The URL can be used to link to this page

15110040CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10787 S BLANEY AVE CONTRACTOR: A D & C DESIGN PERMIT NO: 15110040 OWNER'S NAME:PACIFIC RIM PARK, LLC 2060 WARM SPRINGS CT APT 4 DATE ISSUED: 11/06/2015 OWNER'S PHONE: 4082554163 FREMONT, CA 94539 PHONE NO: (510) 625-9566 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. # Install (2) illuminated wall signs --�2 Contractor U !�/ *y— 0� ate f _ t 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: 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 Sq. Ft Floor Area: Valuation: $3500 performance of the work for which this permit is issued. 1 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 APN Number: 36934053.00 Occupancy Type: permit is issued. , APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: C7 Date: 1 with all non -point source regulations per the Cu rtfno Municipal Code, Section 9.18. ��(� RE -ROOFS: Signature Date 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property,' am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declaratiops: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this / permit is issued. Owner or authorized agent: Date: v 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with Isuch provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildings cuoertino.org tji 1 DOLM PROJECT ADDRESS % G Q � � Ave APN # OWNER NAME PHONE J� 7E -MAIL STREET ADDRESS U 5 CITY, STATE, ZIP ' FAX CONTACT NAME /1 Q/ G u n t 1f�s PHONE E-MAIL I o - STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME A C) D , ->tA LICENSE NUMBER .04- l(f LICENSE Tybp J (/ BUS. LIC # COM91-PANY NAME AV �- ` (J- !L/� E-MAIL `_ L�� FAX _ STREET ADDRESS CITY, STATE, ZIPTV, PHONE 90 62 S 6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME /1 D� r, p r l lJ E-MAIL FAX STREET ADDRESS CrTY, STATE, ZIP PHONE DESCRIPTION OF WORK n IA\ 01 USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE. Commercial ILLUMINATED (Y 1,F) SIGN TYPE (CODE) NO. OF SIGNS SIGN AREA I (SQ 1-T) - VALUATION (S) SIGN TYPE CODES: B - BANNER SIGN M - MONUMENT (GROUND) SIGN BL - BLADE SIGN P - PROJECTING SIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN �' i J l Z �7� v V RECEIVED B C4L TOTI�Ve8 N: By my signature below, I certify to each of the following: I am the property owner or authorized agent to ct n 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 Applicant/Agent: Date: �� °J V 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 Permit application. OFI ICE USE ONLY PLAN CHECK TYPE ' ROMNG SLIP ❑ EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR ❑ BUFLI)ING PLAti REVIENV ❑ PLANNUIG PLAN REQ IENV ❑ oTIIER: SignApp_1011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION SIGN TYPE ADDRESS: 10787 S Blaney Ave DATE: 11/06/2015 REVIEWED BY: Phuong :Meeh. Permii Fee: APN: 369-34-053 BP#: *VALUATION: 1$3,500 *PERMIT TYPE: Building Permit f'1-',;� (:1fECk ]'HIE, PRIMARY USE: Sign PENTAMATION PERMIT TYPE: 10EAP5 WORK Install 2 illuminated wall signs SCOPE Suppl. Insp. Fee.S Reg. OT0 SIGN TYPE FEE ID 'tarnah. Plane Check QTY :Meeh. Permii Fee: SIGN FEE IESIGN Elec. Permit Fee: IEPERMIT Wall Sign, Electric 1SIGNWELEC Other Elec. Insp.0.0 $48.00 2 $572 Permit Fee: $572.00 Suppl. Insp. Fee.S Reg. OT0 0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 (: onstruclion 7'crx: _ Wministraiiiv Fee: Work Without Permit? Yes (F) No $0.00 TOTALS: $0.00 Travel Documentation Fee: ITPA VDOC $572.00 Strong Motion Fee: IBSEISMICO NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These Pees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) ilech. Plan Check 'tarnah. Plane Check # Branch Circuits 1 $48.00 :Meeh. Permii Fee: lliw0" Po-r;ir 1-°, , IESIGN Elec. Permit Fee: IEPERMIT Suppl. PC Fee: (F) Reg. OTFO-OThrs 113iher.Plunib Ir,sp.Li Other Elec. Insp.0.0 $48.00 $0.00 Permit Fee: $572.