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13120078p CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20620 HOMESTEAD RD CONTRACTOR: ALLEN SIGNS INC PERMIT NO: 13120078 OWNER'S NAME: THE SOBRATO ORGANIZATION 1982 STONE AVE DATE ISSUED: 12/10/2013 OWNER'S PHONE: 4084460700 SAN JOSE, CA 95125 PHONE NO: (408)280-6500 C LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL, �/� License Class `"�� Lic. # INSTALL (N) ILLUMINATED CHANNEL LETTER SIGN (EXTERIOR, US BANK) Contractor LDate 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 add 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $2000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32610066.20620 Occupancy Type: 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 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 DAY LAS LLED 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 ssued by. a e. I 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\2—.1 kA- Date t 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, ❑ 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) . 1, 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 declarations: 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 ii Owner or authorized agent: Date: tZ� bb-- permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of theLabor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such 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 reformation 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of:Cupertino against liabilities, judgments, 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, theapplicant understands and will comply with all non -point source regulations.per the Cupertino Municipal Code, Section Licensed Professional 9.18: Signature Date p CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20620 HOMESTEAD RD CONTRACTOR: ALLEN SIGNS INC PERMIT NO: 13120078 OWNER'S NAME: THE SOBRATO ORGANIZATION 1982 STONE AVE DATE ISSUED: 12/10/2013 OWNER'S PHONE: 4084460700 SAN JOSE, CA 95125 PHONE NO: (408)280-6500 C LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL, �/� License Class `"�� Lic. # INSTALL (N) ILLUMINATED CHANNEL LETTER SIGN (EXTERIOR, US BANK) Contractor LDate 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 add 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $2000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32610066.20620 Occupancy Type: 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 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 DAY LAS LLED 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 ssued by. a e. I 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\2—.1 kA- Date t 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, ❑ 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) . 1, 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 declarations: 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 ii Owner or authorized agent: Date: tZ� bb-- permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of theLabor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such 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 reformation 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of:Cupertino against liabilities, judgments, 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, theapplicant 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 • building(akupertino.org 00 1� S PROJECT ADDRESS S n dl APN # 2 lO _ (0/_ • Z O 6 �v ' OWNERNAME TM_ sq 11"01 PHO�� O E-MAIL STREET ADDRESSCITY, w v o N. hre k A245D STATE, ZIP p���' C;0� 1,501 y FAX CONTACT NAME /a /`3 ``Tij(� PHONE • v b b E-MAIL STREET ADDRESS P ` QAwe. CITY, STATE, ZIP �r FAX ❑ OWNER ❑ OWNER -BUILDER„( ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHTTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEI /� NG LICENSE NUMBEk,3 ,n LICENSE TYPE BUS. LIC # COMPANY NAME ` � f A IA e l nG �7 E-MAIL FAX STREET ADDRESS I Q ¢ J Z (fit CITY, STATE, ZIP, PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: Commercial ILLUMINATED N) SIGN TYPE (CODE) NO. OFT SIGNS AREA (SQ. FT.) VALUATION ($) 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 RECEIVED BY: TOTAL U�O By my signature below, I certify to each of the following: I am the property owner or authorized agent to act 