12040063CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10212 N DE ANZA BLVD
CONTRACTOR: JOHNSTON ELECTRIC
PERMIT NO: 12040063
SIGN CO.
OWNER'S NAME: 10212 N DE ANZA LLC
3627 MT VERNON RD
DATE ISSUED: 04/11/2012
OWNER'S PHONE: 4086552326
SEBASTOPOL, CA 95472
PHONE. NO: (707)829-7332
17 LICENSED CONTRACTOR'S DECLARATION
F T_ r
License Class G f Lic. # 0 9,5 2-3
BUILDING PERMIT INFO: BLDG ELECT PLUMB
i (_
Contractor Z(q & Date V -1/—K7 _
MECH RESIDENTIAL COMMERCIAL
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ETRADE - INSTALL TWO(2)ILLUMINATED WALL SIGNS
(commencing with Section 7000) of Division 3 of the Business & Professions
AT
STORE FRONT
Code and that my license is in full force and effect.NEW
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
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
Sq. Ft Floor Area:
Valuation: $3000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 31626088.00
Occupancy Type:
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,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source r ulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date L(`
Issued b Date: �%l!•� l
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
[ have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
permit is issued.
Additionally, should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
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.
i'�ed t: /
Date - L/--,//
�/ /7
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of wrk's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FM -1 FEE ESTIMATOR - BUILDING DIVISION
SIGN TYPE
ADDRESS: 10212 n. de anza blvd.
DATE: 04/11/2012
REVIEWED BY: bobs.
APN:,a,
BP#: /,-)0400&J
*VALUATION: 1$3,000
*PERMIT TYPE: Building Permit
Elec. Permit Fee: IEPERAET
PRIMARY Sign
USE:
PENTAMATION 1 CEAP5
PERMIT TYPE:
WORK
2 illuminated wall signs at new store front.
�install
SCOPE
Suppl. Insp. Fee -0 Reg. Q OT
SIGN TYPE
FEE ID
. .............. ...... ....
QTY
SIGN FEE
JESIGN
Wall Sign, Electric
1SIGNWELEC
Elec. Permit Fee: IEPERAET
1
$260
Permit Fee:
$260.00
Suppl. Insp. Fee -0 Reg. Q OT
I
$0.00
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
Conso-ziction'icM.,
(T.,
Work Without Permit? Yes No
$0.00
TOTALS:
$0.00
Travel Documentation Fee: I TRA VDOC
$260.0
Ia
2.
FEE
. .............. ...... ....
# Branch Circuits1 1 1 $44.00
JESIGN
Suppl. PC Fee: 0 Reg. 0 OT
0.0
Elec. Permit Fee: IEPERAET
EIF-L-
Other Elec. Insp. LLO 1 $44.00
Permit Fee:
$260.00
Suppl. Insp. Fee -0 Reg. Q OT
I
NOTE: This estimate does not include fees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the Dreliminary information available and are only an estimate Contact the Dent for addnl info.
FEE ITEMS (Fee Resolution 11-053 E 711111)
FEE
QTY/FEE
MISC ITEMS
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 hrs
$0.00
Permit Fee:
$260.00
Suppl. Insp. Fee -0 Reg. Q OT
0,0
lirs
$0.00
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
Conso-ziction'icM.,
(T.,
Work Without Permit? Yes No
$0.00
Sign Master Plan: C) Yes (E) No
$0.00
Travel Documentation Fee: I TRA VDOC
$44.00
Stronp, Motion Fee: IBSEISAECO
$0.63
Select an Administrative Item
131da Stds Commission Fee: IBCBSC
$1.00
7"
. ................ . ..... T,
$393.63
$0.00 $393.63
Revised: 0410112012
COMBUILDING
u LNITY NG DIVISION DEVELOPMENT CPERTINO ENT
APPROVED
This set of plans and specmcauonZ) ' ----
Job site during construction. It is unlawful to make anY
changes or alterations from the Bu
nodinvl
ate
therefrom, without approval
9 official.
The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
nrr,visinns of any city Ordinance or State Law.
Proposed
,Sry)PF_ OL we>Lk---
Exterior Signage Plan
PLOT PLANS
CHECKW BY
PATE __ fl l o/ l 2
DATE
Ar 11ar;. r►�''f'.
