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B-2016-1335CITY OF CUPERTINO BUILDING PERMIT BVILDINGADDRESS: CONTRACTOR: PERAW NO. 13-2016-1335 19449 STEVENS CREEK BLVD STE 100 CUPERTINO, CA 95014 (316 20 112) OWNER/BUILDER OWNER'S NAME: MAIN STREET CUPERTINO A03REGATOR LLC DATE ISSUED: 02109/2016 OWNER'S PHONE: 408-777-3081 PHONE NO: LICENSEDCONTRACTOR'S DECLARATION_ BUIILDING PERMIT INFO: License Glass Lie. # Contractor MNEWBUiLDERDate 4210912096 XBLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH _ RESIDENTIAL X COMMERCIAL with Section 7000) of Divislon 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCR PTION: I hereby affirm under penalty of perjury one of the following two declarations: HOWARD'S SHOES - (STE 100) - INSTALL I ILLUMINATED WALL SIGN (MAIN STREET) 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 Cade, 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. Sq. Ft Floor Area; Valuation: $1400,00 APPLICANT CE>7'rIFICATION I certify that 1 have read this application and state that the above APN Number: Occupancy Type: information is correct l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby 31620112 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 PERMIT' EXPIRES IF WORK IS NOT STARTED expenses which may accrueagainst said City in consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAS ED INSPECTION. Cade, Section 9.18. - by:1vl0 Signature Date 02/09/2096 ate: 02/09/2DI6 Date:l RE -ROOFS: OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for i. I, as owner of the property, or my employees with wages as their sole inspection, f .r compensation, will do the work, and the structure is not intended or offered f9r.salc (Sec.7044, Business & Professions Code) Signature of -Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 0210912016 contractors to construct the project (Scc.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations; ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued, I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will �y Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous a. I certify that in the performance of the work. or which this permit is issued, I material. should I use equipment or devices which emit hazardous shall not employ any person in any manncr so as to became subject to the air contaminants definedth the Bay Area Air Quality Management District i Worker's Compensation laws of California. If, after making this certificate of will maintain compliance & S fety the Cupertino Municipal Code, Chapter 9.I2 and mama pl the Health &Safety Cade, ections 255 5533. W255341. exemption, I become subject to the Worker's Compensation provisions of the Labor Cade,'I Hurst forthwith comply with such provisions or this permit shall Owner or' authorizad agent' be deemed revoked. Date; 02(0912096 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY certify that I have read this application and state that the above information is i hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address 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 ARCHI I ECT'S DECLARATION I understand my plans shall be used as public records. Cupertino Municipal Code S coo .18. Licensed Signature �' Date 02/09/2096 Professional SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION '10300 TORRE AVENUE • CUPERTINO, CA 9501€-3255 (408) 777-3228 FAX (408) 777-3333 buildingftunertino.ar0 S PROJECT ADDRESS ! i +� �[ Ul'uV L� f �C 1U 'V r Y APN # 316, G 6 - 70,T 1 A OWNER NAME t { 1VlQ} HON�I jirFl(jf �q(� STREET HE1gH(� qrh V� 7T,wC D J�] } 7 C�T�' 6 I ` P tt� G �03 CONTACT NAMEPHONE �L &MAIL I j .--j � t ! ^ r� � r STREET ADDRESS fol AG [AGENT 1113 .CITY, ST _. ZIP l�� ,I�.� /'1 i �- ?5-1)J FAX C -0-1K 1'Vlctf i• © OWNER 13 OWNED BUILDER 13. OWNER CONTRACTOR © CONPRACTOR AGENT 0 ARCjHI,i r&CT 11(ENGi1NEER 11 DEVELOPER 13 TENANT CONTRACTOR NAME ( LICENSE NUMBER LICENSETYPE. EUS. LIC# COMPANYNAME E-MAIL FAX STREET ADDRESS CrrY, STA -r8, ZIP PHONE - ARCHITECT/ENGEN.BER NAME LICF,NSENUMBER ]3US.LIC4 COMPANYNAME. E-MAIL FAX STREW ADDRESS CITY, STATE, Zn' PHONE DESCRIPTION OF WORK , c �. d � USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial ILLUMINATED SIGN TYPE (Y/N) (CODE) NO, OF SIGNS SIGN AREA (SQ. FT.) VALUATION ($) SIGN TYPE CODES: B - BANNER SION M - MONUMENT(GROUND)SION• BL - BLADE SIGN. P - PROJECTING SIGN D -- DEVELOPMENT 10 SIGN SP - SPECIAL EVENT BANNER DI -- DIRECTIONALSIGN T -- TEMPORARY E - ELECTRONIC W - WALL, SIGN READERBOARD WI - WINDOWSIGN RECEIV VIl U V V� U By mysignature below, leer* to each of the following: I am the property o 6 e r au rized agent to act on the property owner's behalf. Illavereadthis application and theinformation I have rovia, is correc . I h e read the Description of Work and verify it is accurate. I agr to.comply with all applicable local ordinances and State laws relating to 1 coa c I Drize representatives of Cupertino to enter the aboovve-i n of d�operty for inspection purposes. Signature ofApplicanUA ----- - Date: 7 j SUPPLEMENTAL INFORMATION REQUIRED Site Plan Eltvations Sign Details - including LIL listing(s) applicable Structural Calculations (if applicable) Copy