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B-2016-2713CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2713 10477 S DE ANZA BLVD STE A CUPERTINO, CA 95014-3011 (359 17 019) HENRY DESIGN & SIGN CO SAN JOSE, CA 95125 OWNER'S NAME: BDC HAYWARD LP DATE ISSUED: 09/13/2016 OWNER'S PHONE: 650-714-8833 PHONE NO: (408) 269-0888 LICENSED CONTRACTOR'S AR ATION BUILDING PERMIT INFO: License Class ELECTRICAL SIGNS Lic. # 47 1908 Contractor HENRY DESIGN & SIGN CO Date 10/31/2017 X BLDG _ELECT _ PLUMB I hereby affirm that I am licensed under the. provisions of Chapter 9 (commencing _ MECH _ RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL (1) ILLUMINATED WALL SIGN - VERDE TEA HOUSE I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to selfinsure for Worker's . Compensation, as provided for by Section 3700 of the Labor Code; for the "performance of the workfor which this permit is issued. 2 I have and will maintain Worker's Compensation Insurance, as provided for by f -- ,64flon 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $3000.00 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 ordinances and state laws relating to building construction, and hereby authorize 35917019, 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. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18: 180 DAYS FROM LAST CALLED INSPECTION. '.- Signature — Date 9/13/2016 Issued by: AbbyAyende e OWNE&BUfi DER DECLARATION Date: 09/13/2016 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 (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 9/13/2016 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 v , 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, 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, and25534. 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 APPLICANT CERTIFICATION Date: 9/13!2016 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 9/13/2016 Professional s SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • building(cDcupertino.org PROJECT ADDRESS p�l 1 APN # P— f 1q OWNER NAME �� P -MAIL i L9,10 P STREET ADDRESS CITY, STATE, ZIP CONTACT NAMEpp m STREET ADDRESSCITE, c TATE, ZIP co s FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT 0 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME -a LICENSE NUMBER ` LICENSE TYPE BUS. LIC 3 COMPANY NAMEE-MAH STREET ADDRESS /�S S CITY, STATE, ZIP PHONE ? G ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK QVC} � � A� USE OF SFD or Duplex Multi -Family ILLUMINATED SIGN TYPE NO. OF SIGN AREA VALUATION STRUCTURE: Commercial (Y/N) (CODE) SIGNS (SO. 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 6W ' WALL SIGN E - ELECTRONIC 16—>_ READERBOARD WI - WINDOW SIGN RECEIVED BY: TO1TA V UATION: b '``��FF44AN.• By my signature below, I certify to each of the following: I am the property owner or authorized agent to a t on the property owner's behalf. I have read this application' and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Apphcant/Agent: Date: Z 6 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Site Plan _ Elevations ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Wlll�ii Sign Details - including UL listing(S) applicable ElEXPRESS ElPLANNING PLAN REVIEW, 6A1( Structural. Calculations (if applicable) ❑ STANDARD ❑ OTHER: _ _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR SignApp_2011.doc revised 03131/11 STATE OF CALIFORNIA SIGN LIGHTING CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Name: VERDE TEA HOUSE Date Prep': 9-8-2016 A. General Information Project Address: 10477 S. DE ANZA BLVD. Location of Sign Q1 Outdoor Signs 0 Indoor Signs Phase of Sign Construction 0 New Signs ❑ Sign Alterations Type of Lighting Control Q New Lighting Controls ❑ Replaced Lighting Controls [3 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 some 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 (e.g. a C-10 contractor may complete parts 1a and 1b on one compliance document and a C-45 contractor may complete parts 2a and 2b on a separate compliance document — the Responsible Designer shall submit the two compliance documents together or the same complete installation). 1 have responsibility for installing the sign lighting controls: Yes, I have responsibility for the sign lighting controls, and will 0 No, I do not have responsibility for installing the sign lighting controls. complete parts la and lb of this compliance document Someone else will complete parts is and lb of this compliance document. 1a. Check Yes or No for all of the following statements: There are existing sign lighting controls that comply with the applicable provisions of §110.9 and §130.3 1 0 Yes ❑ No There are no existing sign lighting controls and I will be installing sign lighting controls that comply with the applicable 2 provisions of §110.9 and §130.3 ❑ Yes Q No There are existing sign lighting controls that do not comply with the applicable provisions of §110.9 and §130.3 and I will be 3 installing sign lighting controls that comply with the applicable provisions of §110.9 and §130.3 Q Yes 0 No CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE CA Building Energy Efficiency Standards - 2016 NonrifiR &WIlUilirlll►7iArnold Hom August 2016 Date: 09/21/16 STATE OF CALIFORNIA ' 0 SIGN LIGHTING CEC-NRCC-LTS-01-E(Revised 08116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) Project Name: VERDE TEA HOUSE Dike Prepared: 9-8-2016 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- Y N NA 1 switch control. 