Signs of Success
247 Merrick Road, Suite 101
Lynbrook, NY 11563
T: 516 823-9000
F: 516 823-1023
www.signs-of-success.com
REVISIONS
Rev2 reduced logo sizes
11,23.11
Rev2 removed canopy logo
11.23.11
Rev2 revised monument options
11,23.11
Rev2 added reception signage
11.23.11
Rev3 removed options
3.7.12
Rev4 changed face41t to halo-Ilt
3.23.12
Rev4 changedlocation pla
RevS changed lace -lit to halo-Ilt
3,23.12
3.27,12
Rev5 added dimensions
3.27.12
Rev6 added notes to location plan
3,29.12
CLIENT ACCEPTANCE
Drawings must be signed, dated and returned to
Signs of Success to commence fabrication.
Approved By
Date
This custom design Is the exclusive property of
Signs of Success. All rights to its use are restricted.
O
CLIENT -
E"TRADE cv
JOS NUMBER yam:`
11.0973
JOB NAME
10200 North De Anze Boulevard, Cupertino, C�
PROJECT MANAGER V
Steve Cohen S4
1 y
DRAWN BY PeR `O
Sherry Krostich
SCALE
N/A
DATE
29 March 2012 rev6
PAGE
1 of 5
MINE.
gRCIAPSIfQIttfD
SIP UM00(nerMOO Mall
Two 12120 AW
draiitswag hwed dhoL
120 VOLT mut
REQLKD
QaesiaIS16=90 I
to
SIGN UMT K GAOUNDW N COWUANCE W7rN ARME 6W
OF TK NAIIkMt awnw cool
CLIENT -
E"TRADE cv
JOS NUMBER yam:`
11.0973
JOB NAME
10200 North De Anze Boulevard, Cupertino, C�
PROJECT MANAGER V
Steve Cohen S4
1 y
DRAWN BY PeR `O
Sherry Krostich
SCALE
N/A
DATE
29 March 2012 rev6
PAGE
1 of 5
U
28"
cap
Front View
20'- 10-3/8"
• Signage will be comprised of individual fabricated metal letters and graphic.
• All components are halo -illuminated with White LEDs.
• Face of all components will be solid [ non -illuminated 1.
• Letter forms have 5" deep returns.
• All exposed surfaces of the letters will be painted Black.
• The "asterisk" graphic will be painted PMS 2725 CVC Purple and PMS 390 CVC Green, to match
the corporate standards as closely as possible.
• Signage shall be installed 1-1/2" from the exterior building fascia, to facilitate a soft halo glow.
• Quantity: [ 11
TOTALS 1 4.3 A
Exterior.Corporate ID- WALL SIGNAGE SPECIFICATIONS
36"
"E"
5.8 SQ FT
"*'"
9.0 SQ FT
"TRADE"
35.8 SQ FT
TOTAL
50.6 SQ FT
5' 1-1/2"
URGEHL ATTUalmEIECTAICIANS
INo
k
48 x 1/2' S/S SCREWS --�
Sign %rdwmer mgtkhw dw all
PRIMARY ELECTRICAL FEED
F�
LISTED DISCONNECT
SWITCH IN PRIMARY
CLIPS POP RIVETS
at panel.
SUPPLIED
TO LEXAN BACK ---��
Ff
i
POWER
WITH UL LISTED BOX
STRAP TIES
\
CONDUIT CONNECTION
l
TO LETTER RETURNS --�
I
CONDUIT LOCKNUT
F�
CLEAR LEXAN BACKING
WITH 3M DIFFUSER FILAr----
WHITE LED
`j
—
GROUND WIRE
FACE WELDED s--�—
SPACERS, PAINT TO MATCH LETTERS
TO RETURN --�
` —
1/4" DIA ALL THREADED RODS W/
WEEP HOLES
��
DOUBLE NUTS OR 1/4" TOGGLE BOLTS
AS REQUIRED
EXISTING WALL
Side View [ NTS 1
Signs of Success
247 Merrick Road, Suite 101
Lynbrook, NY 11563
T: 516 823-9000
F: 516 823-1023
www.signs-of-success.com
REVISIONS
Description Date
Rey2 reduced logo sizes 11.23.11
Rev 4 face -lit to haJglit�ig 1� _23. 3.12
Rev 5 added dimensions
CLIENT ACCEPTANCE
Drawings must be signed, dated and retumed to
Signs of Success to commence fabrication.
