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15060086211 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19638 STEVENS CREEK BLVD CONTRACTOR:.Ai<tqm4l5jL,-NS PERMIT NO: 15060086 ANO C112FAqi CS OWNER'S NAME: EVERSHINE VI, LP$ DATE ISSUED: 06/11/2015 OWNER'S PHONE: 4083341088 PHONE NO: i � LICENSED CONTRACTOR'S DECLARATION o JOB DESCRIPTION: RESIDENTIAL COMMERCIAL I �7 � �_ , License Class` Lic. # �1 AX<"�"' `y INSTALL NEW SIGN (27'4" LENGTH & 3'6" WIDTH) ON EXTERIOR OF BUILDING - 157.7 WATTS WITH 3 / 60 " ��c ,`s, Mal 5 WATT POWER SUPPLIES Contractor .`, '' r° Date fi° la r�= :€ I hereby affirm that I am licensed under the provisions of Chapter 9 Pa` 'e�7 i7 (y\ -A -b- (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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $2925 have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 36906012.19638 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSP TON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ®®��[ Nui Date: ( I ou granting of this permit. Additionally, the applicant understands and will comply Issued by: with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 918. t.3 Signature Date. 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 1, 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 licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 the Labor Code, for the of the work for which this the Health & Safety Code, Sections 25505,2553 and _ 5534 of performance _ Owner or authorized agent: -�^"' ate: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Signature Date CUPERTINO SIGN PERMIT APPLICATION 15066 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildingC�cuoertino.org S PROJECT ADDRESS � , APN # trV1, OWNER NAME PHONE E-MAIL STREET ADDRESSZO� CIT ,STATE, ZIP �SO/ A/ J_ FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT XCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER DEVELOPER ❑ TENANT CONTRACTOR NAME ij� /f LICF�N�SjN ; —/ CZE-MAILL LIC�,Nf or is G BUS. LIC # COMPANY NAME FAX STREET ADDRESS ,40 ®o 757""'w-�z�QB/�� CTTY, ST ZIP L'f� �flo3� PHONE ao4-X98-9/S3 ARCHITECT/ENGINEER NAME LICE E NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK r USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: Commercial ILLUMINATED (Y / N) SIGNTYPE NO.OF SIGNS SIGN AREA VALUATION (SQ. F].) ($) SIGN TYPE CODES: B - BANNER SIGN M - MONUMENT (GROUND) SIGN BL - BLADE SIGN P - PROJECTING SIGN D - DEVELOPMENT to SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN �(CODE) RECEIVED BY:1&I /�/ - /�_A 1 -0-Q zC-�VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I aut orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant(Agent: _Z��i iii Date: — "y - /S SUPPLEMENTAL INFORMATION REQUIRED _ Site Plan Elevations Sign Details - including UL listing(s) applicable Structural Calculations (if applicable) _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ OTHER: SignApp 201 Ldoe revised 03131/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION SIGN TYPE FEE ID QTY SIGN FEE Wall Sign, Electric 1SIGNWELEC 1 $286 TOTALS: $286.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E(f. 7/1/13) ADDRESS: 19638 Stevens Crk Blvd Ste230 DATE: 06/11/2015 REVIEWED BY: Paul Plan Check Fee: APN: 369 06 012 BP#: 5P�X *VALUATION: 1$2,925 *PERMIT TYPE: Building Permit PLr1N ('/11(.'K TYPE PRIMARY Sign USE: g Plumb.41 tech. /Elec PENTAMATION 1 CEAP5 PERMIT TYPE: WORK Install new sin (27'4" Length & 3'6" Width on exterior of building - 157.7 Watts with 3 / 60 Watt SCOPE Power Supplies SIGN TYPE FEE ID QTY SIGN FEE Wall Sign, Electric 1SIGNWELEC 1 $286 TOTALS: $286.