of Plauning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP ❑ OVER -TILE -COUNTER ❑ XXPRESS ❑ STANDARD ❑ LARGF ❑ vimoR ❑ BUILDING PLAN REVIEW D PLANNING PLAN REVIEW ❑ oTHER- SignApp 2011.doc revised 03/31111 `s CITY OF CUPERTINO FEE ESTIMATOR — RTTTT ,TITNfY` D11VTRIFON SIGN TYPE FEE ID QTY SIGN FEE Wall Sign, Electric 1 SIGNWELEC 1 $286 TOTALS: ,. NOTE. This estimate Anes not include fees clue to other Denarintents (i.e. Planning.. Public Works. Fire. Sarthary Server Mvfrict. -School District. etc). Contact the Dent for adeln'I info. FEE ITEMS (Tee Resolution lI 053 ,E.f, 7111.13 ADDRESS: 19449 STEVENS CREEK BLVDDATE: 02/09I201fi REVIEVYED BY: ABBY Han Check bee: APN: 316 20 112 P,P##: *VALUATION: 1$1,400 PERMIT TYPE: Building Permit PL2:ttll�::'7L: PRIMARY Sign USE:- PENTAMATION PERMIT TYPE: 1 CEAP5 WORD HOWARD'S SHOES - STE 100 - INSTALL 1 ILLUMINATED WALL SIGN SCOPE Suppl. Insp. Feer Reg. 0 OT SIGN TYPE FEE ID QTY SIGN FEE Wall Sign, Electric 1 SIGNWELEC 1 $286 TOTALS: ,. NOTE. This estimate Anes not include fees clue to other Denarintents (i.e. Planning.. Public Works. Fire. Sarthary Server Mvfrict. -School District. etc). Contact the Dent for adeln'I info. FEE ITEMS (Tee Resolution lI 053 ,E.f, 7111.13 FEE QTY/FFE MISC ITEMS Han Check bee: Suppl. PC Fee: (F) Reg. 0 OT F0701 hrs $0.00 Per:nit Pee: $286.00 Suppl. Insp. Feer Reg. 0 OT D.4 firs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 (`nrtslracti n lar' _T7- _4&n Lidwi1 a7five Fee, Work Without Permit? 0. Yes G) No $0,0Q Sign Master Plan: Q Yes (a No $0.00 Travel Documentation Fee; 17RA VDOC $48.00 Strong ful:otion Fee: 1BSE1SMICO$11.50 Select an Administrative Item Bldg:Stds Commission Fee: IBCBSC 1 $1.00 ..................... _.._ SUBTOTALS. $431' .50 $0.00 -. TOTAL FEIJ -: $431 50 Revised: 01/01/2016 :4j V OWNER -BUILDER DISCLOSURE FORM Z-A COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 - FAX (448) 777-3333 building acuaertina.ora _. Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITEADDRESS APH • BP# OIHWNERT3A1�'f/ v �1��fi��! /D OA DESCRIPTION OF WORK: 1�04V440,7 We are providing you with an Owner -Builder AcknoWl"edgment and Information Verification Form to make you aware 'of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to its at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand orverlfy this information.) _ 1 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Buil r" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I., as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. PI understand building permits are not required to be signed by property owners unless they are responsible for econstruction and are not hiring a licensed Contractor to assume this responsibility. . l understand as an 'Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name ' stead of my own. 411 understand Contractors are required by law to be .licensed and bonded in California and to list their license numbers on permits and contracts, understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be consid d an "employer" under state and federal law. understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, ..and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me se ious financial risk. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work Is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work TZ rmed under contract with a licensed general building Contractor. l understand as an Owner -Builder if I sell the property for which this permit is issued, 1 may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. ©wnerBuilderForm 2010•doc revised 04114110 t understand i may obtain more information regarding my obligations as an "employer" from the Internal Rev nue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or w\mY.cslb.ca.gov for more information about licensed 9ctors. 0, 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am th party legally and financially responsible for proposed construction activity at the site address listed above. -I agree that, as the party legally and financially responsible for this proposed construction activity, I wll abide by all I r licable laws and requirements that govern Owner -Builders as well as employers. &&I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the Information- I -have- provided on this form. Licensed contractors are regulated bylaws designed to protect.the.:public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with ally financial loss you may sustain as a. result of a complaint -Your only remedy against unlicensed Contractors maybe in -civil court. Itis also important foryo-u-to understand that if an unlicensed Contractor or employee of that Individual or firm is injured .while working on your property, you may beheld liable for damages. if you obtain a permit- as OwnEr-Builder and wish to hire Contractors, you will be responsible for verifying whether or not -- those Contractors -are properly licensed and the status of theirworkers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: _ LenderAddress: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's drivel's license, form notarization, or other verification cceptable to the city may be required to be presented when the per itis issued to verif the ro edf owner's s! /;n Property Owner's Signature: iC - Date: ._--. ----------------- ----------------------------------- ---------..