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These Pees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Cheek Tee: Suppl. PC Fee: (F) Reg. OTFO-OThrs $0.00 Permit Fee: $572.00 Suppl. Insp. Fee.S Reg. OT0 0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 (: onstruclion 7'crx: _ Wministraiiiv Fee: Work Without Permit? Yes (F) No $0.00 Sign Master Plan: Yes (F) No $0.00 Travel Documentation Fee: ITPA VDOC $48.00 Strong Motion Fee: IBSEISMICO $0.98 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $717.98 $0.00 TOTAL FEE: 1 $717.98 Revised: 10/01/2015 STATE OF CALIFORNIA SIGN LIGHTING EC-NRCC-LTS-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Na— y P Date Prepared: Project Address: Location of Sign l Outdoor Sig—ns ❑Indoor Signs Phase of Sign Construction Tt New Signs ❑ 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 1 have responsibility for installing the sign lighting controls ❑ Yes, complete parts 1a and 1b of this form No, complete part 1a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑ Yes 1;fNo 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls 14 Yes ❑ No 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 installing compliant sign lighting controls ❑ Yes 15 No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and someone 5 else will be responsible to install compliant sign lightin�g�°ntrols ❑ Yes NIo CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC- NRCC-LTS-01 -E (Revised 06114) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) Project Name: Date Prepared: ` 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: 1 §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time- Y N NA switch control_ ❑ ❑ §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N NA switch control, or an astronomical time -switch control. d El 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. ❑ §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 3 Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ ❑ day and night. EXCEPTION to Section 130.3(a)28: Outdoor signs in tunnels and large covered areas that are intended to be Y NA illuminated both day and night. ❑ l9 §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 ❑ ❑ 60 4 reducing the lighting power by a minimum of 30 percent when receiving a demand response signal. EXCEPTION to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, Y NA ordinance, or regulation to be reduced by 30 percent. ❑ Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING AW, CEC-NRCC-1-TS-01-E(Revised 06/14) C ALIFURNIA tNtf,UY WMM[bbIUN CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) Project Name: ' Date Prepared: �, n 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 i Symbol OPTIONAL— Energy Complies Filed Inspector Or Code Description of the Sign Verified Label (see Allotted Watts Design Watts y/N Check that sign instructions below) complies ^ Y = v a a, C: t7 vi _ M 3 3 3 v c x M 5 w C v N m C v c m Y a a N X = II p F- 3 o v LJ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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'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). 1 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 afield inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014 STATE OF CALIFORNIA SIGN LIGHTING sit CEC-NRCC-LTS-01-E(Revised 06/14) UALR-UKNIA ENEKGY UUMMISSIUN CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 4 of 5) Project Na— I v,� j Date Prepared: % _ j tA_- 3. 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 Specific light source used for Symbol ENERGY VERIFIED compliance Field Inspector or Description label Shall include only lighting Check that Sign Code (see instructions technologies listed below Complies below) List all that apply T, 1D (� ❑ ❑ 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 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with 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 wattage to the lamp divided by the measured operating input wattage when tested according to ANSI C82.6-2005. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 percent D 4 when the transformer or power supply rated output current is less than 50 mA. The ratio of the output wattage to the input wattage is at 100 percent tubing load. