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B-2016-2087CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: I CONTRACTOR: PERMIT NO: B-2016-2087 19449 STEVENS CREEK BLVD CUPERTINO, CA 95014 (3 16 20 112) LONGROW INTERNATIONAL CORPORATION SOUTH EL MONTE, CA 91733 I OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC I JDATE ISSUED: 06/08/2016 I OWNER'S PHONE: I I PHONE NO: (626) 443-3333 1 LICENSED CONTRACTOR'S DECLARATION License Class ELECTRICAL SIGNS Lic. #552097 Contractor LONGROW INTERNATIONAL CORPORATION Date 12/31/2016 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: i. I have and will maintain a certificate of consent to self -insure for Worker's BUILDING PERMIT INFO: BLDG —ELECT _ PLUMB MECH _ RESIDENTIAL X COMMERCIAL DESCRIPTION: ALL 4 (I) ILLUMINATED SIGNS - MEET FRESH Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by „gyp Section 3700 of the Labor Code, for the performance of the work for which this U, permit is issued. Sq. Ft Floor Area: Valuation: $9630.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 6/8/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I 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 andlstate laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 13/8/2016 APN Number: Occupancy Type: 31620 112 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 06/08/2016 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 6/8/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE ' I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, S ctions 25505, 25533, and 25534. Owner or authorized agent: Date: 6/8/2016 CO STRUCTIOX I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (40 8) 777-3333 • build! ng(ftupertino. org ?j-`2-�lc�' Z— PROJECT ADDRESS fes+`//f ��J,S C/J� G r7 ) ( APN# Z) (v' 2,`m — 1 12 - `�(/ l/E-MAIIL OWNER NAME%I'V `/�/ �C I YV✓�r1� PHONE STREET ADDRESS 07Q sct� l.h ` <Jp IIo ( • � 1� W��t1- CTTY TATE U JY FAX U� L"[ CONTACT NAME � /�, 1 ` PHONE31N6' U�� E MEvetSU�J !fit �� STREET ADDRES CITY, STATE, ZIPFAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTORAGENT '❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Tp LICENSE NUMBER Zv� LICENSE TYPE ` BUS. LIC # / ``` QC) YU COMPANYNAME SIG.�s arc �� E-MAIL FAX • 6�-c�k�-�z3 STREET ADDRES�q?,,, Sf�Z� �t� ut CITY, STATE, ZIP s- •�-� (-L�� 't PHONE ��•- �(Y3-333' ARCHITECT/ENGINEER NAME 9 LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 66 6F--( stez,1 /tc_� --MtePA t USE OF ❑ SFD or Duplex ❑ Multi -Family ILLUMINATED SIGN TYPE NO. OF SIGN AREA VALUATION STRUCTURE: ❑ Commercial (Y/N) (CODE) SIGNS (SQ. Fr.) (s) // �(f' 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 ss'+ ib-cgy .R CET�ED$} r i'arS �.� '�3St +E`"K'{r-``m�: Ag_' z. � 5-k sJ! TOT ATIOI; C By my signature below, I certify to each of the following: I am the property owner or authorized a ent to At on the property owner's behalf. 1 have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the r above-ide tified pperty for inspection purposes. Signature of ApplicanUAgent: Date: 6 SUPPLEMENTAL INFO R_ 'TION REQUIRED Site Plan � � �''"• �`i--3`--"�'svG�' c-ci'; �FCw4ui aw rLAI`ct�El f'`��, �� ,m -'.mom' KT �?�'u.�sY"' ;�1�":e.. ��Rduz�11€sllfr(zw, p>M 7'°-.```�� hki"�ati`"`r�{a`� �.•pC,�e--t t "�? vc �G^�' r", �y ^Si `G .t�Y. �. `SwS,< �+ RElevations _ _ s'3 — Sign Details - including UL listing(s) applicable �.sz<DARb ,� NR> Q ELANmsPLAoa Structural Calculations (if applicable) Copy of Planning Approval Letter or Meeting with Planning prior to(]; submittal of Building Permit application. �a r Sign,4pp_2011.doc revised 03/16/11 94LCU-,�,_ STATE OF CALIFORNIA SIGN LIGHTING CAI Is:nRNIA PNrPr;V CnMMISSION V G V'IY R V V -L I J`V 1'G R CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Name: 85C BCili:ety CLd e Date Prepared: May 16 2016 Project Address: 1V1 19459 Stevens Creek Blvd., #100, Cupertino, CA 95014 Location of Sign Outdoor Signs 0 Indoor Signs Phase of Sign Construction ,l New Signs ❑ Sign Alterations Type of Lighting Control ❑ Newtighting Controls ❑ Replaced Lighting Controls ❑ Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) ❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power XSpecific Lighting Sources 1. Mandatory Sign Lighting Controls IVOTES: 1. The some 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) ore required for compliance with the sign lighting Standards. if the person responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign, general contractor, or architect shall be responsible to have the sign lighting controls installed. 