Approved By
Date
This custom design is the exclusive property of
Signs of Success. All rights to Its use are restricted.
CLIENT
E"TRADE
JOB NUMBER
11.0973
JOB NAME
10200 North De Anze Boulevard, Cupertino, CA
PROJECT MANAGER
Steve Cohen _t
DRAWN BY01�
Sherry Krostich
SCALE l'
NTS
DATE
29 March 2012 rev6
l
PAGE v .,
2of5
URGEHL ATTUalmEIECTAICIANS
INo
Sign %rdwmer mgtkhw dw all
i One f 1120 AIR
dredMmust haw de&atedhot
120wWd A
REQUIREDreutralgmw4ternt-M
at panel.
dka
deud
Questions rAsw 9000
tosionOWY
9GN MUST BE C40MOED IN COM IAHCE MMX ARTICLE 600
Of THE NATIONAL &EC1W CODE
CLIENT
E"TRADE
JOB NUMBER
11.0973
JOB NAME
10200 North De Anze Boulevard, Cupertino, CA
PROJECT MANAGER
Steve Cohen _t
DRAWN BY01�
Sherry Krostich
SCALE l'
NTS
DATE
29 March 2012 rev6
l
PAGE v .,
2of5
Front View
31-0"
AMP LOAD & POWER SUPPLY
BREAKDOWN
LeTno sr
POWM
AWW
r
CAPKXE
SEELY
VOLTAGE
CtAtRWr
3LOMtN MOD 60
t20V
&D
(OPPOSETE SIDE)
N/A
TOTALS
e.D A
"_" = 6.6 SQ FT
Exterior Corporate ID -LOGO GRAPHIC SPECIFICATIONS
Side View [ NTS 1
PRIMARY ELECTRICAL FEED
LISTED DISCONNECT
SWITCH IN PRIMARY
POWER SUPPLIED
WITH UL LISTED BOX
GROUND WIRE
SPACERS, PAINT TO MATCH LETTERS
1/4' DIA ALL THREADED RODS W/
WEEP HOLES _� DOUBLE NUTS OR 1/4' TOGGLE BOLTS
AS REQUIRED-- EXISTING WALL
• Signage will be comprised of an individual fabricated metal
"asterisk" graphic.
• "Asterisk" graphic will be halo -illuminated with White LEDs.
• Face will be solid [ non -illuminated 1.
• Graphic will have 5" deep returns, painted to match face.
• The "asterisk" graphic will be painted PM5 2725 CVC Purple
and PMS 390 CVC Green, to match the corporate standards
as closely as possible.
• Signage shall be installed 1-1/2" from the exterior building
fascia, to facilitate a soft halo glow.
• Quantity: [ 1 1 _
Signs of Success
247 Merrick Road, Suite 101
Lynbrook, NY 11563
T: 516 823-9000
F: 516 823-1023
www.signs-of-success.com
REVISIONS
Description Date
Rev2 reduced ogo s ze 11.23.11
Re
Rey 5 face-tiWte-hakf-4t-sign --- 3,277.1
Rev 5 added dimensions 3.27.12
CLIENT ACCEPTANCE
Drawings must be signed, dated and returned to
Signs of Success to commence fabrication.
Approved By
Date _
This custom design is the exclusive property of
Signs of Success. All rights to its use are restricted.
