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13010090CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10990 N STELLING RD CONTRACTOR: SUPERIOR ELECTRICAL PERMIT NO: 13010090 ADVERTISING OWNER'S NAME: FRANCHISE REALTY INTERSTATE CORPORA 1700 W ANAHEIM ST DATE ISSUED: 03/28/2013 OWNER'S PHONE: 9254660681 LONG BEACH, CA 90813 PHONE NO: (800) 995-9099 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class C Lic. # (MCDONALDS) INSTALL (N) MONUMENT SIGN (1), fyP��on ffy��;Qr� BUILDING SIGN (1), CANOPY, MENU BOARD, CLEARANCE Contractor T ,, f �r ,,L Date ��-r ? POLE, DIRECTIONAL SIGNS (4), PRESELL BOARD (1), 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: $32000 performance of the work for which this permit is issued. 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. APN Number: 32609051.00 Occupancy Type: 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 ERMIT 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 F 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 applic ds and will comply Issue (Date: with all non -point Wurce regulations per the CxOc rtino icipal Code, Section 9.18. Signature Date--`ri� 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) I, as owner of the property, am exclusively contracting with Iicensed 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. 9 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 II performance of the work for which this permit is issued. will maintain compliance with the Cupertino Munic' o , hapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio s 5505, 2553 nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 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 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 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 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 ICUPERTINO SIGN PERMIT APPLICATION a0 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 0O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 ^ building(5-)cunertino.org PROJECT ADDRESS O AFN y� OWNERNAbtE 4.--3:e/«a PHONE„` _ E-MAIL STREET ADDRESS CITY, STATF, FAX CONTACT NAME PHONE E-MAIL STEETADDRESS CITY, STATE, ZIP X ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENr CONrRACrOR ❑ CONTRACTOR AGENT ❑ ARCHrrFcT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMB R LICENSE E HUS. LIC L G % COMPANY E-MAIL FAX STREET DRECITY, STATE, ZIP P NE i AR CHITECI'/ENGINEER NAME LICENSE NUMBER U5. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ./ .1J i .4/ - lO /G • C/4 USE OF ❑ SFD or Duplex Multi -Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: ❑ Commercial (Y /N) (CODE) SIGNS (SQ. FT.) (3) SIGN TYPE CODES: B - BANNER SIGN M - MO2UMMrr (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 RECEICIEDBY = �' TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property ownr authorize to act On the property owner's behalf. I have read this application and the information I have providso,is-GQlTect. I have read the D ription of Work and ve-i is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi cons on. I authorize r 0 upertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEN INFORMATION REQUIRED—oc><rIs>oN> -mss Y��=' rLArrcJelTgP= ^Itou€n`sL>P€ Site Plan—'= _ uItDLN PLS vlL4� Elevations 1 PRESS — Sign Details - including UL listing(s) applicable Mat- a -Structural StructuralCalculations (if applicable) Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.vr ,� Si ztApp_201 Ldoc revised 03/16/11 CITY OF CUPERTINO ILI FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 10990 STELLING RD DATE: 0111712013 REVIEWED BY: MELISSA iLlech. 1'errrrit b1?1.' APN: 326 09 051 BP#: 'VALIDATION: 1$32,000 'PERMIT. TYPE: Building Permit, PLAN CHECK TYPE., PRIMARY USE: Sign Phernb. hrsp. Fee: PENTAMATION PERMIT TYPE: 10EAP6 WORK I INSTALL N MONLIMENT SIGN 1 BUILDING SIGN 1 CANOPY MENU BOARD CLEARANCE SCOPEI POLE, DIREC-fIONAL SIGNS (4), PRESELL BOARD (1), WELCOME SIGNS (2) & WINDOW PANELJI SIGN TYPE FEE ID Pl unb. Plarr Check QTY iLlech. 1'errrrit b1?1.' SIGN FEE lESIGNADD Elec. Permit Fee: IEPERMIT Ground Sign 1SIGNGR/RF Other Elec. Insp. 0.0 $45.00 1 Phernb. hrsp. Fee: $334 Wall Sign, Electric 1SIGNWELEC Suppl. Insp. Fee,0 Reg. Q �O=To 1 hrs $266 Wall Sign, Non -Electric 1SIGNWNONE PME Permit Fee: 1 $266 Directional Sign 1SIGNDIRECT Administrative Fee: 12 $3,192 $0.00 TOTALS: $0.00 Travel Documentation Fee: ITRAVDOC $4,058.00 Strong Motion Fee: 1BSEISMICO 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 hated an the nreliminary information availahle and are anly an estimate_ Contact the Dent far addn'l info. FEE ITEMS (Fee Resolution 11-053 G . 7/1/12) ,Avteefi. flan .Check Pl unb. Plarr Check # Branch Circuits 5 $136.00 iLlech. 1'errrrit b1?1.' Plumb. Permit Fee: lESIGNADD Elec. Permit Fee: IEPERMIT Orhor,�7ech. Insp. Other Plumb Insp. Other Elec. Insp. 0.0 $45.00 laech. Insp. Fee Phernb. hrsp. Fee: F,lec. Insp. Fee: 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 hated an the nreliminary information availahle and are anly an estimate_ Contact the Dent far addn'l info. FEE ITEMS (Fee Resolution 11-053 G . 