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B-2016-2155 A CITY OFCUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2155 10310 S DE ANZA BLVD CUPERTINO,CA 95014(369 55 081) ACTIVE SIGN CO SAN JOSE,CA 95133 OWNER'S NAME: CIVIC PARK CUPERTINO LLC DATE ISSUED:06/16/2016 OWNER'S PHONE:408-781-2155 PHONE NO:(408)484-1091 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-45 Lic.#622021 Contractor ACTIVE SIGN CO Date 01/31/2017 XBLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapte 9(commencing MECH RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Co a and that my license is in full force and effect. JOB DESCRIPTION: INSTALL(I)ILLUMINATED SIGN-ARMANG TOFU BBQ I hereby affirm under penalty of perjury one of the following two eclarations: 1. I have and will maintain a certificate of consent to self-ins a for Worker's Compensation,as provided for by Section 3700 of the Lab r Code,for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insuranc ,as provided for by Section 3700 of the Labor Code,for the performance of th work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the abov information is correct.I agree to comply with all city and county rdinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby auth�rize 369 55 081 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep hrmless the City of Cupertino against liabilities,judgments,costs,and expen es which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of is permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all nbn-point source regulations per the Cupertino Municipal Code,Section 9. 8. 180 DAYS FROM LAST C L CTION. Signature Date Issued by:Alex Vallelunea Date:06/16/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License La 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 t. I,as owner of the property,or my employees with wages as eir 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 inte ded or offered for inspection. sale(Sec.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with icensed Signature ofApplicant: contractors to construct the project(Sec.7044,Business&P Iofessions Code). Date:6/16/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t. I have and will maintain a Certificate of Consent to self-insa 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. I have and will maintain Worker's Compensation Insurance, s 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 ork 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 3. I certify that in the performance of the work for which this peit 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 bject 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 's certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation p ovisions 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:6/16/2016 I certify that I have read this application and state that the above information isCONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and g�tate laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representati�res 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 purpos9s. (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 Ci y in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply witliiall non-point source regulations per the Cupeino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/16/2016 Professional P SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTIN© (408)777-3228• FAX(408)777-3333•build ingCd)cupertino.org PROJECT ADDRESS , r o 0 (t I APN# OWNERNAME C, ,,/J^n�f`^ PHONE _ I' E-MAIL �/{�/ Ov/2?