O~-,
REQM
ATt>JITIWEELE
REGUM
One (1120 AMP
120VOUt1RWt
Mikaw
toslgnow
*T req i0 dW A
dreulamust have dediatedhot
ne"FourA et pan 1.
gmst m.CASt�68 9000
SIGN MUST M GRDUNM W COMAMCExtm ARMU aoo
OF THE MAMML UK= COOL
APR ] 201
11.0973
#8 x V2* S/S SCREWS
CLIPS POP RIVETS
TO LEXAN BACK --
STRAP TIES
CONDUIT CONNECTION
1
TO LETTER RETURNS
CONDUIT LOCKNUf
CLEAR LEXAN BACKING
WITH 3M DIFFUSER FICifi—� ^ _•.,
E
f
WHITE LED ---
FACE WELDED
TO RETURN — _oil
31-011
Side View [ NTS 1
PRIMARY ELECTRICAL FEED
LISTED DISCONNECT
SWITCH IN PRIMARY
POWER SUPPLIED
WITH UL LISTED BOX
GROUND WIRE
SPACERS, PAINT TO MATCH LETTERS
1/4' DIA ALL THREADED RODS W/
WEEP HOLES _� DOUBLE NUTS OR 1/4' TOGGLE BOLTS
AS REQUIRED-- EXISTING WALL
• Signage will be comprised of an individual fabricated metal
"asterisk" graphic.
• "Asterisk" graphic will be halo -illuminated with White LEDs.
• Face will be solid [ non -illuminated 1.
• Graphic will have 5" deep returns, painted to match face.
• The "asterisk" graphic will be painted PM5 2725 CVC Purple
and PMS 390 CVC Green, to match the corporate standards
as closely as possible.
• Signage shall be installed 1-1/2" from the exterior building
fascia, to facilitate a soft halo glow.
• Quantity: [ 1 1 _
Signs of Success
247 Merrick Road, Suite 101
Lynbrook, NY 11563
T: 516 823-9000
F: 516 823-1023
www.signs-of-success.com
REVISIONS
Description Date
Rev2 reduced ogo s ze 11.23.11
Re
Rey 5 face-tiWte-hakf-4t-sign --- 3,277.1
Rev 5 added dimensions 3.27.12
CLIENT ACCEPTANCE
Drawings must be signed, dated and returned to
Signs of Success to commence fabrication.
Approved By
Date _
This custom design is the exclusive property of
Signs of Success. All rights to its use are restricted.
O~-,
REQM
ATt>JITIWEELE
REGUM
One (1120 AMP
120VOUt1RWt
Mikaw
toslgnow
*T req i0 dW A
dreulamust have dediatedhot
ne"FourA et pan 1.
gmst m.CASt�68 9000
SIGN MUST M GRDUNM W COMAMCExtm ARMU aoo
OF THE MAMML UK= COOL
APR ] 201
CLIENT
"r
E"TRADE+�i
,1�%
JOB NUMBER
APR ] 201
11.0973
JOB NAME Byt__—
10200 North De Anzeva(d, Cupertino, CA
PROJECT MANAGER'
Steve Cohen /°
DRAWN BY `�
Sherry Krostich
SCALE
2"=1'-0•
DATE
"r
29 March 2012 rev6
PAGE
Wit`
3 of 5
PARLETT PLACE
New Illuminated "" Logo - over door
[ to be shlelcied by privacy wall & trees ]
♦
♦
♦
♦ I
♦. -----Nc""''1/W Trees for.
AdUled Privacy :-
-!`�I V New l-ialo-
`'♦ Illuminated Wall Sign
IS ♦
IIIIA
- ---------
'�. *Locat
sign cabineti�^s:. i
to be set
12" Inside of
♦property line
Lj
✓j.
S � i
Property Line;'
Exterior Corporate ID- SIGN LOCATION PLAN
1r
Signs of Success
247 Merrick Road, Suite 101
Lynbrook, NY 11563
T: 516 823-9000
F: 516 823-1023
s 'www.sians-of-success.com
0
�1EVISIONS
rr:pQsclT- nation— Date
(E) SINGLE FAMILY
RESIDENTLAL
NORTH DE ANZA BOULEVARD (public street)
CLIENT ACCEPTANCE
Drawings must be signed, dated and returned to
Signs of Success to commence fabrication.
Approved By
Date
This custom design Is the exclusive property of
Signs of 5uccess. All rights to its use are restricted.
CLIENT
E*TRADE
JOB NIIBER
11.09 1feC-F-1V D
JOB NAME APR 112012
10200 We Anze Boulevard, Cupertino, CA
PROJECT MANAGER
Steve Cohen
DRAWN BY
Sherry Krostich
SCALE
NTS
DATE
29 March 2012 rev6
PAGE
5of5
i
Certificate of Compliance
(Sign Lighting)
(Page 1 of 4) SLTG-1C
PmjectName:
^n
Project Address:
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.
