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B-2016-2271CITY OF CUPERTINO BUILDINGPERMIT BUILDING4DDIZESSy l Ci4 it CICIR: iPERi4TTNO- 13-3CiiG- 273 . 19.70ZrALLCO PKIVY $TE,190 CUPFRTINO, CA, 95014 016'20 108) �SC2Gci-ss GF-APH C SIGNS ISAN JOSE,CA95132 t QiY-N'ER"S ;SAME; KC; k DATE ISSUED: 07107,1201d C3i`IER'S PlIC3E: 650-776-3226ii0lE tO: t U Cie i-i7zi tN '` ' BUILDING PEI PWIT INFO - License ClassL.i c . #D�a 4 Contractor t�.�S ` R Pl tate 1 17 }z BLiI _ ELECT PLifiS l hereby° affirm that I a Ileensed under the pruv, dons of Chapter 9 (commencing, iif CII _ iZFS i7? MAL i Cllll?4IEitCL41 1 -with Section 7000) of Bi ision 3 of the Business & Professions Code and that my= license is £n fuil.force and effect., € JOB DESCRIPTION:, liPerebYaffirm. under penalty c£4I£erjurnonenit IItiLISTALLWALL ILLUMIN.-TED SIGHT- 1980 #LEASING CENT IZ fe£tlusFin two, £leeiaraflonS: REV #I- INSTALL (1), SET OFHALO CHANNEL LETTER -ISSUED i, . I have and av£l maintain a certificate of c nsent to self -insure for 4A orker'S 9/13/201 6. l Compensation as provided for by Sectiai 13700 of the Labor Cade, for the t terfbnnanee af7dic work for which this p emit is issued, i ,.- 0 T have and avi] maintain rker's Cbnrp nsatitin Insurae, as provided for by Section 3'100 6fthe Labor Code, for the I erformance of the work for which this permit is issue 1. APPLICANTR Sol. Ft Floor Area: ��taluation< -S3 00 .0 (CATION. i certify that 1 have rear that the abovel APti Number: Occupancy Type; this application and stale information Is correct. I agree to corl£pty with all city and county ordinances and state latus relating 4 building construe#ion, nd hereby authorize 316 20 09 �A(Tenant,Improavemems) representatives of this ity to enter upon the ab(lve mentioned property for inspection purposes. Ne) agree to save inderr nify and keep harmless the ) City of Cupertino again t liabilities, judgments, t osts and expenses which PERMIT EXPIRES '%NTORK IS NOT STARTED may accrue against satJ Additionally, the applic City in consequence ol ort understands and will the granting of this permit, WITHIN,S� OF PERMIT � E OR amply with all non -point istiurce.regulations psi he ty zt nb l €rat icipal Code, section 9.18. I86 DAYS FROM LAST CALLED INSPECTION. signature Hate 911312016 Issued by: Abby Avende Date: 07/07/2016 , 61ARATION i exempt from the Contractor's License Law'fur one of the RE -ROOFS: 1{31N:-NFR-BUf6RFR I hereby: sfiirm that I a£ following tivo.reassitis: Ali roofs shall be inspected riorto ani raafing material beim installed. If a roof is P P y i. I, as tiuner of he prapertj; tinnyemplov installed without first obtaining a££ inspection, I a e toremove alt iiex' materials far ees 3t'ith;va�esas their Sale v compensation will do tliewprk, mid, the . tructure is not intended or offered for i:sspee#zan. sate (Set.70, ,Business 8. Professions ode), a. 1, as owner of he property; am exclusive] , contraciing with licensed5i�zuat £re afApplicant.' contractors to . milstrnetthe project (Sec. 1044, Business & Professions CoIde)_ d Date: 9A 312016 I hereby affirm under p t, t have and wil Waity ofperjni-y one of tl maintain a Ceitificate of ie fonowing three declaratlons; ALL ROOF Cb i ERi� G5 TC BE SASS "All OR BETTER `onsent to, MPinsure for Worker's Compcosation as provided for bySection 3700 of the Labor Code, for the performance 0 rifle work for, which this ritait is issued.. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and toil .maintain Nllbrizer's Compi nsation Insurance, as provided for by l have read the hazardous niaterlats requirements under Chapter 6.95 of the Section 3760 of the Labor Code, for the I. erfor mance of the work forwhich this California health & Safety Code, Sections 255.05i 25533, and 25534. I will permit is issue ,maintain compliance with the Cupertino Wtunicipal Cade, Chapter 9.12 and the a. 1 certify that in the performance of the work- for which this permit is issued, I Health R Safety Code, Section 25532(a) should I store or handle hazardous shall Writ employarty 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 Say Area Air € uality Iitanaeement District I tyorkcr s Cori en5ation Iaxx S of Califirn a. It after mal ink this cerci catc of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exezaigtian,.l b canis subject to the i ark is Compensation provisions of the- the Health &: S_ afety Cade, Sections 255#3`5 X533, and 25534. Labor Cbdc,'t imist forthwith comply wit isuch provisio gs or this permit shalt be.decnicd rex ked. t7wner or authorized agent: APPI IC°ANTCERT F [CATION Date: 911312016 I certify that I Have read a that the above information is O STR , .TI � INNG At' .N . r this application and sta correct. I agree to, contt y with all city and count ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building con truction, and