7/1/12) FEE QTY/FEE MISC ITEMS Plein Check Fee: Su 1. PC Fee: • Reg. OT PP � g 0.0 hrs $0.00 Plumb.11fech./Elee Permit Fee: $4,058.00 Suppl. Insp. Fee,0 Reg. Q �O=To 1 hrs $0.00 PME Unit Fee: $136.00 PME Permit Fee: $45.00 Construction :Trr_r., Administrative Fee: Work Without Permit? 0 Yes 0 No $0.00 Sign Master Plan: Yes (F) No $0.00 Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: 1BSEISMICO $6.72 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 SUBTOTALS: $4,292.72 $0.00 TOTAL FEE: 1 $4,292.721 Revised: 10/01/2012 1 CONTRACTOR / SUBCONTRACTOR ILHST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: /O' 9g6 157a,1 -//t/ X0 PERMIT # 1-3010090 OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: / d p W, 14Abf /�A S/ CITY/ZIPCODE: 10 *Our municipal code requires all businesses working in the city to have a City of Cupertino business incense. NO BUILDING ]FILIAL OR ]FINAL OCCUPANCY INSPECTIONS WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUIS 'TRACTORS COINED ED A CI'T'Y OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # 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 / Contractor Date Ger iffeate of Compliance (Sign Lighting) (Page Y of 4) SLTG-1C Project Name: 0 d Date: ProjecLAddress: Title 24, Parts 1 and 6 of the California Code of Regulations. j J ®� Location of Sign Outdoor Signs Indoor Sigrd enforcement agency for proval with this building permit applyg" Phase of Sign Construction WNew Signs ❑ Sign Alterations Signature Tye of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls Mot Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) Phone Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power ❑ Specific Lighting Sources 1. Certificate of Compliance Declaration Statement (this may be a C10, C45 or other eligible person) 0 I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. 6 I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. a 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. a The design features represented on this Certificate of Compliance are consistent with the infogn ion provi e o document this design on the other applicable compliance forms, worksheets, calculations, plans and ecifications s d to the enforcement agency for proval with this building permit applyg" Name:� Signature 0 I certify treat the requirements detailed on this Certificate of Compliance have been met. 0 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building Company: Phone Address: w z�Ale— License number (may be contractor's lic #) Responsible P rsos Name: City/State/Zip: Date / 7 2. Installation Certificate (to be signed by responsible person after installation) Permit number ' •. < Checliedby/Date (Enforcement Agency Use, (Fuforcement Agen ' Cise Installation Declaration statement @ I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. ® 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 I 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 I certify treat the requirements detailed on this Certificate of Compliance have been met. 0 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: Responsible P rsos Name: Responsibl e s Si mature. A License number (may be contractors lic ') Date Signed: Posit on witli Company: 008 Nonresidential Compliance Forms October 2010 Certificate of Compliance Sin Lighting (Page 2 of SLTG-IC Project Name:Z2 & ��1z i -L,;) e- complying with the sign lighting control requirements, that person shall answer all of the following questions: 3.1VMandato 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,- esponsible;alternatively, alternatively,the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement for the entire construction. 3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page I of 4 on this SLTG-1C shall complete Part 3a. Check Yes or No for all of the following statements: I I have responsibility for installing the sign lighting con ols §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 4 No, complete part 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑ Yes No 3 There are no existing sign lighting controls and some ne 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 No 1� There are existing sign lighting controls that do not co ply with the applicable provision of §119 and §133 and someone else 5 _ will be responsible to install compliant sign lighting controls N ❑ Yes o 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1C 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 §133(a)I. All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA 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 comply with the applicable requirements of §119. A Q ❑ 2 Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ 1� §133(x)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA sign ower by a minimum of 65 percent during nighttime hours. ❑ ❑ Exception 1 to §133(x)3. Signs illuru&aated far less tlian one hour per day during daylight hours. Y NA11 1 fa 3 Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ fa 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.. ❑ §133(x)4. An Electronic Message Center (EMC) having anew 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 13 ❑ 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 Aronresidential Compliance Forms October 2010 Cerfiflcate of Compliance (Page 3 of S LTG—IC Project Name: Daze: �% �✓ 4. Maximum A1lowed Lilsl> Iia , 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 ecific lighting sources method of com liance A B C D E I F G I CaAllowed Watts Design Complies? Watts Y / N -o A �o Field 00-^ q ^ 3 Inspector Check that o `� v> a` �� u, x a Sign Cd o Cni 3 q ' Complies cu o II Q o O U Description ✓ ❑ ❑ ❑ d ❑ a A Symbol or code used on the plans (when plans are required) and other documents. S A narrative description of the si , 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, 1.NT;I2(:11' VI:;RI H I'D 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 rash labels that li•ill he reeognized f6nhis purpose are 1`,NERGC ' VERIFIFD Certification Marks authorized C by taulerlvriters Laboratories ((JI..) or outer Product Certification 13odp accredilcd to IS011f:;C (.Hide 65 by the Amerimi National Stmdcuds Institute in accol-dallce hill 1S0JFC l 01 1. Surveillance 1)), tl)e Accredited ("ertiiication Body sliail be an ongoing annual nlspection hrogyra.11) t:3liled out by a T.vpe A hispection body in accordance with ISOJEC 111020. 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 I The sign area insquare 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 sip is listed as "E" in column E. G Multiply the square e 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(d ore). I Enter Y if the number in column H is less than orequal to the number in column G. Otherwise, the sign does not coaly. J This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 Certificate of Compliance (Sign U hfin (Page 4 of 4S11.rTsa.S-IC Project Name: az, ] Date: L 5. Specific Ligh6j 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 si s usinE the maximum allowed lighting ower method of compliance) A B C D lE OPTIONAL Field ` ENERGY Specific light source used for lilspector ' Symbol VERIFIED compliance Check that or Description p label Shall include only lighting Code (see instructions technologies listed below Sign- below) List all that apply Complies .�e, 15J aA1 �„�� G'�1!11'4�by PA6 ❑ ❑ A S mbol 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 -sip 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 lahcls that will he rrcoenired for this purpose are ENRRGY VERIFIED Certification Marks authorved bF (Indtarwriters Laborawries ([ It.) or other Product Certification Body accredited to 150!li_.0 Guide 65 by the .American Nal'ional Standards Institute in eccordance a ith JSJ0Il1:C: 17011. Sw-veillence b\ the Accredited Cenifirjtion body shill be an ongoing annual inspection program carried out b� a Type A lnspeoLiosu lxuly in au;ord.utee \00 NO!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 a Iicable numbers 1 throe 10) that apply in column D above for each row. 1 High pressure sodium tamps 2Pulse start or ceramic metal halide lams served by a ballast with _> 88% efficient 3 Pulse start metal halide lamps that are _5 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast with ?i 80% efficient or cold cathode lamps with transformer or ower su I efficiency > 75% with rated output current < 50 MA Neon or cold cathode lamps with transformer or ower supply efficiency ? 68% with rated output current > 50 mA Fluorescent lamps with a minimum color rendering index (CRI) of 80 ore: when usin electronic ballasts for compliance, lamps with a CRI < 80 may be used Li ht emitting diodes LEDs with a ower supply with >_ 90% efficiency Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC gThisNeon output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as om 1 yin with the applicable requirements of the Appliance Efficient Regulations Title 20 Compact fluorescent lamps that do not contain a medium screw base sockets E24/E26) lectronic ballasts with a fundamental output frequency > 20 kHz doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 SIGNAGE CORPORATE IDENTITY April 12, 2911 State of California Department of Building and Safety PROGRAMMED MAINTENANCE K-RjFjT1H1:0O r,) IFA- !WW C7 JiTi0O1lTC T OO �i� B E�ti1�.11�FY0OiF3C�ZOO "�J T R A C�3�T OTF:1 I hereby authorize the following person to act on my behalf in obtaining permits from the Building Department and to sign permit applications for me. I am properly licensed as required by the State of California. I assume full responsibility, under the law, for permits taken by persons authorized to act on my behalf. "chis authorization shall continue until the Department of Building and Safety of the State of California, is notified in writing that such aut" #ea.is cancelled by this contractor. PERSON AUTHORIZED j 1GN PE ISS S SIGNATURE: Mr. Mike Rathbun Company Name: By Licensed Contractor: Date of Birth