15120027CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
19439 STEVENS CREEK BLVD CUPERTINO CA 95014 (316 20 112)
CONTRACTOR:
AD ART SIGN CO
PERMIT NO: 15120027
OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 02/10/2016
OWNER'S PHONE: PHONE NO: 415-869-6400
LICENSED CONTRACTOR'S DECLARATION
License Class C-45 Lic. #826051
Contractor AD ART SIGN CO Date 02/10/2016
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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.
2.I have and will maintain Worker’s Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
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 and state laws relating to building construction, and hereby
authorize 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 may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature___________________________________ Date 02/10/2016
OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor’s License Law for one of the
following two reasons:
1.I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
2.I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
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.
2.I have and will maintain Worker’s Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
3.I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker’s Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker’s Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non-point source regulations per the
Cupertino Municipal Code, Section 9.18.
Signature___________________________________ Date 02/10/2016
BUILDING PERMIT INFO:
BLDG ELECT PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
INSTALLATION OF (2) NON ILLUMINATED WALL SIGNS
(PHILZ).
2/10/16 - ADD ILLUMINATION TO BOTH WALL SIGNS (NEW PLANS)
Sq. Ft Floor Area: Valuation: $5000.00
APN Number:
316 20 112
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: MELISSA NAMES
Date: 02/10/2016
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:_______________________________
Date: 02/10/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: ________________________________
Date: 02/10/2016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT’S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional________________________________________________
CITY OF CUPERTINO BUILDING PERMIT
BUII.DINGADDRESS: WNTRACTOR: PERMITNO; 15120027
19439 STEVENS CREEK BLUD CUPHRTINO CA 95014(316 20 I I2) AD ART SIGN CO
OWNER'SNAME; MAINSTREETAGGRHGATOR DATE ISSUED:02/10/2016
OWNER'S PHONE: PIIONE No:415-ab9-64ao
LICENSED CONTRACTOR'S DECLARATION BUILDING PERNIIT INFO:
License Class C-45 Lic.#826 BLDG _ELECT _PLUMB
Contrector A�ART SIGN CO Date 02/10/2016
I hereby affirm that I am licensed under[he provisions oS CLapter 9(commencing —MECH_RESIDENTIAL_COMMERCIAL
with Sectian 7000)of Divisian 3 of the Buainess&Professions Code and Htat my
I[cense is in full force and effecA JOB DESCRIPTION:
INSTALLATION OF(2)NON ILLUMINATED WALL SIGNS
I hereby afflrm under penalty of perjury oue of the following hvo declarntlons: (pHII,Z).
i. I have and will maintain a certi£cate o£consent to self-insure for Worker's 2/10/16-ADD ILLUMINATION TO BOTH WALL SIGNS(NEW PLANS)
Compensatiou,as prwided for by Section 3700 of tlie Labor Code,for the
�- perfoemance of�he work for which tlus permit is issued.
I have and will maintaiu Worker's Compensatlon Insuxance,as provided for
by Section 3700 of the La6or Code,For tke perFormance of t6e work for whicli
this permit is issued. Sq.Ft FloorArea; Valuation:$5000,00
APPLICANT CERTIFICATION
I certify thal I have read this application and state that the a6ove
information is correct.I agree to comply with all dty and county APN Nmnher: Occupnncy Type:
ordinances and state laws relating to building construction,and hereby 316 20 112
authorize representatives of this city to enter upon the above mentloned
property for Inspectlon purposes. (We)agree to save indemnify and keep
harmless the City of Cupertino against Iiabilities,judgments,costs,and pER�T EXPm�S IF WORI{IS NOT STARTED
expenses whlch may accrue against said City in consequence of the wITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all non-polnt saurce regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Sectian 9.18.
Issued by:MELISSANAMES
Signature� �� �� ��/J� Date 02l10/2016 Date:02/10/2016
OWNER-RUII, .RDECLARATION RE-ROOFS�
I hereby af7irm that I mn exempt from the Cm�trnctor's License Law for one oS the All roofs shall be inspected prior to any roofing material being instxlled,If a roof is
following hvo reasons: inetalled without flrst obtainiug an i�ispacCion,I ageee to remove all new materials for
i. I,as owner of the property,or my cmployees with wages as their sole inspection.
compensation,will do fhe work,and the struclure is not intended or offered
for sale(Sec9044,Busuiess&Professions Code) Signature of Applicant
z. I,as owner of the properfy,am exclusivcly contracting with licensed Date:02/10/201C
contractors W construct the projcct(Sec9044,Business R.Professions Cade).
