B-2016-1991CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1991 10619 S DE ANZA BLVD CUPERTINO, CA 95014-4431 (359 18 044) AD & C DESIGN INC FREMONT, CA 94539 OWNER'S NAME: IRAN XUONG PHUC TRUSTEE & ET AL DATE ISSUED: 05/20/2016 OWNER'S PHONE: PHONE NO: (510) 625-9566 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-45 Lic. #929828 Contractor AD & C DESIGN INC Date 11/30/2017 X BLDG —ELECT _ PLUMB MECH RESIDENTIAL X COMMERCIAL 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: (1) ILLUMINATED WALL MOUNTED SIGN - XIANGXIANG NOODLE I hereby affirm under penalty of perjury one of the following'two declarations: z. 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. - zi 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 Sq. Ft Floor Area: Valuation: $2800.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 359 18 044 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature. \ Date' –�� (6 Issued by: Phuong Devries Date: 05/20/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: • following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 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 compensation, will do the work, and the structure is not intended or offered for inspection. sale (Scc.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. I 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 permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 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, Sections 25505, 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: certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a 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 and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date Professional CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinga-cupertino.org 16--IggI PROJECT ADDRESS ay � IG / ;:EN t9 ` �[ �s TJ'7Y-A 12q OWNER NAME PHONE E-MAII STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL J STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT C1CONIRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 'i 2YgCOMPANY LICENSE TYPE— , BUS. LIC # NAME`9 Ga E-MAIL FAX STREET ADDRESS�' CITY, STATE, ZIP PHO ARCHITECT/ENGINEER NAME�� y �� G r L LICENSE NUMBER p it' I a BUS. LIC # COMPANY NAME /� A _ og �t - �E-MAIL FAX — STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION ^►OFWORK USE OF ❑ SFD or Duplex ❑ Multi -Family ILLUMINATED SIGN TYPE NO. OF SIGN AREA VALUATION STRUCTURE: COmnlerClal (Y/N) (CO,DEE) SIGNS (SQ. FT-) ($) 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 RCEj�El a.x'' TOTAL VALUATION: : By my signature below, I certify to each of the following: I am the property owner o au t to act on the property owner's behalf. I ave read this Jktd, application and the information I have provided is correct. I have read the Description of rift' it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authori�representatives of Center the above -identified property for 'C pection purposes, �"— Signature of Applicant/Agent: VDate: SUPPLEMENTAL INFORMATION REQUIRED jx j=,a Site Plan _ Elevations CESSp r I ❑ BUII READ _ 1. 2 REVTEW Sign Details - including UL listing(s) applicable ❑ sTAxnnRD r � , P a v`G PiAxREv�w , Structural Calculations (if applicable) D Li'AJtGE� �,� D oT>Ii a� Copy of Planning Approval Letter or Meeting with Planning prior to intIT niaaoR — submittal of Building Permit application. r3 t Signflpp_2011.doc revised 03/16/11 STATE OF CALIFORNIA SIGN LIGHTING !.Gl. 1.— 1 TC — ercea.A— I aMA\ rAI wnpmla FAIFRr:V rnMRA1QCInM CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Name: - Date Prepared: Project Address: Location of Sign Mautdoor Signs ❑ Indoor Signs Phase of Sign Construction New Signs ;®.Sign Alterations Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls Not Installing Lighting Controls TgP Certificate of Compliance includes the following components (check all that apply) Wandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power 0 Specific Lighting Sources 1. Mandatory Sign Lighting Controls NOTES: I. 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; alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement for the. entire construction. la. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E shall complete Part la. Check Yes or No for all of the following statements: 1 I have responsibility for installing the sign lighting controls O Yes, complete parts la and lb of this form E: No, complete part 1a of this form 2 There -are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑ Yes allo There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls 3 (§-Yes ❑ No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and 1 will be 4 installing compliant sign lighting controls ❑ Yes [�,No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and someone 5 else will be responsible to install compliant sign lighting controls 0 Yes I_No �rt CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E(Rev4sed 06/14) CALIFORMA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of S) Project Name; - _�. Date Prepared: lb. 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. ❑ ❑ §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. a 1 ❑ ❑ 2 EXCEPTION to Section 130.3(a)2A: Outdoor signs in tunnels, and signs in large permanently covered outdoor y NA areas that are intended to be continuously lit, 24 hours per day and 365 days per year. ❑ I1. §130.3(a)26. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides the ability to automatically reduce sign lighting power by a minimum of 65 percent during nighttime hours. Y N NA Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ ❑ 3 day and night. EXCEPTION to Section 130.3(a)26: 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 ❑ ❑ E� 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 f�A ordinance, or regulation to be reduced by 30 percent. ❑ Field Inspector Notes: CA Building Energy Efficiency Standards;. 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING 'EC-NRCC-LTS-01-E(Revised 06114) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) Prosed Name: - Date Prepared: �-15 ->b. 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 1 J Symbol Or Code Description of the Sign OPTIONAL—Energy Verified Label (see Instructions below) Allotted Watts Design Watts Complies YEN Filed Inspector Check that sign complies ry C Q` fto in O w =>Y c C > c t++ O $ 3 r -i cmv Q= 'r (U Q Cvi tip F at o L ❑ A Z. vJ 11❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑, ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label, columns 'D'through'I' are not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method,to validate compliance. An ENERGY VERIFIED label is not needed for compliance. D The sign area in square feet. E List "I" if the sign is internally illuminated. List "E" if the sign is externally illuminated. F Allowed watts per square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2.3 if sign is listed as "E" in column E. G Multiply the square footage in column D times the allowed Lighting Power Density (LPD = watts) in column F. H Show the total installed watts in the sign, as determined according to the applicable provisions of §130(c). I Enter Y if the number in column H is less than or equal to the number in column G. Otherwise, the sign does not comply. J This page doubles as a field ins ection 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 06114 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 4 of 5) Project Name: Date Prepared: 3. Specific Lighting Source Met od 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 Com liance if there are signs using the maximum allowed lighting power method of compliance) A B C ® _ . 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 ❑ n ❑ ❑. ❑T ❑; 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 'F 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 150/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 wattor 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 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 powerless than or equal to 2S0 watts,, shall comply with the applicable requirements of the Appliance Efficiency Regulations (Title 20). . 9 Compact fluorescent lamps that do not contain a medium screw base sockets{E24/E26). E This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 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: .. Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: ��- Documentation Author Signature: v �� Company: Signature Date: b Address: 4ti✓tom CEA/ HERS Certification Identification (if a plicable):CT City/State/Zip: f y • V�� �Phone: (-o— , 3 ( 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. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: v V v Responsible Designer Signature: f �� Company: /cY (7Q� ! JS Date Signed: Address: � n C A--- (� c � Ucense: City/State/Zip: Phone: o q CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 6" HIGH ILLUMINATED LED CHANNEL LETTER FOR " XIANGXIANG NOODLE" 26" COLOR & MATERIALS ftf 't k 1)SIGNFACE--WHTTRANSLUCENT ACRYLIC SHEET WVINYL Gla" 2)LETTER BODY --4" DEEP PAINTED INTO BLACK ALL LE CAP—TERS3l4"SILVER flu IN ALL LETTERS ARE UL LISTED 17.5" LED:10.5 FOOT LAMBERT. I ING NOODLE 111.5" 48.8' R TGA �i =-zNT t., d j4 - C L ROVED on, Itis unia EXISTED, $�I -� alterations on Sam without approval from the The Stamping of this plan and specifica be held to permit er to be an approva of Y.8' p nisi s o rty City Crdinan( 48.8' _ � C 7 k: � 3 J�1977M�. PEGGED OUT FROM BLDG. SILICONE SEALED :DERT)NO TRANSLUCENT PLEX FACE ► —+ ST be kep�46WCREWS ✓ful to mdk , 'Y ER) luildin g Official. )ns SHALL Ni q of the violatiOQr�AP � 4/44'' DRAIN HOLE tate Law. PROPOS I nFICE COP"' y�wt. SCALE: 1"=18-i/3", Sign size: (105Me64')1144=46.6SQFT - BLDG. WALL( BRICK ) #10X1' SELF DRIVE SCREW SECURED LETTERS ON METALBAR SPLICE CONNECTORS POWER SUPPLY I ENCLOSURE IN 112° MC DISCONNECT $WITCH TRANSFORMER CLASS 2 POWER SUPPLY GROUNDING WIRE AW 14) FROM TERMINAL LUG (PAINT GREEN) TONCLOSURE LED LETTER SECTION New Sign "E� R 1 0 y't CODE PLOT PLANS CHECKED BY �At DATE PLANNING DEPT CUPERTINO PROJECT APPLICANT name: ad&c design Inc. address: 2060 Warm Springs CT#4 Fremont .CA 94539 phone: 510-625-9566 contact person: Ana m�nb-: r 929828 m date_ 5-19-2016 BUSINESS OWNER ' nlocation address: 10619 S De Anaa Blvd, Cupertino, CA 05014 Contact: Mrchang Phone: 415-610-9386 Company: X1 ngXiang Noodle date: 5-19-2016 APPROVAL BY PROPERTY OWNER address: phone: signature: date: NO ment OMPLIANCE Customer Signature and Date: This rendering Is computer generated. Drawings are to scale using acetal colors but Images rosy appear slightlydaktent On you! monitor m printer depending on the model. We have made every afrort to make this to your specirkatlons, but please take a moment and make sure we have It night. This b an an proof that Is designed to meat the approval of the customer, Once approval Is granted we are no longer liable nor typographical and/or design layout errors. please do not give approval until it meets your requiroments. You Will be held hnmclally responsible lot this order when we recelue your approval. TNODIIION DFIONW fO TNI ADA(DISION IN(. AMO II/10aAQIfeTYOFtis!(USTONFa OtNtY yl)1DF'ON f ON W 110N OF AN OA D F a.