00 E) §330.3(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. O 0 O 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. O O §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% during nighttime hours. Signs that Y N NA are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both day and p p (D 3 night. EXCEPTION to Section 130.3(a)2B: Outdoor signs in tunnels and large covered areas that are intended to be Y NA illuminated both day and night. © E) §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 p 0 4 reducing the lighting power by a minimum of 30% 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%. Field Inspector Notes: CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE CA Building Energy Efficiency Standards - 2016 NonreDsWRm ArE pti EEIOId Hom August 2016 Date: 09/21/16 STATE OF CALIFORNIA SIGN LIGHTING CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) Project Nem" VERDE TEA HOUSE Date PrePered:9-8-2016 2. Mandatory Sign Lighting Measures I have responsibility for installing the sign lighting 13 Yes, I have responsibility for the sign lighting, and will complete ❑ No, I do not have responsibility for installing the sign lighting. Someone parts 2a and 2b of this compliance document else will complete parts 2a and 2b of this compliance document. 2a. 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 2b 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 OPTIONAL — Field Symbol or Description of the Sign Energy Verified Label (see Allotted Watts Desi g n Watts Complies p Y/N Inspector p Checkthat Code instructions Sign Complies below) _ 0 N yy i. Q7 OC 75 (Q d M C f6 C '— y M N V X N o N C 42 = , w n !/1 C tL U ❑ E 0 ❑ ❑ 0 ❑ ❑ 0 ❑ ❑ 0 ❑ ❑ 0 ❑ ❑ 0 ❑ ❑ 0 ❑ ❑ 0 ❑ ❑ 0 ❑ ❑ 0 ❑ 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 2016 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 C 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 inspect' t. Field Inspector Notes: _ GUPERT'NO Building Department REVIEWED FOR CODE COMPLIANCE CA Building Energy Efficiency Standards - 2016 Nonrd3miRi9 "rBm1Ar 101 d H OITI August 2016 Date: 09/21/16 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 08116 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign lighting (Page 4 of 5) Profeta Na—: VERDE TEA HOUSE °aLe °fe -d` 9-8-2016 2b. 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 B C D E OPTIONAL ENERGY Specific light source used for Field Inspector. Symbol VERIFIED compliance Check that Sign or Description label Shall include only lighting Complies Code (see technologies listed below d instructions (List all that apply) below) CHANNEL LETTERS SIGN WITH LED 0 7 ❑ ❑ 0 ❑ 1 ❑ ❑ ❑ 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 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 2016 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 C 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% or greater. 2 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%. 3 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% when D 4 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% tubing load. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68% when 5 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% tubing load. Fluorescent lighting systems meeting one of the following requirements: A.) Use only lamps with a minimum color rendering index 6 (CRI) of 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 801y. 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). 9 Compact fluorescent lamps that do noedi (E24/E26). E This page doubles as a field inspection checIt Miding Department Field Inspector Notes: iF\AiFn FOR rnnF Cnnnpl„ CA Building Energy Efficiency Standards - 2016 Nonre I Xa gn0 OITI August 2016 Date: 09/21/16 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E(Revised 08/16) CALIFORNIA ENERGY COMMISSION "OF' - CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 5 of 5) Project Name: VERDE TEA HOUSE Date Prepared: 9-8-2016 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: HENRY CHEN (ZHONG Y CHEN) Documentation Author Signature: �HENRY CHEN fiys ti Company: HENRY'S DESIGN & SIGN CO. Signature Date: 9-92016 Address: CEA Certification identification (if applicable): 2018 EVANS LN. # 4 City/State/Zip: SAN JOSE CA 95125 Phone: 408-888-7681 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. 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 i 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: HENRY CHEN Responsible Designer Signature: Company: HENRY'S DEAIGN & SIGN CO. Date Signed: 9-8-2016 Address: 2018 EVANS LN. # 4 license: C-45 741908 City/state/up: SAN JOSE Phone: 408-888-7681 CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE CA Building Energy Efficiency Standards - 2016 NonreJj&ftii4LSdrr"9)%e nOld HOm August 2016 Date: 09/21/16 Z_ FRONTAGE IS 25'-2" LETTER SECTION PCL -LED FACE LIT INTERNALLY ILLUMINATED PAN CHANNEL LETTER .063 ALUM. BACK 3.5" .040ALUM.RETURN 2013 TRIM CAP WALL IS WOOD ACRYLIC FACE Si�l/l d8 x'EXTERIOR SCREW WIENG WORK LEST4 EACH PER LETTER J"I TO BREAKER DISCONNECT SWITCH1y LEDs 12 V DC POWER SUPPLY THE SIGN IS ILLUMINATED CHANNEL LETTERS WITH LED, s' COLORS ARE AS SHOWING AS THE DRAWING. THE COLOR OF CAN OF THE LETTER IS WHITE WITH SILVER TRIM CAP. m 011 sign 20„ location 147-1 " CUPERTINO —011 Building DTrQiikLtSIGNAREA 22.25 SQ FEET LENGTH OF SIGN IS THAN LESS 70% OF 25'-2" (STORE FRON iWDEcPIlR�NffLUMINATION< 250 FEET LAMBERTS Reviewed By: Arnol J �fODI FOR PLANNING & FOR BULLDING APPLICABLE CODES 2013 CBC 2013 CEC 2013 CPC 2013 CMC 2013 CALIFORNIA ENERGY CODE SCOPE OF WORK; L LLll 11-OPMENT OEPARTMEI IN, fjION-CUPERTINO S I(WPROVED This set of plans and specifications MUST be kept at the j site during construction. It is unlawful to make any change. alterations on same, or to deviate n ate therefrom, without app SHEET'11eIllI"50"'I 1. The stamping of this plan and specifications SHALL NOT held to permit or to bean approval of the violation of an provision of any City Ordinance or State Law. DATE 09/22/16 PERMIT NO B-2016