I hereby affirm under penalty oFperjury one of the follnwing three declarations: �L ROOI�'COVERINGS�TO BE CLA5S"A"OR BETTER
v I have and will maintain a Certificate oFConsent to self-iusure for Worker's
Compensafion,as provided for bySection 3700 oFthe Labor Code,for the HA2ARDOUS MATERIALS DISCLOSURE
performance of the work for which Uus permit is issued, I have read the hazardoux mxtedals requlrements uuder Chapter 6.95 of the
z. I have and will main[ain Worker's Compensalio�i Insurance,as provided for California Health&Safety Code,Sectians 25505,25533,and 25534, I will
6y Seation 3700 of lUe Labox Code,for the perf'ormance oFthe wark for which maintain compliance w3th the Cupertino D2unicipal Code�Chapter 9.12 and the
this permi[is issued. He�l[h&Safety Cade�Sec[ion 25532(a)should I store or handle hazardous
3. I ce�tiFy[hat in tlte performnnce of the wmk for wliich[lils pexmi[is issued,I materinl. Additianallg should I use equipment or devices which emit hazardoue
shall not employ any person in eny manrier so as to hecome subject to the flir coutaminants as deflucd by the Bay Area Air Qunlity Managemen[District I
will maintain compliance with the Cupertino Municipal Code�Chapter 9,12 and
� Worker's Compensaflon laws of California, If,after making Ihis certificate of the Hea1tL&Safety Code,Sectlons 25505,25533,nnd 25534.
excmption,I become subjec[To the Worker's Compeusa4on provisions of the ��.'�/..�7
, Labor Code,I mnst fo�thwith comply with such provisions or this permit ahall �,Hner ar authorized agent:E�7��
be deemedrevoked. Date:02f10/2016 �-
APPLICANT CERTIFICATTON CONSTRiIC I N LENDINGAGENCY
I certifythat I have read ihis application and state that the above information Is I hereby affrm that there is a conshuction lending agency for the peAormance
corract.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.)
relafing to bullding construction,and hereby authorize representatives of this city Lender's Name
to enier upon lhe above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless fhe City of Cupertino againsl liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of fhe granting of this permit. Additlonally,the applicant ARCHIT�CT'S DECLARATION
understands and will comply with all non-point source regulations per the I understand my plans shall 6e used as pu6lic records.
�Cupertino Municipal Code,Section 9.18.
Licensed
Signature Date 02/10/2016 Professional
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� � 7he,s �, ` �� Pro - �om� nt o� �mak, any
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D�scrip4ioro Spece�Ficafion/Maierial Finesh Calor :: � t �e a�� `�"�� ��SxA�L PJOT
Backer panel 4"Deep aluminum pan Paint(satin) Darl<Brown PMS 81ack 4 C wl .s��'� r, V
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`Philz Coffee"Letters 2"Deep.063"aluminum Paint(satin) White \ '�1 "�� N
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"Philz Coffee"Illumination 10mm Neon Tecnolux White 6500 Daylight , ,� _ 4 � � OO - �/vI
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� NEON SIGN SPECIFICATIONS
Manufacture and install one(1)3'-6' OAH exposed neon sign. �
' Z�1
Description Specifioation/Material Finish Color , 3'-1 131T6" I � I
Backer panel 4"Deep aluminum pan Paint(satin) Darl<Brown PMS Black 4 C w! �
Red to match wall in open areas
"Philz Coffee'Letters 2"�eep.063"aluminum Paint(satin) White m �
'Philz'Illumination 15mm Neon Tecnolux White 6500 Daylight � .; � I �,I
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' PftOJECT: REVISIOY ➢AiE�� DESCRIPTION APPROVFLS � ' �' SHEET
♦ � 1
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� - STATE OF CAIJFORNfA
STATEOFCAI.IFORNIA SIGN LIGHTING �
SIGN LIGHTING ceGNacc-�rsa,-� �sed�5/1 CAL�FORNIAENER6YCOMMISSION
CEFNRCGL7S-�7-E Revised o5lt CALIFORNIA ENERGY COMMISSION. CERTIFICATE OF COMPLIANCE NRCC-LTS-Ol-E
CERTIFICATE OF COMPIJANCE NRCGLTS-0I-E (Page 2 of 5)
Sign Lighting
Sign Lighting (Page 1 of 5) ���� o�ra��e
Pm1�Namz � Ua�PreWred:.� r�C
lb_ Maodatory Sign Lighting Controls