/p/ �Vn� STREET ADDRESS V I I C� IW1 I/1C/�� CITY,STATE,ZIP r J(FAX `'� CONTACT NAME �M�_ PHONE E-MAIL C44— STREET ADDRESS A Y STATE, IP p�'AX El OWNER ❑ OWNER-BUILDER El OWNER AGENT CONTRACTOR El CONTRACTOR AGENT S❑ ARCHITECT El ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME KENS NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME ^ ,�, E-MAIL J FAX STREET ADDRESS I, CITY,STATE,ZIP ^ PHONE II 2 6 ARCHITECT/ENGINEER NAME iICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK T=16 USE OF ❑ SFD or Duplex ❑ Multi-Family I ILLUMINATED SIGN TYPE NO.OF AREA VALUATION STRUCTURE: ❑ Commercial (Y/N) (CODE) SIGNS (SQ.Fr.) (S) SIGN TYPE CODES: I � O B - BANNER SIGN M - MONUMENT(GROUND)SIG 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 RECEIVED BY: TOTALMI ON: By my signature below,I certify to each of the following: I am the pjoperty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is cone I have rea the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons cti I authorizrepresentatives of Cupertino to enter thea ve- fie )rolperty Pr inspection purposes. Signature of Applicant/Agent: - Date: !� SUPPLEMENTAL INFORMATION REQUIR�D OFFICE USE ONLY Site Plan PLAN CHECK TYPE ROUTING SLIP Elevations OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Sign Details-including UL listing(s)applicable ❑ EXPRESS ❑ PLANNING PLAN REVIEW Structural Calculations(if applicable) ❑ STANDARD ❑ OTHER: _Copy of Planning Approval Letter or Meeting with Planni g prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR SignApp_2011.doc revised 03/31/11 I i I D&T SIGN PROJECT/LOCATION: DATE: 05/05/2016 JOB NUMBER: ❑ Art ❑ Plex/Asm. D &T San se,C Park Dr. San Jose,CA 95136 Afirang SALES PERSON:TOMMY YOON DRAWING NUMBER: � Vinyl ❑ Paint Office:408.781.8602 signI Fax:408.484.1091 TOFU & BBQ PROJECT MANAGER:TOMMY YOON SHEET NUMBER: 11 Elect. ❑ Install E-mail: tyoon123@gmail.com 10310 S De Anza Blvd DRAW BY: LENA KWEON SCALE: NTS Non Elect. Shp./Rec. ./Rec. I Signs&Graphics Cupertino,CA 95014 a ❑ P ALL RIGHTS RESERVED.This is an original unpublished piece of artwork generated by D&T Designs Ture Signs&Graphics.It is not to be shown to anyone outside your organization,not is to be used,reproduced,copied or exhibited in any fashion without written authorization from D&T Designs. SIj,'U L NG D1VI'ON-CUPERT NO ENT AppVED t at the c sciiications ,9tlST be kept This Get of plans and..p v is ur job site duringrCot'alt mations ontsamElaorito JevA P lAN CHECKED `�`tchange 'cling c=' LP therefrom,v�ithout approval from ti e�caf ®,,,,,141�s SECEIVEl kation 3 RIRA I\T ®ATEin of this plan s r •SPMThe stamp g or toanor)Val of :he behcidtopgr it Or ',iancearSGPLANNING DEPT JUN 1 6 ?0`!5 of any prow iso ' y CUPERTINO ITOFU - - 0 � 13Y =-_- ---a=------------------ - DATE O�C�' i �� PERMIT NO. 71-1/8" -a� 157-3/8 3O // Y 1s F3' Sign ! R 209- Proposal View. * ® E L F h �`IEWEi� FOR C,�:`7(" IaOivipl_lArIGE EVERSE CHANNEL REviev�bdBy' � s1 ,� rN RED COLOR - OXTO CONTACTOR BY 10°BOLTS&NUTS NLESS BRACERS TOFU :: • : N./LETTER) CLASS POWERSUPPLYW/ DISCONNECT SWITCH Return will be Painted Blue— uuoo A 9 12 VOLTS WHITELE.D. ouoo LIGHT MODULES ���� UL Sticker Located Top of Letters *Sign Controlled by Timer Interior of Letter to be Painted White White LED No Visible Fasteners No Weep Holes No Light Leaks This design is the layout we will use in producing your signs per your instructions. LANDLORD APPROVAL: CLIENT APPROVAL: PLEASE CHECK IT CAREFULLY!Mark any changes or revisions dearly on the layout.We furnish art for a II----11 one-time set up charge.Your design will be kept in a permanent file.In the event you need more signs,you will not u Art approved as E] Art NOT approved-note changes. Art approved as I--1u Art NOT approved-note changes. incur another set up charge,if you use the original design.Whereupon you purchase signs elsewhere or elect not to purchase signs,we will bill you for an amount not to exceed the amount of the set up charge. Signature: Date: Signature: Date: Please note:D&T Design Signs&Graphics Solutions retains copyright of this art. *Your signature is required before we can begin production. D&T SIGNO PR JECT/LOCATION: DATE: 04/18/2016 JOB NUMBER: ❑Art ❑ Plex/Asm. - . - D &T San Josese,,CA 951366 Arirang ❑ Pa3580 Park SALES PERSON:TOMMY DRAWING NUMBER: Vinyl int C Office:408.781.8602 signFax:408.484.1091 TOFU • BBQ PROJECT MANAGER:TOMMY YOON SHEET NUMBER: Elect. Install J E-mail: tyoonl23@gmail.com 10310 S De Anza Blvd DRAW BY. LENA KWEON SCALE: NTS Non Elect. Shp./Rec. Rec. Signs&Graphics Cupertino,CA 95014 ❑ ❑ p•/ ALL RIGHTS RESERVED.This is an original unpublished piece of artwork generated by D&T Designs Ture Signs&Graphics.It is not to be shown to anyone outside your organization,not is to be used,reproduced,copied or exhibited in any fashion without written authorization from D&T Designs. Sign 2. 