------------------- ------------------------------- -------------------- (NOTE. The following Authorization Fortin is required to be completed by the property owner only when designating an agent of the property owner to apply fora construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, i hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Buiider Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy.. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OwnerBullderForm z0l0.dor,revised04/19/10 Certificate of Compliance (Si n Lighting) (Page 1 � SLTG-1C Project Name: HOWARD'S SHOES FOR CHiE QREN DIte: f U!!thin /No Project Address: 19449 STEVENS CREEK #100 U J 21)& Location of Sign m Outdoor Sigtrs aI Indent Signs .) P Phase of Sign Construction CJ New Signs 0 Sign Alterations �}'� 000- C e of Li htin Control ® New Lighting Controls ©Re laced Li htin C naglowe t Install � This Certificate of Compliance includes the following components (check all that apply) -� 0 Mandatory Measures (Lighting Controls) © Maximum Allowed Lighting Power 13 Specific Lighting Sources . Certificate of Compliance Declaration Statement (this may boa CIO, C45 or other eligible person) ❑ 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. 0 1 am eligible under Division 3 of the California Business and :Professions Code to accept responsibility for the lighting design. 0 This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24, farts i and 6 of the California Code of Regulations, 11 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: ZHONG Y CHEN signature Company: Henry Design & Sign Company phone 4088887681 Address: 2018 Evans Lame, #4 License number (tray be contractor's lie #) 741908, C-45 City/statelzip: San Jose, CA 95125 pate 2. Installation Certificate (to be signed by responsible E2rson aftor installation) Permit number Checked byMata (Enforso-ol't ft—mcy tlso (EnforecmentA one Use' Installation Declaration statement C3 1 certify under penalty ofpor ury, under the laws of the State of California, the information provided on this forth is true and correct. 0 1 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. 0 1 certify that the installed features, materials, components, or manufactured devices identified on this certificate conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency, 0 1 certify that the requirements detailed on this Certificate of Compliance have been met, to 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or 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 signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: Henry Design & Sign Company Responsible Person's blame: Responsible Person's Signature: ZHONG Y CHEN License number (may be contractor's lie #) Date Signed: Position With Company: 741908,C-45 2008 Nonresidential Compliance Farms October 2010 Certificate of Com lianceSi n Li htin (Page 2 of 4 SLTG-1C Projectlrlame: HOWARD'S SHOES FOR CHILDREN lata: 3. Mandatory Sip Ugtiting 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 he 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 Certy1cate 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-I C shall com late part 3a. Check Yes or No for all of the following statements: 1 I have responsibility for installing the sign lighting controls ® 0 3 Yes, complete parts 3a and 3b of this form 0 Na com Tete art 3a of this form Y N N/A Where are no existing sign lighting controls and 1 will be installing compliant sign lighting controls 2 0 Yes © No 0 N0 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls 3 Dyes El No 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 0 Yes O No There are existing sign lighting controls that do not comply with the applicable provision of §119 and §133 and someone else 5 will be responsible to install compliant sign lighting controls 0 Yes 0 No 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance I)eelaration Statement on page I of 4 of this SLTG- IC is responsible for com 1 in with the! i n li tin 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 li ting control note block can be located: §133(a)1. All indoor sign lighting is controlled with an automatic time -switch control that complies with the © N� NL'A 1 j applicable requirements of §119. §133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA control or an outdoor astronomical time switch, that corn with the a licable re uirements of § 119. © iD YNA 2 Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during 01 U da li ht hours. §133(x)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce NA © NCl 3 oceat durin ni&tim�_ ____ e ,_. hours. sin ower b a minimumf tis er Y Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours. ri 13 3 Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during ! Y NA p 0 da li ht hours. Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for ® 0 illuminatin si ns or arts of si ns. ower.toad rester than §133(a)4. An Electronic Message Center (EMC) having a new connected lighting p g Y N N/A 15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when 0 0 E03 4 receiving a demand res onse si at that is sent out b the local utility. Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including 0 N0 L­ut notlimited to exit signs and traffic signs. Field Inspector Notes: October 2010 2008 Nonresidential Compliance Forms Certilficate of Com fiance Si n Light!n Pa e 3 -of 4 SLTG-IC Project Name: HOWARD'S SHOES FOR CHILDREN pate: 4. Maximum Allo W 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 Com fiance if there are signs using the Ssailo lightiU sources method of compliance A B C D. F FI G H I J Allowed Watts Design Complies? Watts Y / N Uv O N o- *..Ti /.•.e1N �11 � W`� .�j �I a V V1 ►i.. o "' UJ W w°�y ` Field -� cy ii *� Inspector S Cheek that o u o U sigh. �., CompliesDescription ✓ channel letters LED sign © 19.2 1 12 230.4 60 Y (3 t3 13 Q p 13 1 ® 13 A Symbol or code used on the plans Lthen ans are requird required and other documents. B A narrative deser tion of the st n i or location of si non the buildln and the Iocation 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 by Underwriters Laboratories (UL) or otherProduct Certification Body accredited to ISOIIEC Guide 65 by the AtnericanNational C Standards institute in accordance with ISDIIEC 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 com fiance. An ENERGY VERIFIED label is not needed for compliance. D The sig area ins uare feet. E List'f if the sign is internall illuminated. List "F' if the sign is externally illuminated. F Allowed watts per square foot. Enter 12 if the si is listed as "r in column E. Enter 2.3 if si is listed as "E" in column E. G Multi I the Marc footage in column D times the allowed Lightuig Power Densit I.PD = watts in column F. H Show the total installed watts in the sie, as determined according to the applicable provisions of R 1300 or 0. in H is less than orequal to the number in column G. Otherwise the sign does not comply. I 1 Enter Y if the number column J This 12a e doubles as a Reid ins ection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 Certificate of Com fiance (Sign Lighting) (Page 4 of 4 SLTG-lC Project Name: HOWARD'S SHOES FOR CHILDREN Aute; 5. Nggei is 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 4 of this Certificate of Corn liance if there are signs usin the maximum allowed fighting ower method of compliance) A B C D E OPTloivAL ENERGY Specific light source used. for Field Symbol VERIFIED compliance Inspector p Check that or Description label Shall include only lighting Sign Code (see instmotions belo)Complies technologies listed below List all that apply � 13 C3 ❑ 0 ❑ ❑ 0 13 ❑ C3 A I Symbol or code used on the plans when plans are re aired and other documents. ii I A narrative description of the sin 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 (LIF.) or other Product Certification Body accredited to iSO/1EC 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 com liance. Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies: List all applicable numbers 1 drrouh 10 that a in column D above for each row. I High Messure sodium lam s 2 Pulse start or ceramic metal halide lamps served by a ballast with >_ 88% efficiency 3 Pulse start metal halide lamps that are <_ 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast with?: 80% effrcienc 4 Neon or cold cathode lamps with transformer or power Lualy efficiency>_ 75% with rated output current < 50 m 5 Neon or cold cathode lamps with transformer or power supply efficiency > 68% with rated out ut current> 50 MA U Fluorescent lamps with a minimum color rendering index (CRI) of 80 6 ote: when using electronic ballasts for conipAiancS, lam s with a CRI < 80 may be used . 7 Light emitting diodes LEDs with a 2ower Mpply supplywith ? 800/6 efficiency Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC S output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as with the a licable requirements of the Appliance Effieiene , Regulations Title 20) 9 Corn act fluorescent lam s that do not contain a medium screw base sockets E24/E26 LEcomplying 10 Electronic ballasts with a fundamental o ut fre uenc ? 20 kHz This page doubles as afield inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 z w Ow F- W cl co LLJ Wz F— D UJ ...J — maj>1 uu Z Q 3:-z 0 MLLJ Y LU Q LUm OR C; CD r' ria z CO W LLI U U) 0 F- 0 C z 'n s ,+ or o aeptn cnannel letters AW 30° 11° R I 9„ This set of piens and specifioatlane MUST a kept atthe job Vto dudng conatmction; itis Imlawful o make any changas or alterations on same, or to evlete .nthzlrofrom, witfwut approval from the Buil Ing OBlclai. -- 7v7ast�m -- .span apecitl-I SWILL NOT aldM per approval ofiha violation PLAT PLANS CHANNEL LETTERS SIG ,E__ y DATA INTERIOR ILLUMINATED WITH LEff""o. _ /S- Zo/6 '33 PLANNING M SIGN SURFACE COLOR AS SHOWING AS DRAWING CUPERTINO THE COLOR OF CAN OF THE LETTER IS WHITE WITH SILVER TRIM CAP. CHR:NNEL LETTER SECTION rFh INTERNALLY ILLUMINATED LETTER Fy nvereoa�soxca� \ .. ix accE ���Oy CO�a9�Or1' F° y v NOTTO SCALE APPROVED BY - PROPERTY MANAGER: BY USINESS