A_ General Infoemation If the person signing the Certificate of Compliance Dedaration Statement on this NRCGLTS-Ol-E is responsible for complying with
Project Address: ,,��` tfie sign lighting wntrol requirementr,that person shail answer alI of the following questions:
�� �/.�.y9✓r�S' '���l�G��/`3 �-- If tfiere are construction documents,indicate where on the buiiding plans the
Location of Sgn - utdoor Signs ❑IndoorSigns mandatory measures(sign lighting control)note block can be located:
Phase of Sign Construction ,�New Signs ❑Sign Akerations
g �_ g 1 §130_3(a)1.All indoor sign lighting is tontrolled with an automatic time-switch control or astronomical time- Y❑ N❑ ❑
Type of Gghting Control ❑New Ligh[ing Corm'ols ❑Replaced Lighting Controls Not Installin ❑ nn Controls gy�jt�h conVoL
This Certificate of Compliance indudesthe foltowing componerrts(check all that appty)
❑Mandatory Measures(Lighvng Controls) � �Maximum Allowed Lighting Power pedfic Ligfiting Sources §130.3(a)2A- AII outdooe Sign lighting is controlled with a photocontrol in addi6on to an automatic time- ❑ ❑ ❑
switch contro�,or an astronomical tim�switch control_
- : Z IXCEPTION to Section 7303(a)2A:Outdoor signs in tunnels,and signs-in large permanenUy covered outdoor Y NA
1. Mandatory Sign Lighting Cont�ols areas that are intended to be continuously lit,24 hours per day and 365 days peryear. II �
NOTES: §130-3(a)2B. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides
1. The same responsible person moy instal!both the sign lighting power ond the sign ligfiting controls, or a different responsible the abiVity to automafically reduce sign lighting power by a minimum of 65 percent during nighttime hours. Y N NA
penon mayinstall the sign lighting controls than Yhe responsib7e person insCaOing thesign lighting power. Signs that are iltuminated at nig6t and for more than 1 hour during daytight hours shall be considered ON both ❑ ❑ ❑
2. The Mondotory Measures (sign (igi�ting controlsJ are required for compliance with fhe sign lighting Standards_ ff the person 3 day and night
responsible for instolling the sign lighting powe�is not also responsi6fe for the sign lighfing rontrols,then the owner of the sign, , IXCEPTION to Section]309(a)ZB:Outdoor signs in tunnefs and large covered areas that are intended to be Y NA
genera!contractor,orarchitectshall be responsible to 6oveYhe sign(ighteng controts installed. illuminated both day and night. � �
3. !f more than one person has respansibility for compliance, eoch responsible person shall p�epare and sign a Cert�cate of §y303(a)3. Dema�d Responsive ElecVonic Message CeMer ControL An E[ectronic Message Center(EMC) Y N N/A
Compliance and an lnstallation Certificate applicnble to the portion of ronstruction for which they are responsible;akernativety, having a new connected I�g6ting power load greaterthan IS kW has a mntroi instalfed that is tapable of � � �
the person witb chief responsibilify for canstructia�shall prepare and sign the CerYificate of Compliance Declaration Statement 4 reducing the Iighting power by a minimum of 30 percent when receiving a demand response signaL
for the entire construdion. IXCEPTION to Section 1303(a)3:Lighting for EMCs ffiat is not permitted by a health or life safety statute, Y❑ N❑A
1a.StOtf'_ITIentS Of RESpon5lblii'L�/ ordinance,or regcciatioMo be reduced by 30 percent
Any person signing the Certificate of Compliance Declaration Statement on this NRCGLTS-0I-E shall complete Part la.Check Yes or Field inspector Notes:
No for all of the following statamentr: � -
1 1 have responsibility for insiailing the sign lighting controi �
❑Yes,complete parts Sa and 15 ofithis form �No,mmplete part la of this form
� Z There are no e�dsting sign tighting controls and I wili 6e i Iling compliant sign lighting controls
❑Yes NO
3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
, s ❑No
There are existing sign lighting controls that do not comp(y with the applicable provision of§110.9 and§130.3 and I wili be
4 installingcompliantsignligfitingcortrols _ � ����(�"�°���
❑Yes NO ..