18" i 1 128-3/4" 12'-6" Proposal View. , - - - - - - - ---- i` f 8;illdingg Dz_,F.,�rt Bent JUN 201-5 C;a..`.aE Gt?f'viPLIANi,E 1 i=re ;ewed [3y This design is the layout we will use in producing your signs per your instructions. LANDLORD APPROVAL: CLIENT APPROVAL: PLEASE CHECK IT CAREFULLY!Mark any changes or revisions dearly on the layout.We furnish art for a one-time set up charge.Your design will be kept in a permanent file.In the event you need more signs,you will not E] Art approved as Art NOT approved-note changes. E] Art approved as Art NOT approved-note changes. incur another set up charge,if you use the original design.Whereupon you purchase signs elsewhere or elect not to purchase signs,we will bill you for an amount not to exceed the amount of the set up charge. Signature: Date: Signature: Date: Please note:D&T Design Signs&Graphics Solutions retains copyright of this art. *Your signature is required before we can begin production. D&T SIGN PROJECT/LOCATION: DATE: 04/18/2016 JOB NUMBER: ❑ Art ❑ Plex/Asm. D &T S Office: se,C Park Dr. SALES PERSON:TOMMY DRAWING NUMBER: ❑ Vinyl Paint San Jose,CA 95136 Arirang fice:408.781.8602 sign Fax:408.484.1091 TOFU & BBQ PROJECT MANAGER:TOMMY YOON SHEET NUMBER: E] Elect. Install E-mail: tyoon123@gmail.com 10310 S De Anza Blvd DRAW BY: LENA KWEON SCALE: NTS 5 Signs&Graphics Cupertino,CA 95014 ❑ Non Elect. ❑ Shp./Rec. ALL RIGHTS RESERVED.This is an original unpublished piece of artwork generated by D&T Designs Ture Signs&Graphics.Itis not to be shown to anyone outside your organization,not is to be used,reproduced,copied or exhibited in any fashion without written authorization from D&T Designs. Sign 2. r-(4)W 7hru­Bolts I%"Space r -8'- 15018'iJd Strut-- t2' _-•4*xF9 J8•AMrnkrum Plate Welded M Back Plata 30 � r rir.0--t/2"ihru•Bans , - - 4/4•Thru-Botts w/Spacers 318' • -- AIMMUM Ptak (q Per Letter) t 318'Alum.GusSetts =2' r ,-Machine Bolt to Rec. • rubes � r r --3V 7hru-Boss(4) ej --- -----Wr Aluminum Plate Alum.Reverse- -• r �r Qo QI Bolts Per Plate - Channel Letters ` k -e----Cut-off ftdch r (8)Total i-ft2'x3 P Alum Gussetts(v ill* Top Ulew r r --W 7hru-Bolts r ~2• LED Modules 2* Backs- - - -While.Lexan Backs- - -- Rectangular Tube Supports r = • r —=28 Wath-= _rt r -42 VOC Power Supply i r g Push Thar- - @120V FronlView :,� re 47c4'x3J8=-� - Characters SideYew plum plate 4" Top View ---.Wall (Welded)v�. -----------------------Steel FramaUpports-Painted Black END VIEW i .- Y------------------Sign Backer Cabinet ` - - - --- - s , , -- • e- --- O 45k4`083- _ —�' Push Thru Acrylic Characters-------- ,' ;a___- ---------Reverse Channel Letters Alton.Plate 4" (Welded) . , ,' `� `% % '� , a a ` ------Brackets(see Above) r --------------------------------••-•--------------.....-]v'_Jw---------------------------------------------------•- REVIEWED FOR %:;DE G" iyiE i_lfi%rG _ Reviewed By Over-Head View of Sign A This design is the layout we will use in producing your signs per your instructions. LANDLORD APPROVAL: CLIENT APPROVAL: PLEASE CHECK IT CAREFULLY!Mark any changes or revisions clearly on the layout.We furnish art for a one-time set up charge.Your design will be kept in a permanent file.In the event you need more signs,you will not ❑ Art approved as Art NOT approved-note changes. ❑ Art approved as ❑ Art NOT approved-note changes. incur another set up charge,if you use the original design.Whereupon you purchase signs elsewhere or elect not to purchase signs,we will bill you for an amount not to exceed the amount of the set up charge. Signature: Date: Signature: Date: Please note:D&T Design Signs&Graphics Solutions retains