Location of Sign
door Signs ❑ Indoor Signs
Com an
P y � tt ✓U�r C
Phase of Sign Construction
W -W Signs ❑ Sign, Alterations
License number � be contractor's lie
-Type of Lighting Control
❑ New Lighting Controls ❑ Replaced Li ling Controls
of Installing Lighting Controls
This Certificate of Compliance includes the following components (check all that apply)
License number (may be contractor's lic)
❑ Mandatory Measures (Lighting Controls) 11 Maximum Allowed Lighting Power
Specific Lighting Sources
1. Certificate of Compliance Declaration Statement (this may be a CI0, C45 or other eligible person)
• c �maer penalty ofy, .under the laws of the 5tate_of C i ornia the inform 'on provided oil tiffs fog is true and
correct.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24, Parts 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Name:
Signature -
Com an
P y � tt ✓U�r C
Phone a -7 ., 2 l — (�
Address;-, y � J �
License number � be contractor's lie
building owner at occupancy.
Company Name:
City/Staiz/Zip: C�� IOR T � �'�"� h
Dale ✓�` y / �i
2. Installation Certificate (to be signed by responsible person after installation)
PermmtnUmber :: ciz�t�ID�::.r•.
Date:
� ✓ / /tel
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.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative ofthe person responsible for construction.
• 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_
• I 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 lic)
Date Signed:
Position With Company:
2008 Nonresidential Compliance Farms
October 2010
0
Certificate of Compliance LSign Lighting) (Page 2 of 4L_SLTG-1C
ProiectName:
Date:
� ✓ / /tel
3. Mandatory Sign Lighting Controls
NOTES:
1. _ The some responsible person may install both the sign lighting power and the sign lighting controls, or a diferent responsible
person may install the sign lighting controls than the responsible person installing the sign lightingpower.
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 Liwallation Certificate applicable to the portion of construction for which they are responsible;
Ite�aaaiively, the exson=with-chief responsibilit3Lfor_ construcetticc�rr shall-prEpcn a -and igrthe-Gece-
Declaration Statement or the entire construction.
3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG-1C shall complete Part 3a Check Yes or No for all ofthe following statements:
❑
I have responsibility for installing the sign lighting C"Optrqls
1
❑ Yes, complete parts 3a and 3b ofthis form % % complete part 3a of this form l
N
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
2
❑ Yes o
❑
There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
3
Yes F-1NO
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
davlikht hours.
0 Yes o
❑
There are exrisfmg 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 co is
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 ofthe following estions:
If there are construction documents, indicate where on the building plans the
mandatory measures (sign lighting control) note block can be lgcated:
1
§133(a)l. 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)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(a)2. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
davlikht hours.
❑
❑
§133(a)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(a)3. Si illuminated for less than one hour per during hours.
P P �y g
Y
11❑
NA
3
Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require• illumination during
Y
NA
daylight hours.
❑
❑
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for
Y
NA
illuminating signs or parts of signs.
❑
0
§133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than
Y
N
N/A
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when
❑
❑
❑
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 trafnc signs.
❑
❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms
October 2010
\-
Certificate of Compliance (Sign Lighting) (Page 3 of 4 SLTG-1C
Project Name:
Date:
4. Maximum Allowed Liahtine 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 liting sources method of compliance)
A
B
C
D E I F J G
H
I
J
ca
Specific light source used for
Allowed Watts
Design
Complies?
VERIFIED
compliance
Check that
or
Description
watts
Y / N
o e
see �Et-i
�nh io ogies e 61UW
• i
below)
List all that apply
Complies
V
So
Field
v l
Check that
T]
D
A
�t1�
other documents.
B
A native description ofthe- sigo, or location of sign on the budding; 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 VERIFFIED label, conf m ing that
this sign complies with the Section 148 of the California 2008 Title 24, Part 6 Standards, using the Specific Lighting Source Method of
Q
§
-�,
m
.Complies
Institute in accordance with ISO11EC 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 VERgTED label,
column `D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to valid a compliance. An
ENERGY VERIF-lED label is not needed for compliance.