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 o i g cons tion. I authorize representatives of Cupertino to enter the above-ide ti fie property for inspection purposes. Signature of Applicant/Agent: Date: 2 u SUPPLEMENTAL TNFIdMATION REQUIRED /Site Plan * / Elevations �,ign Details - including UL listing(s) applicable �Sttyctural Calculations (if applicable) s—,C/opy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR BUILDING PLAN REVIEW (PLANNING PLAN REVIEW ❑ OTHER: SignApp_2011.doc revised 03/31/11 ,,,��� CITY OF CUPERTINO IFF.F. F.CTiMATOR — RITII,DING DIVISION SIGN TYPE ADDRESS: 20620 HOMESTEAD RD DATE: 12/10/2013 REVIEWED BY: MELISSA Plan Check Fee: APN: 32610066.20620 BP#: "VALUATION: 1$2,000 %PERMIT TYPE: Building Permit PLAN CHECK TPPE: pRIMy Sign Plumb.itYlech./Elec PENTAMATION 1 CEAP5 USE: Permit Fee: PERMIT TYPE: WORK INSTALL N ILLUMINATED CHANNEL LETTER SIGN EXTERIOR US BANK SCOPE $0.00 SIGN TYPE FEE ID: , QTY/FEE QTY Plan Check Fee: SIGN FEE Wall Sign, Electric 1SIGNWELEC hr's 1 Plumb.itYlech./Elec $278 Permit Fee: $278.00 Suppl. Insp. Fee Reg. 0OT0.0 hrs $0.00 PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction .Tar: Administrative .Fee: Work Without Permit? . ® Yes (E) No $0.00 TOTALS: $0.00 amu;, t.T $278 00 5 Xkch. Plan Check Phwib. Plan Check # Branch Circuits 1 $47.00 Llech. Pe rinit Fee:: Plumb. Permit Fee: IESIGN Elec. Permit Fee: IEPERMIT Other Rech. 'Insp. L CJiher Plumb Insp. - Other Elec.-Insp.0.0 $47.00 Adech. Insp. lee: Plumb. Insp. Fee: Elec. Insp. Pee: NOTE: This estimate does not'include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.). These fees are based on the prelinddna information available and are only an estimate. contact the ue t or aaan't in o. FEE ITEMS (Fee Resolution 11-053 E . 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee: (2) Reg. 0 OT 0!01 hr's $0.00 Plumb.itYlech./Elec Permit Fee: $278.00 Suppl. Insp. Fee Reg. 0OT0.0 hrs $0.00 PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction .Tar: Administrative .Fee: Work Without Permit? . ® Yes (E) No $0.00 Sign Master Plan: ® Yes : (E) No $0.00 Travel Documentation Fee:1TRAVDOC $47.00 Strong Motion Fee:IBSBISNiICO $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 q $ 420.50 SO :. 0. ' i $00 $420,50 Revised: 10/01/2013 Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTG-1C Project Name: /yS Date: Project Address: � Title 24, Parts 1 and 6 of the California Code of Regulations. r this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the Location of Sign R Outdoor Signs 0 Indoor S gns Name: Kimberly Lin Phase of Sign Construction M New Signs ❑ Sign Alterations Company:Phone Type of Lighting Control E New Lighting Controls ❑ Replaced Lighting Controls ❑ Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) Address: 1982 Stone Ave " ❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power ® Specific Lighting Sources 1. Certificate of Compliance Declaration Statement (this may be a CIO, C45 or other eligible person) N I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. R� I am eligible under Division of the California Business and Professions Code to accept responsibility for the lighting design. PS This Certificate of Compliance identifies. the lighting features and performance specifications required for compliance with Title 24, Parts 1 and 6 of the California Code of Regulations. ® The design features represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for -approval with this building permit application. Name: Kimberly Lin Signature . Company:Phone { X I certify that the requirements detailed on this Certificate of Compliance have been inet: ' Allen Signs, Inc 408-280-6500 Address: 1982 Stone Ave " License number (may be contractor's lic #) Company Name: C-45 834580 City/State/Zip: San Jose, CA 95125 Date F k ncf 1 A 2013 2. Installation Certificate (to be signed by responsible person after installation) Permit number rt , } Checkedby/Date— (Enforcement Agency Use , . i.. (Enforcement Agency Use Installation Declaration statement X I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. X I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction. X I certify that the installed features, materials, components, or manufactured devices ti c iLcrti a ^o oapplicable codes and regulations, and