License No. CDL Fed ID: State I D: Work Comp: Superior Electrical Advertising, Inc. Jim Sterk 06/24/442 C271598 H0518510 552221116 244171575 X244-94 If you should have any questions or comments, do not hesitate to contact me. Si ely, Jim Sterk Chief Executive Officer JS/ft 1700 West Anaheim Street, Long Beach, CA 90813-1102 Phone: 562.495.3808 Fax: 562.43S. 1867 www. superiorsigns.com McDonald's USA, LLC One McDonald's Plaza _�-- Oak Brook, Illinois 60523-1900 Direct Dial Number (630)623-3778 e -Fax Number (630)214-6530 Email Address cathy.griffln@us.mcd.com To whom it may concern: Re: Superior EectricaD Advevtusin¢g, inc. This is to confirm that Superior Electrical Advertising, Inc. is authorized to obtain signage permits on behalf of McDonald's. Please contact me with any questions. a •, Catherine A. Griffins U.S. Vice President an-& c)re Document#:791060-v1 I .Cert frate of Comp Bance Sg n Li h�tin - (Page I ®f 4) SL'�G-1 C Project Name: CD QAJ A Lea 5 Date: y Project Address: enforcement agency for approval with this building permit a.ppli • 'io Name: .i !) its Signature r L� r Location of Sign Outdoor Signs 13Indoo Signs City/State/Zip: Phase of Sign Construction New Signs ❑ Sign AIterations Company Name: Tye of Ligbting Control ❑ New Liglithig Controls ❑ Replaced Lighting Controls 10 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. Certificate of Compliance Declaration Statement (this maybe a C10, C45 or other eligible person) ® I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. U I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. a 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. m The design features represented on this Certificate of Compliance are consistent with the ' 'ded to document this design on the other applicable compliance forms, worksheets, ations, plans d specifications subm d to the enforcement agency for approval with this building permit a.ppli • 'io Name: .i !) its Signature r Company: Phone Address: �� License number (maLbe contractor's Iie #) -- City/State/Zip: Date 3— IF 2. Installation Certificate (to be signed by responsible person after installation) Permit number .. Checked by/Dete (Ecy " � " . of rcemcnt -4-- hie' " " ' (Fuforcement Ageacy Lise ` . Installation Declaration statement ® I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. a I am eligible tinder Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction. a I 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. ® I certify that the requirements detailed on this Certificate of Compliance have been met. 0 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: Responsible Person's Name: Responsible Person's Signature: License number (may be contractor's lie #) Date Signed: Position With Company: •008 Nonresidential Com Bance Forms C E C r 00 1 4 ] MAR 10 Certificate of L L�U Sg >�!Lt a e 2 of 4SLTG-1C Project Name: Date: complying with the sign lighting control requirements, that person shall answer all of the following uestions: 3. Mandato tiara Lititin Controls MOTES.- OTES:1, 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. ;t more than one person has responsibility for compliance, each responsible parson 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. 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 N ❑ Yes, complete parts 3a and 3b of this form t No, com fete art 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑ Yes No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls Exception to §133(x)2. Outdoor signs in tunnels or large covered areas that require illumination during ❑ Yes No NA 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 ❑ Yes gNo, §133(x)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce 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 cntrols 13 Yes 'No 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1C is responsible for complying with the sign lighting control requirements, that person shall answer all of the following uestions: If there are construction documents, indicate where on the building plans the mandatory measures (si2 lighting control) note block can be located: §133(a)l. All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA I applicable requirements of § 119. ❑ ❑ b §133(a)l 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 comply with the applicable requirements of § 119. ❑ ❑ 2 Exception to §133(x)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ §133(x)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. ❑ C� Eliceptior 1 to §133(x)3. Signs liiunlinated for less than one hour per day during daylight hours. Y NA ' 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 siarts_ ❑ 0 §133(a)4. An Electronic Message Center (EMC) having a new connected Iighting power load greater than .t, N N/A I5 10AI has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ 4 receiving a demand response signal that is sent out by the local utility. Exception to §133(x)4. EMC required by a health or life safety statue, ordinance, or regulation, including Y NA but not