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68 percent 5 when the transformer or power supply rated output current is 50 mA or greater. The ratio of the output wattage to the input wattage is at 100 percent tubing load. 6 Fluorescent lighting systems meeting one of the following requirements: A. Use only lamps with a minimum color rendering index (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 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 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 not contain a medium screw base sockets (E24/E26). E This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014 c STATE OF CALIFORNIA ih SIGN LIGHTING CEC-NRCC-LTS-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting l> (Page 5 of 5) Project Na— Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Company: Signature Date: i I -C -qtr Address: CEA/ HERS Certification Identification (if applicable): City/State/Zip: �,� Phone: J Cj 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 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: L,4 -i _7 / _, —Responsible h.. Designer Signature: , ^ Company: Date Signed: t _ (0 Address: /_ O ... �� , ; License: City/State/Zip: Phone: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 r. STATe OF CALIFORNIA SIGN LIGHTING EC-NRCC-LTS-01-E(Re,Ased 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of S) 'roject Name: /�,� _ /�i/ 7 /,� o /� Date Prepared: V vvi'V l h✓�� ((� {r fes+ Project Address: Location of Sign 14 Outdoor Signs ❑ Indoor Signs Phase of Sign Construction J"ew Signs ❑ Sign Alterations Type of Lighting Control ❑ New Lighting Controls J -Replaced Lighting Controls ❑ Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) .1 -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 hove 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 1 have responsibility for installing the sign lighting controls ❑ Yes, complete parts la and lb of this form i6o, complete part la of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑ Yes 16 No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls 13 -Yes ❑ No 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 installing compliant sign lighting controls ❑ Yes1Vo There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and someone 5 else will be responsible to install compliant sign lighting controls ❑ Yes EtBO OFFICE COPY '�ECEIV ED CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING o CEC-NRCC-LTS-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) Project Na- Date Prepared: ' j l2;,, C 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: 1 §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time- Y N NA switch control. ❑ ❑ 0 §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N NA switch control, or an astronomical time -switch control. t§ ❑ a 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. ❑ 1 1a §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 3 Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ ❑ day and 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. ❑ §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 ❑ ❑ 0- 4 reducing the lighting power by a minimum of 30 percent when receiving a demand response signal. EXCEPTION to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, Y NA ordinance, or regulation to be reduced by 30 percent. ❑ C> _ Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) Project Name: ' ^ i i� 0o Dale Prepared: / 1 ` —2-6T -6I 2 Maximum Allowed Liehtin¢ 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 Symbol y Or Code Description of the Sign OPTIONAL - Energy Verified Label (see instructions below) Allotted Watts Design Watts Complies y/N Filed Inspector Check that sign complies ✓ N Q in = ai v _> ? M C f0 C c E 61 X _� X = — a 3 3 LL N M y X 3 r ry O I I I O Q =- y Y " O vl w E 0 V ✓ -'119 ❑ 2 W [ VJ "J ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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. C OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed, ENERGY VERIFIED label, confirming that the sign