3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement for the entire construction. 1a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E shall complete Part 1a. Check Yes or No for all of the following statements: 1 have responsibility for installing the sign lighting controls 1 ❑ Yes, complete parts la and lb of this form JU No, complete part la of this form There are no existing sign lighting controls and I will be installing compliant sign lighting controls 2 ❑ Yes JU No There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls 3 M Yes ❑ No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and I will be 4 installing compliant sign lighting controls 11Yes M No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and someone L else will be responsible to install compliant sign lighting controls ❑ Yes M No I CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC NRCC-LTS- 1 E(R.,r..d 06114) CALIFORNIA ENERGY_ COMMISSION " CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) Project Name: 85C Bakery Cafe Date Prepared: May 16 201 V/ 1b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E is responsible for complying with the sign lighting control requirements, that person shall answer all of the following questions: If there are construction documents, indicate where on the building pians the F_ mandatory measures (sign lighting control) note block can be located: §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time- Y N NA 1 switch control. ❑ I ❑ x §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N NA switch control, or an astronomical time -switch control. ju ❑ ❑ 2 EXCEPTION to Section 130.3(a)2A: Outdoor signs in tunnels, and signs in large permanently covered outdoor Y NA areas that are intended to be continuously lit, 24 hours per day and 365 days per year, ❑ $3 §130.3(a)2B. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides the ability to automatically reduce sign lighting power by a minimum of 65 percent during nighttime hours. Y N NA Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ J:p ❑ 3 day and night. EXCEPTION to Section 130.3(a)2B: Outdoor signs in tunnels and large covered areas that are intended to be Y NA illuminated both day and night. ❑ X §130.3(x)3. Demand Responsive Electronic Message Center Control, An Electronic Message Center (EMC) Y N N/A having a new connected lighting power load greater than 15 kW has a control installed that is capable of ❑ ❑ x 4 reducing the lighting power by a minimum of 30 percent when receiving a demand response signal. EXCEPTION to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, Y NA ordinance, or regulation to be reduced by 30 percent. ❑ ju Field Inspector Notes: CA Building Energy Efficiency Standards 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCGLTS-01-E Rovised 06114 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCGLTS-01-E Sign Lighting (Page 3 of 5) °iM` "'°'�; 85C Bakery Cafe May 16 2016 2. Maximum Allowed Lighting Power Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 3 of this Certificate of Compliance if there are signs using the Specific lighting sources method of compliance) A B C D E F G H I J Symbol Y Or Code Description of the Sign OPTIONAL—Energy Verified Label (see instructions below) Allotted Watts Design Watts Complies y/N Filed Inspector Check that sign complies . 4_1 ^N c- � `m .... y mow— ¢"w Q c o � N 3 £ 0 East loo j1 16 1 12 192 132 Y ❑ East 85C Bakery Cafe j1 45.4 I 12 545 264 Y ❑ South 85C Bakery Cafe M 66.5 1 12 798 396 Y ❑ South square icons jI 25 1 12 300 .264 Y ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ A Symbol or code used on the plans (when plans are required) and other documents. B A description of the sign, or location of sign on the building; and the location of sign on construction documents. C OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed, ENERGY VERIFIED label, confirming that the sign complies with the Section 140.8 of the California 2013 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual Inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label, columns 'D' through 'I' are not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance. An ENERGY VERIFIED label is not needed for compliance. D The sign area in square feet. E List "I" if the sign is internally illuminated. List "E" if the sign is externally illuminated. 1= Allowed watts per square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2:3 if sign is listed as "E" in column E. G Multiply the square footage in column D times the allowed Lighting Power Density (LPD = watts) in column F. H Show the total installed watts in the sign, as determined according to the applicable provisions of §130(c). 