the installation is consistent with the plans pe tco h enforcement agency. ` { X I certify that the requirements detailed on this Certificate of Compliance have been inet: ' %i I will ensure that a completed, signed copy of this Installation Certificate shallbe posted, or rgdd, N®the building y permit(s) issued for the building, and made available to the enforcement 'agenc for all appWcaIf �i> c � derstand builder that a signed copy of this Installation Certificate is required to be included with;the documentation a provides to the building owner at occupancy. ' Company Name: Allen Signs, Inc E Responsible Person's Name: Kimberly Lin Respon ible ii's 11 License number (may be contractor's lic #) Date Signed: PositioA Witho any: 834580 Pject M ger ro 2008 Nonresidential Compliance Forms October 2010 Certificate of Compliance (Sign Lighting) (Page 2 of 4 SLTG-1C Project Name: Date: 3. 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 or the entire construction. 3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of 4 on this SLTG-1C shall complete Part 3a. Check Yes or No for all of the following statements: 1 I have responsibility for installing the sign lighting controls §133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo ❑ Yes, complete parts 3a and 3b of this form ® No, complete part 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls 2 ❑ Yes R No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls ❑ ❑ Yes ® No Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and I will be 4 installing compliant sign lighting controls daylight hours. ❑ Yes M No 1 g] There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and someone else 5 wijl be responsible to install compliant sign lighting controls N 1 10 Yes WNo 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-I C 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 ma datory measures (sign lighting control note block can be located: 1 §133(a)1. All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA applicable requirements of § 119. ❑ ❑ M §133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA 2 control, or an outdoor astronomical time switch, that comply with the applicable requirements of § 119. KI ❑ ❑ Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ 1 g] §133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA sin power by a minimum of 65 percent during nighttime hours. 131, ❑ 91 Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours. Y ® NA ❑ 3 Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for Y NA illuminating signs or parts of signs. ❑ 91 §133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than Y N N/A 15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ P9 4 receiving a demand response signal that is sent out by the local utility. Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including Y NA but not limited to exit signs and traffic signs. ❑ Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 Certificate of Com , liance. (Sign Lighting) a e 3 of 4 SLTGIC Project Name: Date: 4. 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 5 of this Certificate of Compliance if there are signs using the S eciftc lighting sources method of compliance A B C D E I F G H I J A Allowed Watts Design Complies? Watts Y / N w o >� 0 w° w 3 N A Field o Inspector rn o W �, .f. 11 0 a" Check that �? w ¢0 Sign a Complies Description V,F Internally Illuminated Letter Sign ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 buildin • 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 148 of the California 2008 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 C by Underwriters Laboratories (ITL) 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 insquare feet. E List "I" if the sign is internally illuminated. List "B"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 Iisted as "E" in column E. G Multiply the square footage in column D times the allowed Lighting Power Density PD = watts) in column F. H I Show the total installed watts in thesign, as determined according to the applicable provisions of § 130(d ore . I Enter Y if the number in column H is less than or equal to the number in column G. Otherwise the sign does not comply. J This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 Certificate