complies with the Section 140.8 of the California 2013 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For Signs with such an ENERGY VERIFIED label, columns 'D' through 'I' are not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance. An ENERGY VERIFIED label is not needed for compliance. D The sign area in square feet. E List "I" if the sign is internally illuminated. List "E" if the sign is externally illuminated. F Allowed watts per square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2.3 if sign is listed as "E" in column E. G Multiply the square footage in column D times the allowed Lighting Power Density (LPD = watts) in column F. H Show the total installed watts in the sign, as determined according to the applicable provisions of §130(c). 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: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STA? OF CALIFORNIA SIGN LIGHTING (F/ CEC-NRCC-1-TS-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 4 of 5) Project Name: Q Date Prepared: 3. 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 Specific light source used for Field Inspector Symbol ENERGY VERIFIED compliance Check that Sign or Description label Shall include only lighting Complies Code (see instructions technologies listed below below) List all that apply Grti G� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with 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. y 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 wattage to the lamp divided by the measured operating input wattage when tested according to ANSI C82.6-2005. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 percent D 4 when the transformer or power supply rated output current is less than 50 mA. The ratio of the output wattage to the input wattage is at 100 percent tubing load. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68 percent 5 when the transformer or power supply rated output current is 50 mA or greater. The ratio of the output wattage to the input wattage is at 100 percent tubing load. 6 Fluorescent lighting systems meeting one of the following requirements: A. Use only lamps with a minimum color rendering index (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 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 power less than or equal to 250 watts, shall comply with the applicable requirements of the Appliance Efficiency Regulations (Title 20). 9 1 Compact fluorescent lamps that do not contain a medium screw base sockets (E24/E26). E This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 SWIE OF CALIFORNIA SIGN LIGHTING r.;" CEC-NRCC-LTS-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 5 of 5) Protect Name: Date Prepared: I / / tL� _ DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Company: 4 D p , � i�% �(J> ` Signature Date: -- r r ,NIC—" Y� n l Address: 1'o b o 1'J C—" CEA/ HERS Certification Identification (if applicable): City/State/Zip: � � _ �v� Phone: 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 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: L.� Responsible Designer Signature: !� Company: /�� n ) ✓may Date Signed: / Address: b ,.� c c� S Com-. License: z >4 /State/Zip: 2 – ) r Phone: v ! -4- ` 9 f CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 18" HIGH ILLUMINATtu CHANNtL L,LTT'LK � UK "MUNVftJT1L11X4 'Uu'UA " UN 11;AC1LWAY11 COLOR AND MATERIAL: SIGN FACE: WHITE PLEX SHEET COVERED BY VINYL SIGN BODY: BROWN , TRIM CAP: 3/4" BRONZE RACEWAY: PAINTED IN GREEN TO MATCH THE EXISTING WALL ALL SIGNS ARE UL LISTED EXISTING SIGN PROPOSED SIGN 200„ D !F7 n D D TEA U DESSERT J SCALE: 1'=2'-1" Note: Colors depicted here are a graphic representation actual colors may vary. total sign size: 200x18/144=25SQFT SIGN OCCA. frAn G WtAF .