hereby aur prize representatives of this city lof works for -which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree � Lender's blame ito save Indemnify and leep harmless the City o Cupertino against liabilities, Lender's Address' 'judgments, crests, and expenses which may accrue. against said City in ; ,consequence of the grz riling of this permit. Ad itionally, the applicant understands I Sand will comply with all non -point regulations per the Cupertino Municipal € � � AiRC`IdITFf'T S BFC IN cR: iTIf1N Cade; Section 9.18, ; I understand my pians shalt be used as public records. Licensed FSigndture hate 911312016 Professional W041 CONSTRUCTION PERMIT APPLICATION COMMUNI DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORR AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(o�cupertino.org �® UPERTINO ❑ NEW CONSTRUCTION Cl ADDIT ON ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PF.RlJTT 9 PROJECT ADDRESS OV,NTER NAME[ n n PHO E E-tvLAIL STREETADDRESS �r in CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL _ STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ ,OWNER -BUILDER ❑ OWNER) GENT ° CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER. ❑ TENANT CONTRACTOR NAME z LICENSE NUMBER LICE S � to tj („ NSE TYPE J BUS. LIC # COMPANY NAME r MAIL U '�" �" u Q eG 4rt�n 6� rQ C� FAXX it Mit Sue STREET ADDRESS S CITY, STATE; ZI PHOT _q a, - / ) w ARCHITECT/ENGINEER N` AME LICENSE NUMBER BUS. LIC �I e COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE I DESCRIPTION OF WORK f t EXISTING USE PROPOSED USE CONSTR TYPE Y STORIES USE TYPE OCC. SQ.FT. VALUATION (S) 1AG AREA OR DEM TOTAL AREA � �y } 0 d64: BATHROOM KITCHEN OTHER REMODEL AREA : REMODEL, AREA REMODEL AREA j 1] ATTACH DWELLING U?3ITS: IS A SECOND UNIT YES SECOND STORY ❑ YES BEINGADDED? NO ADDITION? NO PRE-APPLICAT10 xTsf IF YES; PROVIDE COPY 0F IS THE BLDG AN ❑YES RECEIVEDBY �� TOTALVALUATION: PLANNING APPL' NO ' PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below„I certify to each of the following: I am the property owner or authorized agent It, act the property owner's behalf. I have read this application and the information I have provided? correct. I read the Description of Work and verify it is accurate. I agree to comply with I applicable local ordinances and state laws relating to building con on. I authorize representatives of Cupertino to enter the above -id ti ed prop ty ory ection purposes. �. Signature ofApplicant/Agent: Date: New SFD or Multifamily dwellings: . existing building(s). Demolition permit is permit for new building. _ Commercial Bldgs: Provide a comple forin if any Hazardous Materials rare being _ Copy of Planning Approval Letter or I submittal of Building Pemut application. .TION REQUIRED )ly for demolition permit for Hired prior to issuance of building Hazardous Materials Disclosure ;d as part of this project. :ting with Planning prior to BldgApp_2011.doc remised 06/21/11 CITY OFC PERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2271 19700 VALLCO PKWY STE 180 CUPERTINO, CA 95014 (316 20 108 SUCCESS GRAPHIC SIGNS SAN JOSE, CA 95132 OWNER'S NAME: KCR MGT DATE ISSUED: 07/07/2016 OWNER'S PHONE: 650-776-3226 PHONE NO: (408) 667-1777 LICENSED CONTRACTOR'S DECLARATION I BUILDING PERMIT INFO: License Class ELECTRICAL SIGNS Lic. #B964 -5a X BLDG Contractor SUCCESS GRAPHIC SIGNS Date 05/31/2017 _ELECT _PLUMB MECH RESIDENTIAL X COMMERCIAL q, I hereby affirm that I am licensed under the provisions of Chapter - I (commencing _ with Section 7000) of Division 3 of the Business & Professions Code ' nd that my license is in full force and effect. JOB DESCRIPTION: INSTALL WALL ILLUMINATED SIGN - 19800 LEASING CENTER I hereby affirm under penalty of perjury one of the following two d clarations: 1. I have and will maintain a certificate of consent to self-insur 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. I 2. I have and will maintain Worker's Compensation Insurance, provided for by Ihs Section 3700 of the Labor Code, for the performance of the Work for which this Sq. Ft Floor Area: Valuation: $3000.00 permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county or finances 316 20 108 and state laws relating to building construction, and hereby authorfize representatives of this city to enter upon the above mentioned prc''perty for inspection purposes. (We) agree to save indemnify and keep haless the City of Cupertino against liabilities, judgments, costs, and expens7s 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 i :)Wpoint source regulations per th pertino Municipal Code; Section 9.1* 180 DAYS FROM LAST CALLED INSPECTION. iII Signature Date 7 7 2©16 Issued by: AbbyAyende Date: 07/07/2016 OWNER -BUILDER DECLARATION I I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: 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 