copyright of this art. *Your signature is required before we can begin production. D&T SIGN PROJECT/LOCATION: DATE: 04/18/2016 JOB NUMBER: ❑ Art ❑ Plex/Asm. D &T San se,C Park Dr. San Jose,CA 95136 Afirang SALES PERSON:TOMMY YOON DRAWING NUMBER: �] Vinyl El Paint Office:408.781.8602 Fax:408.484.1091 TOFU & esQ PROJECT MANAGER:TOMMY YOON SHEET NUMBER: Elect. ❑ Install 10�� gn E-mail: tyoonl23@gmail.com 10310 S De Anza Blvd DRAW BY: LENA KWEON SCALE: NTS Signs&Graphic Cupertino,CA 95014 ❑ Non Elect. ❑ Shp./Rec. ALL RIGHTS RESERVED.This is an original unpublished piece of artwork generated by D&T Designs Ture Signs&Graphics.It is not to be shown to anyone outside your organization,not is to be used,reproduced,copied or exhibited in any fashion without written authorization from D&T Designs. i Blade Sign. Proposal-View. 30" TO =:• TOFU 30" This design is the layout we will use in producing your signs per your instructions. LANDLORD APPROVAL: CLIENT APPROVAL: PLEASE CHECK IT CAREFULLY!Mark any changes or revisions dearly on the layout.We furnish art for a one-time set up charge.Your design will be kept in a permanent file.In the event you need more signs,you will not ❑ Art approved as ❑ Art NOT approved-note changes. ❑ Art approved as ❑ Art NOT approved-note changes. incur another set up charge,if you use the original design.Whereupon you purchase signs elsewhere or elect not to purchase signs,we will bill you for an amount not to exceed the amount of the set up charge. Signature: Date: Signature: Date: Please note:D&T Design Signs&Graphics Solutions retains copyright of this art. *Your signature is required before we can begin production. D&T SIGN PROJECT/LOCATION: DATE: 04/18/2016 JOB NUMBER: ❑ Art Plex/Am. 3580 Chater Park Dr. ❑ s D &T ffi San Jose,CA 95136 ArirangSALES PERSON:TOMMY YOON DRAWING NUMBER: ElVinyl ❑ Paint Oce: 408.781.8602 Fax:408.484.1091 TOFU & BBQ PROJECT MANAGER:TOMMY YOON SHEET NUMBER: E] Elect. ❑ Install S gnE-mail: tyoonl23@gmail.com 10310 S De Anza Blvd DRAW BY. LENA KWEON SCALE: NTS Signs&Graphics Cupertino,CA 95014 ❑ Non Elect. ❑ Shp./Rec. ALL RIGHTS RESERVED.This is an original unpublished piece of artwork generated by D&T Designs Ture Signs&Graphics.It is not to be shown to anyone outside your organization,not is to be used,reproduced,copied or exhibited in any fashion without written authorization from D&T Designs. Blade Sign. 8ff 3'-6„ LIGHT BRACKET -- SIGN 2'-10" - � rose •- r " 2-6 TOFUBBQ 8'-6/1 21-6" f �� i B REVIEWED FOR C'r.)E i.WIPL.IANCE Reviewed By: This design is the layout we will use in producing your signs per your instructions. LANDLORD APPROVAL: CLIENT APPROVAL: PLEASE CHECK IT CAREFULLY!Mark any changes or revisions clearly on the layout.We furnish art for a one-time set up charge.Your design will be kept in a permanent file.In the event you need more signs,you will not ❑ Art approved as ❑ Art NOT approved-note changes. El-Art approved as Art NOT approved-note changes. incur another set up charge,if you use the original design.Whereupon you purchase signs elsewhere or elect not to purchase signs,we will bill you for an amount not to exceed the amount of the set up charge. Signature: Date: Signature: Date: Please note:D&T Design Signs&Graphics Solutions retains copyright of this art. *Your signature is required before we can begin production. D&T SIGN PROJECT/LOCATION: DATE: 04/18/2016 JOB NUMBER: ❑ Art ❑ Plex/Asm. D &T 3580 Chater Park Dr. San Jose,CA 95136 SALES PERSON:TOMMY YOON DRAWING NUMBER: DVinyl El Paint Office: 408.781.8602 Afirang . Fax:408.484.1091 TOFU F u & BBQ Q PRO ECT MANAGER:TOMMY YOON SHEET NUMBER: Elect. ❑ Install10��sI E-mail: tyoon123@i)gmai1.com 10310 S De Anza Blvd DRAW BY: LENA KWEON SCALE: NTS Non Elect. Sh Rec. Signs&Graphics Cupertino,CA 95014 ❑ ❑ p•/ ALL RIGHTS RESERVED.This is an original unpublished piece of artwork generated by D&T Designs Ture Signs&Graphics.It is not to be shown to anyone outside your organization,not is to be used,reproduced,copied or exhibited in any fashion