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: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION CERTWICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 4 of 5) OfeCName: 85C Bakery Cafe o"e Prepared' May 16, 2016 3. Specific LiehtinizSource Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the, Specific lighting source method of compliance. (Complete part 2 of this Certificate of Compliance if there are signs using the maximum allowed lighting power method of compliance) A B C D OPTIONAL Specific light source used for field inspector ': Symbol ENERGY VERIFIED compliance Check that5ign or Description label Shall include only lighting "Complies Code (see instructions technologies listed below below) List all that apply East logo ❑ Y �, Q East 85C Bakery Cafe ❑ Y South 85C Bakery Cafe ❑ y [] South square icons ❑ Y << ❑�,. 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 sigrron the building; and the location of sign on construction documents C OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed ENERGY VERIFIED label, confirming that this sign complies with the Section 140.8 of the California 2013 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with 150/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label, column 'D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance, An ENERGY VERIFIED label is not needed for compliance. Specific Light Source Compliance Method, The sign(s) identified above use only the following lighting. technologies: List all applicable numbers (1 through 9) that apply in column D above for each row. 1 High pressure sodium lamps Metal halide lamps that are pulse start or ceramic served by a ballast that has a minimum efficiency of 88 percent or 2 greater. Ballast efficiency is the measured output wattage to the lamp divided by the measured operating input wattage when tested according to ANSI C82.6-2005. Metal halide lamps that are pulse start that are 320 watts or smaller, are not 250 watt or 175 watt lamps, and are served by a ballast that has a minimum efficiency of 80 percent. 3 Ballast efficiency is the measured output wattage to the lamp divided by the measured operating input wattage when tested according to ANSI C82.6-2005. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 percent D 4 when the transformer or power supply rated output current is less than 50 mA. The ratio of the output wattage to the input wattage is at 100 percent tubing load. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68 percent 5 when the transformer or power supply rated output current is 50 mA or greater. The ratio of the output wattage to the input wattage is at 100 percent tubing load. 6 Fluorescent lighting systems meeting one of the following requirements: A. Use only lamps with a minimum color rendering index (CRI) of 80; or B. Use only electronic ballasts with a fundamental output frequency not less than 20 kHz. i Light emitting diodes (LEDs) with a power supply having an efficiency of 80 percent or greater; Single voltage external power supplies that are designed to convert 120 volt AC input into lower voltage OC or AC output, and have a 8 nameplate output power less than or equal to 250 watts, shall comply with the applicable requirements of the Appliance Efficiency Regulations (Title 20). 9 Compact fluorescent lamps that do not contain a medium screw base sockets (E24 E26). EI This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards -2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting I (Page 5 of 5) Proiett Name: 85C Bakery Cafe nate Prepared: May 16 2016 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Lavender Fung Documentation Author Signature: Company: S i s Ex cess M. Co Signature Date: May 16, 2016 Address: 1438 Santa Anita Ave CEA/ HERS Certification Identification (if applicable): City/State/Zip: South El Monte, CA 91733 Phone: 626-443-3333 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am. eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specification's, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features Identified on this Certificate of Compliance are consistent with the information provided on other applicable Compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: o� Responsible Design Sgnature: Company : Si ns Express Mf . Co Date Signed; 16, 2016 Address` 1438 Santa Anita Ave License: C45-552097 South El Monte, CA 91733 Phone: 626-443-3333 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014