eu 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 notinterrded or offered for sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Pri fessions Code). Date: 7/7/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labo i 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, �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 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 i 3. I certify that in the performance of the work for which this prmit s 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 uit tthe is air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making certificate of will maintain compliance with the Cupertino ipal Code, Chapter 9.12 and 25534. exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sect' 25505, 25533, a Labor Code, Imust forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: \ APPLICANT CERTIFICATION Date: 7/7/2016 CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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 shall be used as public records. Code, Section 9.18. Licensed Signature Date 7/7/2016 9 ---T— Professional CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408)77-3333 • buildinga_cupertino.org ogre t So 0 [�,Z ,V 2Z:I-� PROJECT ADDRESS /A 7 ® 0 VD,V��. l APN # ��i %r, P1 0 C it OWNERNAME Q s? PHON 776 E-MAIL STREET ADDRESS � /a /�� ��Q�`�� � CITY, STATE, ZIP �L FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME p _ °�, v`J `�( LIICENSE NUMBER Sq oqI CENSE TYPFJ ` BUS. LIC # t COMPANY NAME _ E-MAIL FAX STREET ADDRESSr� �E C/�!I �y CITY, STATE, ZIP 9&1 Obl-6_PHO �` P -/4T, ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE i DESCRIPTION OF WORK �J syn! USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: FIrcommercial ILLUMINATED (Y /N) SIGN TYPE (CODE) NO.OF SIGNS SIGN AREA (SQ. FT.) VALUATION (S) SIGN TYPE CODES: B - BANNER SIGN M - MONUMENT (GROUND) SIIN 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 t V RECEIVED BY: TOTAL ALUATION: By my signature below, I certify to each of the followi am t e property owner or authorized a nt to ac on the property wner's beh f. I have read this application and the information I have provided i Irect. I hav read the D. scnption of Work and verify it is accurate. I a e to compl with allapplicable local ordinances and state laws relating to building nstruction. I au orize repres ntatives of Cupertino to enter the abo nti pe or jns on purposes; Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED Site Plan Elevations Sign Details - including UL listing(s) applicable Structural Calculations (if applicable) _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Pen -nit application. OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ OTHER: SignApp_2011.doc revised 03131111 STATE OF CALIFORNIA -8i6N LIGHTING CEC-NRCC-LTS-01-E(Revised 08115) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Name: Date Prepared: A. General Information NOTES: Project Address: 01-1'.o 1/; I,g „ D �C� '�s 1 0 Location of Sign E:1 Outdoor Signs [:1 Indoor Signs Phase of Sign Construction ew Signs I ❑ Sign Alterations Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls ❑ Not Installing Lighting 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. Mandatory 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 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: 1 I have responsibility for installing the sign lighting contr Is p Yes, complete parts 1a and 1b of this form No, complete part 1a of this form There are no existing sign lighting controls and I will.144eing compliant sign lighting controls Z © Yes e will be responsible to install compliant sign lighting controls There are no existing sign lighting controls and somVNo 3 Yes There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and I will be 4 in ailing compliant sign lighting controls Yes o Th re are existing sign lighting controls that do not c with the applicable provision of §110.9 and §130.3 and someone 5 else will be responsible to install compliant sign lighting 4ntrols 0 Yes o CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance August 2015 STATE OF CALIFORNIA SION LIGHTING CEC-NRCC-LTS-01-E(Revised 0811 CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) Project Name: 1�f1 q/Y) I Date Prepared: L 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 s�all answer all of the following questions: If there are construction documents, indicate wherel'on the building plans the mandatory measures (sign lighting control) note blo�-k can be located: §130.3(a)1. All indoor sign lighting is controllec with an automatic time -switch control or astronomical time- Y N 1 switch control. 0 0 XN §130.3(a)2A. All outdoor sign lighting is contr [led with a photocontrol in addition to an automatic time- Y N NA switch control, or an astronomical time -switch control. 