without written authorization from D&T Designs. Site map. Rodrigues Ave o ngues Ave Cn v o m 'm N a Town Center n ;,�,o,� Town Center Ln - v _- - O N Q j'AG°aECMFlFm - ` Civic ParK Ln e - E � io a ID rn CD v _.. N ' d p y . g Pacifica Dr E i I . i .,� - �, Pacifica Dr h�����ELr , t,i� i�_�,I� �.;°)iy„ yi-M�•`f `- ReviewedBy .m► This design is the layout we will use in producing your signs per your instructions. LANDLORD APPROVAL: CLIENT APPROVAL: PLEASE CHECK IT CAREFULLY!Mark any changes or revisions dearly on the layout.We furnish art for a one-time set up charge.Your design will be kept in a permanent file.In the event you need more signs,you will not ❑ Art approved as ❑ Art NOT approved-note changes. ❑ Art approved as ❑ Art NOT approved-note changes. incur another set up charge,if you use the original design.Whereupon you purchase signs elsewhere or elect not to purchase signs,we will bill you for an amount not to exceed the amount of the set up charge. Signature: Date: Signature: Date: Please note:D&T Design Signs&Graphics Solutions retains copyright of this art. *Your signature is required before we can begin production. STATE OF CALIFORNIA STATE OF CALIFORNIA Mk _CERTIFICATE OF COMPLIANCE, SIGN LIGHTING ��`{ � CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1C(Revised 10110) CALIFORNIA ENERGY COMMISSION CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTG-1C Certificate of Compliance (Sign Lighting) (Page 2 of 4) SLTG-1C Project Name: P,I�`� (� � Project Name: � � Date-6- ater (V Date: / l Project Address: � S �� �rl` � 3.Mandator Sign Lighting Co rola NOTES.- Location of Sign Outdoor Signs ❑Indoor Signs 1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible Phase of Sign Construction XNew Signs ❑Sign Alterations person may install the sign lighting controls than the res onsible erson installing the sign lightingpower. Ty e of Lighting Control 1771 New Lighting Controls ❑Replaced Ligting Controls ❑Not Installing Lighting Controls This Certificate of Compliance includes the following components(check all that apply) 2. The Mandatory Measures (sign lighting controls) are requiredfor compliance with the sign lighting Standards. If the person ❑Mandatory Measures(Lighting Controls) ❑ Maximum Allowed Lighting Power ❑Specific Lighting Sources 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 Certifcate of 1. Certificate of Compliance Declaration Statement(this may be a C10,C45 or other eligible person) 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 ® I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and Declaration Statement or the entire construction. correct. 3a. Statements of Responsibility:Any person signing the Certificate of Compliance Declaration Statement on page 1 of ® I am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibility for the lighting design. 4 on this SLTG-1C shall complete Part 3a.Check Yes or No for all of the following statements: ® This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with 1 I have responsibility for installing the sign lighting co trols Title 24,Parts 1 and 6 of the California Code of Regulations. ❑Yes,complete arts 3a and 3b of this form No,complete art 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls ® The design features represented on this Certificate of Compliance are consistent with the information provided to document ❑Yes KNo this design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls enforcement agency for approval with this building permit application. 3 ❑yes 1N0 Name: , / Signature There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and I will be ��dV 4 installing compliant sign lighting controls Company: Phone ❑Yes No / Q 6 There are existing sign lighting controls that do not comply with the applicable provision of§119 and §133 and someone else j Address: License number may be contractor's lic#) !s g - �• t 5 11 be responsible to install compliant sign lighting controls k LZ a a 6Z Lci ty/State/Zip: � Date / I'� ❑No �L�/`Q�!'