limited to exit siEns and traffic signs. ❑ Field Inspector Notes: 2008 Alor-rresidential Compliance Forms October 2010 Certificate of (Page 3 of 4) SI ,Tr -1 C Project Name: Date: 4. MaiitlllttF>il Allowed Ligl-ting, Power Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Comptete 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 Specific lighting sources method of com liance A B C D F I F C 11 1 Allowed Watts Design Complies? Watts Y / N 0 Field W Q En vl Inspector Check That o Uv w T w 3 Sign 'b° Complies p 0 U Description ✓ V. ❑ ❑ IC ��CB L ❑ ❑ ` r , ❑ ❑ ;ASymbol ❑ ❑ or code used on the plans (when plans are required) and other documents. B A narrat;ve description of the sign, or location ofsign on the building; and the location of sign on construction documents. PTib-NAL - Check this box only if this sib has a permanent, pre-printed, factory -installed, F\ f?I2f ?Y VERIFIED label, confirming that 0 the sign complies with the Section 148 of the California 2005 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power method ofcompliance. 1'ne. nuh lapels that %aiil hr recognized for this ptirpasr are ia'JL{<C;4' VLlahlFiCi Certi{icutian 6larks authenited C bV l.n lerecriters l.Aorati}ries (N..) or miter Product Certilicalion Both to lS{ )iIF.0 Uuidc tis by the Arnedcmr tlauonal Strmd:nds lnsiiuiic in nccordancc ,�kiih I.` O!'j '` 170i t. SlIrt eillmu•e by the: Accrediird Ceriiiicaiiun Body shall he an ongoin_ annual inspecrirn l}err ;;urr av;ied oui h a Tvpe ?1 Im;pcctiurr bn+{i in accurdancc. \pith ISOd-E .' 11,020. 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 complance. The sign area n s uare feet. ithe sign is internally illuminated. List "E" ifthe sip t is externally illuminated. N per square foot. Enter 12 if the sign is listed as 'T' in column E. Enter 2.3 if si6n is listed as "E" in column E. G Multi ly the square footage in column D times the allowed Lighting Power Density (LPD = watts) in column F. II Show the total installed watts in 4he sign, as deternined according to the applicable provisions of § I30(d or e). I i Enter Y if the number in column U is less than or equal to the number in column G. Otherwise, die sign does not comply. J This pa e doubles as a field ins ection checldist. Field Inspector Notes: i I 2008 Noreresio�Mal Corrpliarace For rets October 2010 2008 A/onresid-erstial Compliance forms October 2010 Certificate of Compliance On (Page 4.2-f� SLTG-IC Project Name: —Mcff{ ayII /V +V� s ` Date: I�fryr �J — 0 S. Specific Liahtinls Source Method of Compliance Certificate of Compliance and Field Inspection Enerp, 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 lighting ower method of compliance) A B C D E OPTIONAL Field E1�TERGY Specific light source used for I nspector Symbol VERIFIED compliance Check that or Description label Shall include only lighting Code (see instructions technologies listed below Si gn below) List all that apply Complies g A -12c- H `s ( ME-- LA EkM18 H CG04). C -A o p it g r L Le ❑ ❑ r_ y�./ Dt lz rc �i0AL 1'Jf41-0 y L ❑ ❑ t.. �- p Ric-7"+�ti� � •,U ° C, o Li f .01`� IrQ CG 'V Si �� 4t ❑ 6) ❑ A Symbol or code used on the plans (when plans are required) and other documents. S A narrative description of the sip, 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 link. RC3i1' VERI TIED 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. Me only 1nbck that mill be rccoenized for this pit rpow are kNFKGY VER [FI C.D C:ertitiaation P.i;uks cutthorized b} llndrrvvriie�� L.abut�irrrir� t f 1L;t ur nihc'� I'roduta !_'erliliccdinn 11�1i1}' dccruiitcd tc; l.S(?!11�C' tiuiiie Gi by the Amcriatn National 5u,tulard� 11I.s6une in aero;;lance with 1" YIEC 17011, Sur ed4inoe. br the accredited C'en ficatiun Bodv shall be an ungoing annual inspeciion prn`.rnm carried uui h� a T. pe A Inshauticm body vi nccordf tre a itlt Jti(.Yi l'( 1 7021). 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 a licable numbers (I through10) that apply in column D above for each row. I Hi h ressure sodium lamps 2 Pulse start or ceramic metal halide lamps served b a ballast with > 88% efficient 3 Pulse start metal halide lamps that are 5 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast �a i h > 80% efficiency 4 1;eon or cold cathode lamps with transfon-ner or ower supply efficient > 75% with rated output current < 50 MA 5 Neon or cold cathode lamps with transformer or ower supply efficiene f > 68% wiih rated ou ut current>_ 50 mA D 6 Fluorescent lamps with a minimum color rendering index (CRI) of 80 (Note: when using electronic ballasts for compliance, lamps vrith a CRI < 80 may be used i Li ht etnittuag diodes LEDs with a ower 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 A plias-ice Efficient Regulations Title 20 9 Compact fluorescent lamps that do not contain a medium screw base sockets (E24/E26) 10 Electronic ballasts with a fundamental output frequency > 20 kHz E This Page doubles as a field inspection checklist. Field Inspector Notes: 2008 A/onresid-erstial Compliance forms October 2010