0 0 2 EXCEPTION to Section 130.3(a)2A: Outdoor signs in tunnels, and signs in large permanently covered outdoor Y Njr areas that are intended to be continuously lit, 4 hours per day and 365 days per year. 0 §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 Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both p 0 3 day'and night. EXCEPTION to Section 130.3(a)2B: Outdoor signs in tunnels and large covered areas that are intended to be Y N illuminated both day and night. 0 §130.3(a)3. Demand Responsive Electronic Mssage Center Control. An Electronic Message Center (EMC) Y N NA having a new connected lighting power load grlater than 15 kW has a control installed that is capable of 4 reducing the lighting power by a minimum of 3� percent when receiving a demand response signal. 0 EXCEPTION to Section 130.3(a)3: Lighting for E MCs that is not permitted by a health or life safety statute, Y N ordinance, or regulation to be reduced by 30 percent. 0 Field Inspector Notes: STATE OF CALIFORNIA SI13N LIGHTING R I CEC-NRCC-LTS-01-E(Revised 08/15) CALIFORNIA ENERGY COMMISSION" CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting(Page 3 of 5) Project Name: Date Prepared: 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 I J Field 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 +; ;� `o v D o $aj T vl CL UJ _ N C_ 'a) -O X L m C 41 N M C E 3 -, �i o v O G 4— Y UJ _ C I I II p w o Q v U in c Q a° � O I- 3 C' E 0 E]0.0006 E] ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ 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 '1' 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 de ermined 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: l I CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance August 2015 STATE OF CALIFORNIA SIGN LIGHTING CEC- NRCC-LTS-01-E(Revised 08/15) CERTIFICATE OF COMPLIANCE Sign Lighting Project Name: TW e` r)r CALIFORNIA ENERGY Date Prepared: N RCC-LTS-01-E (Page 4 of 5) 3. Specific Lighting Source Method of Compliance Certificate of Compliance and Field Inspection Energv 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 B C D E •' OPTIONAL Specific light source used for Field Inspector Symbol ENERGY VERIFIED compliance ��Check that Sign : or Description label Shall include only lighting Compiles Code (see instructions technologies listed below below) List all that apply .. �� ,' ❑ El?' y sir S ❑;� El 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 itle 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 a ballast that has a minimum efficiency of 80 percent. 3 Ballast efficiency is the measured output wai tage 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 out ut 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 ower 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 25 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 I This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance August 2015 STATE OF CALIFORNIA SIGN LIGHTING CEC- NRCC-LTS-0I-EIRevised 08/151 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting Project Name: Z (Page 5 of 5) Date Prepared: RAF DOCUMENTATION AUTHOR'S DECLARATION STATEM T 1. 1 certify that this Certificate of Co fiance doc tion is accurate and complete. Documentation Author Name: / Documentation Author Signa e: Company: Signature Date: % / Address: CEA Certification Ide a ion (if applicable): r City/State/Zip:—� Phone: cv RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under they 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 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 t ilding owner at cupancy. Responsible Designer Name: Responsible Designer Signatur "-. Company: C97 _ Date Signed: Address: License: \ `] City/State/Zip: �"C� _ hone: J-1. ELOPMENT DEPARTMENT Halo Letter 10!32" Screws Minimum (3) per Letters or as required per field conditions 2" 1" spaces (1) CIRtUlt-l' '' I 120 VOLT/20 AM'Pjl 1/8" Alumi . i M fir? £at of plans and Gh site wring const Changes or alter; thi ; afrom, without al Class 2 Low Voltage IVISION - CUPERTINO PROVED ecifications MUST be kept at the !ction. It is unlawful to make an :ions on same, or to deviate y oroval from the Building Official. -; ` I LED Wiping'`amping of this pin Note:_;N.o;cbbdujt orrf'l & i required p�e�y;cl�ssl�2r�gv�f voltage wiring guldghng „ and specifications SHALL NOT be an approval of the violation iy City Ordinance or State Law. J-1. r. .Ysy D_ A, pneoeoi Switches Canopy W ,-.. wa E314310 Sign type: (1) internally illuminated L.E.D individual Halo channel letters Sign. Ouccess • 1744 Queens Crossing Drive — San Jose — CA 95132 T.• (408) 667-1777 E-mail. swu1966@gmail.com I 19700 Vallco Parkway Ste. 180 Cupertino CA I p� LPN�1�N� p pT IN u~ 8 U PERTINp i f ng cepartrnenf `-`weSJ IUL 0,7- 2016 E��D rOR CODE CO Reviewed ay: MPL `��DANCE ,; � GE Vii/" 0"'P N