There are existing sign lighting cortrols that do rtot com y with the applicable provision of§110.9 and �130.3 and someone �WIIdif1Q (�pA���n�
JI
5 else will be responsible to install compliant sign lighting mntrols �"�'� �"�+i:..�'� � � �4���'
, _"""'-.�t
❑Yes NO (kEVIE1N�f:e t�Q� COD�
con����an�c�
rteviewed 8Y: �`��---
----.
CA Building Energy E�ciency Standards-2013 Nonresidential Compliance May 2015
�.,A 3«ilcing�nzrs�E�ciency itandar3s-ZC23 Nonresident�ai�ompYance Ylay 20i
� - - STATE OF CAUFORPIIA � �
sTAreoFca�iFORr�u utGN L1GHTING
�1C�N LIGHTIT�G CAt1FORP1IA eME.RG'!CCMMISSlQN CEC-NRCGLTS71-E ftevised CElt4 CALIFGRNIA EPIERGY COMMISSION
GEGNP,CG!TS-�'I-E Revised C81�4 NRCC-lTS-01-E CERTIFICATE OF COMPtiANCE NRCGLTS-01-E
� CERTIFICATE OF COMP1-1ANCE Si L' hiin (Pag=4 of Sj
r---- (7age 3 ot 5) � B� �B � �
5�$f1� U3hting o-mea.ec�rm: � a.ae.srome: I o-ete�eaaraa�� ���
� P qtttNa 1 �.
3.Specifie LirthHr�c Source Mzthod of CompGance
,2�n �mum Ailawed 4plui�Pawee Methoel af CompNartce �
Certifiwce of Complierxa and FieW Inspection Energy Cfiecklist
Certificate of Compliance ared freld ir�sPe�iQ�EneTBY���n Camplete th'u-part'rf there are signs using tne Specific lighting source method of compiiancz. ;Complete part 2 or±his Cer!ificar.e
Compiete this gart'rfthere are sigrrs using the maximum aitowed iighting power method of wmpliance. (Compiete part 3 oF of Compliance ifthete are signs using the maximum altowed lighting power method of compliancej
tfiis Certificate of tompliance'rf tfiere are sigr�s using the Sqecific Iighting wurces method of compliance) A B C D E
A g C D E F G H I 1
avirotut-�nerg�� rtted inspeccor OPTIONAL Specinc light source used for Eield Inspettor
Symbol Rilotted Watts Design+Natts ��mP��� Checktha[sign
OesariptionoftfieS+gn v^r'rt'iedwbe�tsee y�N Symboi ENERGY�/ERIFIED compliance Checkthat5ign
or code ��sV��o�helow) ��mP��� qr �escription label Shai!Snciude only figh6ng
{;z<_instructions � tzchnologies IiSed be(ow Compiies
Code �
'o � � below} List all that apply
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❑ D p Sym6o1 or code used un+i�e plans(when Flans are r=quired)and other dacumenLs.