`` �::11!Gi1 ia D:?:P fi�1K?nt 1 3b.Mandatory Sign bighting Controls ������ �1�`�� If the person signing the Certificate of Compliance Declaration Statement on paged of4 of this SLTG-1 C is responsible for 2. Installation Certificate(to be signed by responsible person after installation) complying with the sign lighting control requirements,that person shall answer all _fith oa10�I'ln uestions; •r ,;r-I I v:11f F: Permit number Checked by/Date If there are construction documents,indicate where on the building plans the EnforcementAgen- Use EEn&ccanentAgency Use mandatoEZ measures Lsi2 lighting control note block can be located: Reviewed By Installation Declaration statement §133(a)1.All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA ® I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and 1 applicable requirements of§119. ❑ ❑ correct. §133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo N NA ! ® I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized 2 control,or an outdoor astronomical time switch,that comply with thea applicable requirements of§119. 11 ❑ I representative of the person responsible for construction. Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA , I certify that the installed features,materials,components,or manufactured devices identified on this certificate conforms to all daylight hours. ❑ j applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the §133(x)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA i enforcement agency. si ower b a minimum of 65 percent duringnighttime hours. ❑ 1 ❑ Exception Ito§133(a)3.Si p y g y gh Y NA a I certify that the requirements detailed on this Certificate of Compliance have been met. p ' Signs illuminated for less than one hour per da Burin da li t hours. ❑ ® I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building 3 Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand daylight hours. ❑ that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the Exception 3 to §133(a)3.Only metal halide,high pressure sodium,cold cathode,or neon lamps used for Y NA building owner at occupancy. illuminating signs or parts of signs, ❑ Company Name: _ §133(x)4. An Electronic Message Center(EMC)having a new connected lighting power load greater than 1, N ,,1`' ,,, �- 15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when El 1:11`1�� Responsible Person's arae: Responsible Person's Si 4 receiving a demand response signal that is sent out by the local utility. (�)� YL--) Exception to§133(2)4.EMC required by a health or life safety statue,.ordinance,or regulation,including Y NAi 1 License number(ma,�be contraeWs lic# Date ign d: / Position With�orppany: but not limited to exit signs and traffic si ❑ /d�J Field Inspector Notes: j 3 k STATE OF CALIFORNIA -CERTIFICATE OF COMPLIANCE SIGN LIGHTING STERTIATE OF CALIFORNIA TE ' �•••�. CERTIFICATE OF COMPLIANCE, SIGN LIGHTING �1..-.-•� CEC-SLTG-1 C(Revised 10110) CALIFORNIA ENERGY COMMISSION CEC-SLTG-1 C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Compliance (Sign Lighting-) (Page 4 of 4) SLTG-1C Certificate of Compliance (Sign Lighting) (Page 3 of 4 SLTG-IC Project Name: R 1 Date: �J Project Name: kv I P_h—� Date: !�Z_i _Aa 5. Specific bighting Source thod of Compliance 4. Maximum Allowed Li htin PoWer Method of Compliance f Certificate of Compliance and Field Inspection Energy Checklist 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 Complete this part if there are signs using the maximum allowed lighting power method of compliance.(Complete part 5 Certificate of Compliance if there are si s using the maximum allowed lighting ower method of compliance) of this Certificate of Compliance if there are signs using the Specific lighting sources method of compliance A B C D E A 1$ C I D E F G )EI I J OPTIONAL Allowed Watts Design Complies? ENERGY Specific light source used for Field w° Watts Y/N Symbol Inspector .. VERIFIED compliance x 3 or Description Check that W o o Field P label Shall include only lighting .