03
Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies:
CIO
1
bZ
2
Pulse start or ceramic metal halide lams seived by a ballast with > 88%. efficiency
91
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
0-5
4
Neon or cold cathode lamps with transformer or power supply efficien > 75% with rated output current < 50 mA
5
U
D
6
Description
ote: when using electronic ballasts for compliance, lamps with a CRI < 80 may be use
7
o
'- =
Single voltage LID external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8
output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations(Title 20
9
Com act fluorescent lamps that do not contain a medium screw base sockets (E24)E2
10
Electronic ballasts with a fundamental output frequency > 20 kHz .
E
This page doubles as a field inspection checklist
Field Inspector Notes:
•
❑
LI
❑
❑_ .
A
Symbol or code used on the plans (when p uirei unments.
B
A narrative description of the sign, or location of sign on the bolding; and the location of sign on construction documents.
OPTIONAL -Check thisbox 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 D Certification Marls authorized
C
by Underwriters Laboratories (UL) or'other Product Certification Body accreditedto ISOfMC Guide 65 by the American National
Standards Institute in accordance with ISO/!EC 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 `1' are not required to be filled out Note: Using an ENERGY VERIFIED label is an optional
method to validate compliance. An ENERGY VERTF7ED label is not needed for compliance.
D
The sign area in square feet
E
List IT, if the sign is internally illuminated. List `E" ifthe sign is externally illuminated-
*
Allowed waits per square foot Enter 12 if the sign is listed as '2" in column E. Enter 2.3 if sign is listed as `3;" in column E.
G
Multiply the square footage in column D times time allowed Lighting Power D (LPD = watts) in column F.
H
Show the total installed waits in the sign, as detemlined according to the applicable provisions of §130(d or e).
I
Enter Y if the number in cohimn H is less than or equalto the number in column G: Otherwise, the sign does not comply.
J
This page doubles as afield inspection checklist
Field Inspector Notes:
2008 Nonresidential Compliance Forms
October 2010
Certificate of Com fiance (Sign Lighting) (Page 4 of 4 SLTG-1C
Project Name:
X— )com
Date.
Z_
5. Specific Lighting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are signs using the maximum allowed lighting ower method of com fiance
A
B
C
D
E':
OMONAL
Specific light source used for
Field
Izispector
ENERGY
Symbol
VERIFIED
compliance
Check that
or
Description
label
Shall include only lighting
o e
see �Et-i
�nh io ogies e 61UW
• i
below)
List all that apply
Complies
V
T]
D
A
Symbol or code used on the plans (when plans are required) and
other documents.
B
A native description ofthe- sigo, or location of sign on the budding; 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 VERIFFIED label, conf m ing that
this sign complies with the Section 148 of the California 2008 Title 24, Part 6 Standards, using the Specific Lighting Source Method of
Compliance. The only labels that -will. be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories (UL) or other Product Certification Body accredited to ISOIMC Guide 65 by the American National Standards
Institute in accordance with ISO11EC 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 VERgTED label,
column `D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to valid a compliance. An
ENERGY VERIF-lED label is not needed for compliance.
Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies:
List allapplicable numbers 1 through 10 that apply in column D above for each mw.
1
High pressure sodium lam. s
2
Pulse start or ceramic metal halide lams seived by a ballast with > 88%. efficiency
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 >_ 80% efficiency
4
Neon or cold cathode lamps with transformer or power supply efficien > 75% with rated output current < 50 mA
5
Neon or cold cathode lamps with transformer or power supply efficien > 68% with rated output current> 50 mA
D
6
Fluorescent lamps with a minimum color rendering index (CRI) of 80
ote: when using electronic ballasts for compliance, lamps with a CRI < 80 may be use
7
Light emitting diodes s with a power supply with> 80% efficiency
Single voltage LID external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8
output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations(Title 20
9
Com act fluorescent lamps that do not contain a medium screw base sockets (E24)E2
10
Electronic ballasts with a fundamental output frequency > 20 kHz .
E
This page doubles as a field inspection checklist
Field Inspector Notes:
2008 Nonresidential Compliance Fortes
October 2010