❑ � B A narrative deunption of ihe sign,or iacation oi sign or.he buitding;and ffie bcatlon of sign on construri9on documents
� ❑ C OPTIONAC-Check this box cnly if this sigr.ha�a permanen[,pre-printed,fadory-inn�alled EyER6`t V`cftIP1ED'abel,confic�ing that this;ign
❑ ❑ i compiies with ttte Section 140.8 of the Caliiornia 2013 TiUe 24,Part 6 Standards,using+he Specific Lighting Source Method ef Compiiance. The
fl � oniy Iabels that wi11 be r�rngnized ior this ourpose arz E�lERGY�/ERiFlED Certificadao Ma1cs authorized'oy UnderHriters laboratones(Ul)or
� othet°roducT Certification 6edp accr�dited to I50/IEC Guide`05 by tMe American Naqoaat Standards Inst'rtute in accerdance witn I50!IEC
� [� 17011.Surveillance by the?,cc,rodited Cer[ification Body shall be an ongoing annual inspection progrem carried out 6y a 7yqe A Inspection body
in accordance with ISOjIEC llC20.For signs Nitfi such an ENERGY VE�2IFIED Iabel,cofumn'D'is net required to be n"tled eut.Note:Using an
❑ ❑ • ENERGY VERtF1ED abe!is ar.oukiona!meLhod to vaiidate compliante.M ENERG`!VERIPIED lahe(is nat needed for wmpliance.
� ❑ I Specific lght Source fAmpliancz Methcd. Tne sigms>identified above usz onlythe followi�g lighting technolcgies:
� ❑ l;st ali applicable numbers(T througn 9i that appty in coiumn D above Por eacfi row.
; 1 i High pressure sodium lamps
� ❑ F Nletal halide lamps that are puise start or ceremic served by a bailast that has a minimum efficiency of 88 percent or
C ❑ i 2 j greatsr,Ballast ztTiciancy is the measur�d output wa`[aga to the iamp divieed'oy the measured opera�ing input wattage
i
p Symbol or code used on[he plans(when plans are required)and other documents. . � when t2sted according to AN51 C82.fi-2005.
B � A descr.ptioo of the sign,o��ocation of sign on the buitding;and the location oY sign en consiruction documents. �,�tetal halide lamps that are oulse start that are 32o avatts or srraller,are not 250�ffatt or 175 wati lamps,and are servad b��
OPSIONAL-Check this 6ox onty if this sign has a permanent,pre-prinTed,{ac[ory-installed,ENERGY VERfFlE�labei,canfirmirtg that Lhe i 3 a baliasE tfiat has a minimum efficienc)of 80 Percent.
, sign complies witF,tfte Section 14Q.8 ot tFe Cai;Pomia 2013 Title 2�,Part 5 Siandards,using the Maximum Allowed�ghtir.g Power j Ballast efficiency is the measured oukput aattage to the Iamp divided by the rrreasured ooerating input��xattage when tesied
� Imethod af compliance. The onlV la6efs Lhat wiif be recegnized fo�Yfiis purpose are ENERGY Y€RIFIED Certification Mar�s au#fionzed by I accofding to AN54 C82.6-2C05.
Underwricers Eaboratories(ULl or other Product Certification Bady acaedRed ta ISQ/IEC Guide 65 by the American Natlanal Sta�dards . Neoa er cold wthede lamps with trens#ormer or power supply zfficizncy greater than or equal to a minimum eti'iciency of 75 pescent
;m�tute in auor3a�ce wit`.?I50/IEC 17021.Surreiliance by tfie.ascr�ditad Certification Body shall be an ongoing annual inspectier D� � whe�the transformer o�power wppl�J rated output cur�ent is less tnan�0 mA.7he raao oi the ouipuc wa#tage to the input waiTage is at
program carried ouc by a TYPe A'.nspection body ir.accordance wiU':t50/!EC ll020.For signs witfi such an ENERGY VEftif1ED Ia6eI, � 100 percent tubing!oad.
coiumns'0'through'!'ar�not required to be r'ilied out.Note:Using an ENERGY VERiFIED label is an opVonai method ia vatidate i Neon or rold cathode�amps•xith traosformer or pov+er suppb(�Fficie�cy�r=_ater than or equat to a mi�imum eificiency of o8 perrert
compliance-An EhERGY VERIfIED Ia6el is net needed for wmpiiance. �i 5 when khe trensfo{mes or power supply rated output cu[%nt is 56 mA or gr=ater.The ratio of the outpuc wattage io Che input wattage is a1
D The sigo area in square feet. { 100 Rercent cubing ioad.
F lisk`t"if the sign is intemally iliuminated. tist"E"if the iign is e�cternalfy illuminatzd. Fiuoresceni Nghting rystems mee6ng or.e of the following requirements:A.Use only lamps with a minimum color rendering iadex(CRfj of
F Allowed+,vatts per square foot. Enter 12 if the sign is lisked as"I"in colam�E.Entzr 23 if sign is lisYed as"E"in column E. � 6 S0;or B.Use only elec2ronic 6allasts with a fundamental output frequency not Vess than 20 kHz.