� > a� 4, Code e (see instructions technologies listed below Sign �j � � Inspector below) Complies L w o °v.n Q N' vi Check thatg List all that apply _o z ; �, ' 3 w Sign w di Complies _ chawi^4 00 _ —Oil 11 Oil U � 011 Cd 0 JE02' Cd H Description ✓ M2 )Z/A�J&Toj ZJ9 0 F ° ill N �- (� (2- ® ❑ ❑ ❑ ° ❑ A S mbol or code used on the plans when plans are re wired and other documents. I B A narrative descrition-ofthe-sign,or-location-of-si n-on-the-buildin and=the-location-ofsi n-on construction documen s C OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed ENERGY VERIFIED label,confining that ° ; �1a� this sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Specific Lighting Source Method ofu4ai d1n� Dul Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by ❑ s {v, ❑ Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards 1 a r n { Institute in accordance with ISO/lEC 17011.Surveillance by the Accredited Certification Body shall be an ongoing annual inspection �- -'x •� � �� �; program carried out by a Type A Inspection body in accordance with 1S0/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 n c c c c n t'y•r c ; i, a µ.l ENERGY VERIFIED label is not needed for compliance. A Symbol or code used on the plans(when plans are required)and other documents. 4 r Specific Light Source Compliance Method. The sign(s)identified above use only the following lighting technologies: I B A narrative description of the sign,or location of sign on the building;and the location of sign o eonsUuo Qn�tocument . -V ,`7�f , List all a lice le numbers 1 throw 10 that a 1 in column D above for each row. OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed,ENERGY VERIFIED label,confining that 1 Hi h pressure Sodium lams the sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Maximum Allowed Lighting Power I 2 Pulse start or ceramic metal halide lamps served by a ballast with >88%efficiency method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized f I! 3 Pulse start metal halide lamps that are<320 watts,are not 250 watt or 175 watt lamps,and are served by a ballast C by Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National ` with>80%efficiency Standards Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body shall be an ongoing annual I aF on or cold cathode lamps with transformer or ower supply efficient > 75%with rated output current<50 mA inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY on or cold cathode lamps with transformer or ower supply efficiency 2:68%with rated output current>50 mA VERIFIED label,columns`D'through`I'are not required to be filled out Note:Using an ENERGY VERIFIED label is an optional I) method to validate compliance.An ENERGY VERIFIED label is not needed for compliance. orescent lamps with a minimum color rendering index(CRI)of 80 B The signarea ins ware feet. 1 te-when usin electronibllsts for corn liance lam s with a CRI<80 ma beused E List"I"if the si n is internal] illuminated. List"E"if the sin is external] illuminated. ht emittin diodes(LEDs)with a power supply with> 80%efficiency 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. s Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC G Multiply the square footage in column D times the allowed Li ting Power Density(LPD=watts)in column F. 1 8 output,having a nameplate output power less than or equal to 250 watts,and certified to the Energy Commission as H Show the total installed watts in the sign,as determined according to the applicable provisions of§130(d or e). complying with the applicable requirements of the Appliance Efficiency Regulations Title 20 IPEnis=rYif thenumber in column H is less than ore ual to the number in column G. Otherwise,the si n does not com I .9 Com act fluorescent lam s that do not contain a medium screw base sockets E24/E26 J a e doubles as a field inspection checklist. } 10 1 Electronic ballasts with a fundamental output frequency_>20 kHz Field Inspector Notes: E This page doubles as afield ins ection checklist. Field Inspector Notes: {