of Compliance (Sign Lighting) (Page 4 of 4) SLTG-1C Project Name: Date: 5. Specific Lii!htine 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 4 of this Certificate of Compliance if there are signs using the maximum allowed lip!!ng power method of compliance) A B C D E OPTIONAL Field ENERGY Specific light source used for Inspector Symbol VERIFIED compliance Check that or Description label Shall include only lighting Code (see instructions technologies listed below Sign Complies below) List all that apply Internally Illuminated Letter Sign ❑ 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 148 of the California 2008 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 I through 10 that apply in column D above for each row. I High ressure sodium lamps 2 Pulse start or ceramic metal halide lamps served by a ballast with >_ 88% efficient Pulse start metal halide lamps that are < 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast 3 with > 80% efficient 4 Neon or cold cathode lamps with transformer or power supply efficient > 75% with rated output current < 50 mA 5 Neon or cold cathode lamps with transformer or power supply efficient >_ 68% with rated output current >_ 50 mA D Fluorescent lamps with a minimum color rendering index (CRI) of 80 6 (Note: when using electronic ballasts for compliance, lamps with a CRI < 80 may be used 7 Light emitting diodes LEDs with a power supply with > 80% efficient Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC 8 output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as complying 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 1 10 Electronic ballasts with a fundamental output frequency > 20 kHz E This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 -Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: , io gnature Date Please check applicable subcontractors and co lete the following information: G/ JOB ADDRESS: Zo6zo PERMIT # 3 ZOb BUSINESS NAME OWNER'S NAME: PHONE #$�Z—+�S�3z� GENERAL CONTRACTOR: e� BUSINESS LICENSE # ADDRESS: r CtRZ TY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: , io gnature Date Please check applicable subcontractors and co lete the following information: G/ SUBCONTRACTOR BUSINESS NAME BUSINESS CENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / 1kobtractor Signature lz/, 0%3 Date 27.9 SQUARE FOOTLED ILUMINATED CHANNEL LETTERS '.I�tj(;L J;UF YPLAIN-, CCIKED BY 2 FACES: 3/16" #7328 White acrylic w/ surface applied Trans. Red vinyl 1 O (+ I J DATE overlay leaving white "us" copy show thru White 959 T YLER BL VD. bank 279379 70/09!13 Sign TRIMCAP: 2" jewelfte painted Matthews Red TOR OHIO 44060 PH. A40.209.8200 7 I .: E.- IACO DN©EF Partnarwththaeesf. T'FAX RETURNS: 5" deep .063 alum. -painted Matthews Red N 20620 HOMESTEAD ROAD _Y PLANNING DEPT. Lwww.mcsip ;, FACES: 3/16" #7328 White acrylic TRIMCAP: j"-jewelfte painted Matthews Blue CUPERTINO, CA 95014 US BANK\2013 NETSVSAFEWAYICA�3251 - CUPERTINO NOTE: PRINTS ARE THE EXCLUSVE PROPER7V OF'MCSIGN DATE RETU 5° deep .063 alum. -painted Matthews Blue O tJ LJACKS: g ( - BLDG. DEPT, .063 Num. - pre -painted White < �` �! ILWM : White GE Tetra PowerMax WHPMS2-65K led's as required; a channel letters to be equipped with photocell u i I d i n g Den f1}T 1ft p 27=1 '-0 G�NTING: Mounted flush to wall using appropriate fasteners p� 32'-O" STORE FRONTAGE 10 COMMUNITY DER/=LOPM NT t •Tly#� NT BUILDING UlviSiON - C !� . . 14'-6" f✓' - C OLOR MICNING r"�fe Plf°� led Northern RRG L �JIEVVEG FOR CODE COMP IANCE � MatthewsMP10918. L t Scale: 2" = 1'-0" Panto Panton 193 Red sitC during construction. It is Lln!a'�vful to m« a II �� changes or alterations on same, or . niak�:� :1= =1�,:.?;F>:=,1:;:1. . 293Red LED CHANNEL - REMOTE, FLUSH ESU �"° Photo Cell Trim cap AN. r..r F- Ttinop ,w.HkMWI­ AlutlgmEitJm DUdMAd LED 1117rytlgi': I.. 959 T YLER BL VD. bank 279379 70/09!13 Sign TOR OHIO 44060 PH. A40.209.8200 7 I .: E.- IACO DN©EF Partnarwththaeesf. T'FAX 440-2094277 20620 HOMESTEAD ROAD '. �. I Lwww.mcsip com CUPERTINO, CA 95014 US BANK\2013 NETSVSAFEWAYICA�3251 - CUPERTINO NOTE: PRINTS ARE THE EXCLUSVE PROPER7V OF'MCSIGN COMPANY'. ANY UNAU7140ROED USE OR DUPUCAnON tMLL RESULT INA 2095; CHARGE PER OCCURANCE PER 7HE VALUE OF 7HE®' AIQSIGN CO 1998 'Zo *L# I I -Ir - -I HOMESTEAD, ROAD