G Multiply the square foetage i�column D times ihe allowed Lighting Power Densib)(LPO=watts�in column F. 7 Light emi[ting diodes{LEDsl with a aower supply having an ei5ciency of 80 percent or greater;
H Show the total installed wa#s in the sign,as determined according to tfie app�icable pwvisions of§130(c). ; Single vokage e�emal power supplies that ar<designed to comrert 220 volt AC input into lower�rokage CC or AC autput,and have a
1 Enter`f if the number in column H is less than or equal to the number in column G. Otherwise,the sign does not campiy. i 3 �ameplate output power iess than ar zqua±ia Z50�r+atts,sha41 complY avitfi the applica6ie requirements of the Appiiance Eificiency
1 This page dau6les as a field insPection checklist. � Regulations(Title 20i.
1 3 Compact fluorescen[lamos that do not contain a medium>crew base socketr(E24jE26).
Pield Inspector Nofes:
� E This gage doubles as a field inspection checktfst.
Field InspeRor Motes:
Ca Building Energy ERiciency Star.dards-2C13 NonresidenTial Compliance
lune 201? tA Building�ners/Etficienc�Standaras-20.3�lort�=sidential Compiiance lune 20:
STATE OF CALIFORNIA
SIGN LIGHTING
- CEC-NRCC{TS-01-E Revised OSHS CALIFORNIA ENERGY COMMISSION
CERT7FICATE OF COMPLIANCE NRCGLTS-0I-E
� Sign Lighting (Page 5 of 5)
Pmje¢Namc /'
� 6ate P�ePared �V ��-�
, . DOCUMENTATION AUTHOR'S DEOARATION STATEMEN(
„ 1. I certi(y thatthis Certificate of Compliance documentation is accurate and complete.
DocumenfationAWrorNam � DowmentationAutMrS a
. � �� � !%' (�v� /1p Y.� .
famPa�Y- (/f� ,.n�.,�„/,��_--. Sigmture�al�c �j ('� /
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Address: �AC¢rtifimtion IdenliUcation(iFapplka6le)_
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RESPONSIBLE PERSON'S DECLARATION SfATEMENT
- I certify the following under penaliy of perjury,under the laws of the Siate of Califomia:
. 1. The information provided on this Certificate of Compliance is we and covect
- - 2_ I am eligible under�ivision 3 oftfie Business and Professions Code to accept responsi6ility forthe building design orrystem design
identified on ffiis Certificate of Compliance(responsible designer�.
3. The energy features and performance spec�wtions,materials,components,and manufactured devices fortfie building design or ryrtem
• design identified on this Certificate ot Comptiance conforzn to the requirements of Trtle 24,Part 1 and Part 6 of the Califomia Code of
Regulations_
_ � 4_ The building design features orrystem design featvres iderttified on this fertifi�te of Compliance are consfrtertt with the information
3 provided on other applicable complianre documerrts,worksheets,calcula5ons,plans and specifications submitted to the enforcement
- agenry for approvat with ffiis building permit application.
5_ I witl ensure thata completed signed copy ofthis Certificate of Compfiance shall be made available with the building pertnit(sj issued forthe
building,and made available to the enforcement agencyfor all applicable inspections.I understand thata completed signed copy ofthis
_ Certificate of Compiiance is required to 6e induded with the documentation the builder provides�.o e building ownerat occupancy.
, Respo�ssbfe Oesigie�Namc
. �- �v�,' ,�+�/,�/ Responsi6leDezignerS r€`
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. �OmPa�'���i . �-� �� DareSi�ed �
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Addres: ['' / y� //^�.�(7/ / /] ",-/ /-�
, c.� �'� � C.���/��! P/ '�"'YC �C�._ Gcertse_�t/� V .7
. . �/S��Lp��P'r/��f"���v�%J L� % /l✓ Phonr `2�lJ '����� `0 V 4
CA Building Energy E�cie�cy SEandards-2013 Nonresidential Compliance May 2015