- 9 t2o13 CSC, eEC1 A CGV'C 4RTMENT NNO iT be kept at the ful to make any to deviate uilding official. ms SHALL NOT -- -• -- a 14wruvai of the vi I f 4„ t L.E.D. UNITS TRANSLUCENT FLEX FACE �--� 1/4"04" SELF DRIVE SCREW WITH'/,' DIAMETER ROUND ALUM. TUBE (1" HIGH) V aeon •0ru+na„nce or State I_aw it 6 RACEWAY S e o>Pe o� Y1G'. (2) i (1 tAM(ro,% WA I I 51ers RACEWAY BE SECURED ON METAL PANEL BY USINGI/4"x2" SELF TAP METAL SCREW, EVERY 36" INTERVALS OF BLDG.WALL (METAL WALL) CLASS 2 POWER SUPPLY DC 12V, 6 Amp PRIMARY ELECTRIC LINE (NEC600.5) TO JUNCTION BOX (120V, 20Amp CIRCUIT) 3/4" TRIM CAP + 1/4" DRAIN HOLE • ��jj L GROUNDING LUG OR RING - ---- - - LED LETTER SECTION �" .I NECKED DY SING DEPT CUPERTINO CUPERTINO . Building Department r ... NOV 0 6 2015 REVIEWED FOR CODE COMP'. Reviewed By: wD_� 'ICE COPT RECEIVED NOV 062015 BY PROJECT APPLICANT name: AD&C DESIGN (CONTRACTOR) address: 2060 Warm Spring CT#4 Fremont, CA94539 phone: 510-625-9566 contact person: Simon contractor number: 929828 date: 11-2-2015 BUSINESS OWNER(sign location) address: 10787 S Blaney Ave, Cupertino . CA 95014 Contact: Phone: Company: date: APPROVAL BY PROPERTY OWNER address: phone: signature: date: Customer Signature and Date: This rendering is computer generated. Drawings are to scale using actual colors but images may appear slightly different on your monitor or printer depending on the model. We have made every effort to make this to your specifications, but please take a moment and make sure we have it right. This is an art proof that is designed to meet the approval of the customer, once approval is granted, we (Ad&c design .Inc ) are no longer liable for typographical and/or design layout errors. Please do not give approval until it meets your requirements. You will be held financially responsible for this order when we receive your approval. 1611 HIGH ILLUMINATtu CHANNEL LtTTEK rUK "MUN�T�� U�A" UN �;A��WAY�I COLOR AND MATERIAL: SIGN FACE: WHITE PLEX SHEET COVERED BY VINYL SIGN BODY: BROWN , TRIM CAP: 314" BRONZE RACEWAY: PAINTED IN GREEN TO MATCH THE EXISTING WALL ALL SIGNS ARE LIL LISTED EXISTING SIGN PROPOSED SIGN J!JJ'J SCALE:1 '=2'-1" 200" D Note: Colors depicted here are a graphic representation actual colors may vary SIGN TEA DESSERT total sign size: 200x18/144=25SQFT 4„ RACEWAY RACEWAY BE SECURED ON METAL PANEL BY USING1/4"x2" SELF TAP METAL SCREW, L.E.D. UNITS EVERY 36" INTERVALS TRANSLUCENT PLEX FACE • 1/4x314" SELF DRIVE SCREW WITH Yi' DIAMETER ROUND ALUM. TUBE (1" HIGH) Ci ;—� (METAL WAALL ) CLASS 2 POWER SUPPLY DC 12V, 6 Amp\./ �' PRIMARY ELECTRIC LINE (NEC600.5) TO JUNCTION BOX (121V, 20Am1 CIRCUIT) 3/4" TRIM CAN �-------------- _ 1/4" DRAIN HOLE • GROUNDING LUG OR RING -- - LED LETTER SECTION - - - PROJECT APPLICANT CUPERTINO AD&C DESIGN Bui+ding Department J Ay. rz address: 2060 Warm Springs CT#4 NUOV 0 6 2015 RE`diEViED FOR CODE COMPIL _— —� R3vieW,e 510-625-9566 4„ RACEWAY RACEWAY BE SECURED ON METAL PANEL BY USING1/4"x2" SELF TAP METAL SCREW, L.E.D. UNITS EVERY 36" INTERVALS TRANSLUCENT PLEX FACE • 1/4x314" SELF DRIVE SCREW WITH Yi' DIAMETER ROUND ALUM. TUBE (1" HIGH) Ci ;—� (METAL WAALL ) CLASS 2 POWER SUPPLY DC 12V, 6 Amp\./ �' PRIMARY ELECTRIC LINE (NEC600.5) TO JUNCTION BOX (121V, 20Am1 CIRCUIT) 3/4" TRIM CAN �-------------- _ 1/4" DRAIN HOLE • GROUNDING LUG OR RING -- - LED LETTER SECTION - - - PROJECT APPLICANT name: AD&C DESIGN (CONTRACTOR) address: 2060 Warm Springs CT#4 Fremont, CA 94539 phone: 510-625-9566 contact person: Simon contractor number: 929828 date: 11-2-2015 BUSINESS OWNER(sign location) address: 10787 S Blaney Ave, Cupertino . CA 95014 Contact Phone: Company: date: APPROVAL BY PROPERTY OWNER address: phone: signature: date: NCE Customer Signature and Date: This rendering is computer generated. Drawings are to scale using actual colors but images may appear slightly different on your monitor or printer depending on the model. We have made every effort to make this to your specifications, but please take a moment and make sure we have it right. This is an art proof that is designed to meet the approval of the customer, once approval is granted, we (Ad&c design .Inc ) are no longer liable for typographical and/or design layout errors. Please do not give approval until it meets your requirements. You will be held financially responsible for this order when we receive your approval.