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E(f. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 Plumb.41 tech. /Elec Permit Fee: $286.00 Suppl. Insp. Fee:Q Reg. OT 0.0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: rl:clrninistr^ative Fee: Work Without Permit? 0 Yes E) No $0.00 Sign Master Plan: C) Yes E) No $0.00 Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $0.82 / Select an Administrative Item Bld.& Stds Commission Fee: IBCBSC $1.00 .SUBTOTALSc' $431.82 $0.00 TOTALF 19620 Stevens Creek Blvd. Suite 200, Cupertino, CA 95014 phone: 408-343-1088 May 1, 2015 Planning Department Building Department City of Cupertino 10300 Torre Avenue Cupertino. CA 95014 Dear City of Cupertino: On behalf of Evershine VI, L.P., the owners of Marketplace Shopping Center, this letter authorizes Halstrom Academy to submit their drawings and pull their permit for their Marketplace store at 19638 Stevens Creek Boulevard, Suite #230. Please let me know if you need additional information or documentation. KCR Management PRt t .1 10 t RECE� JUN I it LAE e: a :IimUNITY (LEVE _OPMENT DEPARTMENT BUILDING Ul\l SION - CUPERTINO API ROVED This set of plans ani sp cifications 1UST be kept at the Job site during cor`stru tion: It is unlawful to make any changes or alcerati ns on same, or to deviate therefrom, with. ap oval from the Building Official. The Stamping of this pl i and specifications SHALL NOT be held to permit or to be an approval of the violation of any r isions of a City Ordinance or State Law. SY DATE Academ PERMIT Mor y LEO 0— E-IL;,Wu 19620 Steven Creels Blvd., Cupertino, CA 95014 • • 13580 5th Street • Chino, CA 91710 a Tel: 909.591.4 742 . FAX: 909.591.9792 ! Toll Free: 877.877.N PLO DATE CU ECKED BY DEPT NO a w7 10 —+ t... S'tevens r ek B ��d sB �SteWens�1CMre k;61�d _°� =- A Stevens Qeek BI>>d r _ , �l, • ( ' t. ��.� � �q,'�1 iii _ q Stevens Creek Blvd .. -¢ ie4RCreelk,Bl�idtil :;"=�-St - L , •. s sa £ �T - _ •! w • rr +� J 4. a .414 �rl 1 t Kong T --6f' d , ,.• t ;� _ i•= BBQ Korean CuTi Gyu-Kaku JaEmil panese BBQ i}ii�7 Ric' ��,`C14] a•rr Aa LV '. K erlion it ,Wingst'op4. 4 sKil r .ate twLXJ ' ,JL, ML s CUITS i • • rs1 � � t xc Q SI , 8 Y - C1 s Nr r • 8i �,� 1 j • �lpc� r' THIS IS AN ORIGINAL UNPUBLISHED DRAWING CREATED FOR YOUR PERSONAL USE IN CONNECTION WITH A PROJECT PLANNED FOR YOU BY NSMC.IT IS • fl"sIn Pro ec y m co 27'-4" Halstrom Academ NEW ILLUM. LOGO AND CHANNEL LETTERS SIGN Specifications: LOGO: NEW ALUMINUM FABRICATED CABINET. TRIM CAP AND RETURNS TO BE PAINTED TO MATCH PMS 288C. FACE TO BE WHITE ACRYLIC WITH TRANSLUCENT DIGITALLY PRINTED VINYL OVERLAY. CHANNEL LETTERS: NEW ALUMINUM FABRICATED CHANNEL LETTERS. TRIM CAP AND RETURNS TO BE PAINTED TO MATCH PMS 288C. FACE TO BE WHITE ACRYLIC WITH TRANSLUCENT VINYL OVERLAY. ILLUMINATION: WHITE LED ALL WIRING AND COMPONENTS TO MEET U.L. STANDARDS PMS 2925C D PMS 2925C @50 PMS 116C PMS 288C NEW ILLUMINATED LOGO AND CHANNEL LETTERS SCALE: 3/8" =1'-0" 95.66 SQ FT G.0 TO SUPPLY PRIMARY POWER SOURCE ALL COMPONENTS TO BE y�y U.L.LISTED& APPROVED A A LED ILLUMINATED CHANNEL LETTERS (TYR) National Sign Ihissign ieendedtobeine 0a0of the with R8Vi51011S: _ = = ®® Project: HalstromAcademy Client Approval: 1111,`uiremenlsdtAbideinoc0dhh0 "„"e„ P"" Drawing Number tloiannl Elamiml (ode and/or other mnnss �o"�M" moi,,. & MARKETING CORPORATION Address: 19620 Stevens Creek Blvd., Cupertino CA95014 opplimhlal6mlcodas lhisincludes proper 26488 13580 5th St., Chino, CA 91710 Phone' Account Mgr. C. Tillery gmundmgand banding ofNssign . — ® —® Tel 909.591.4742 Fax 909.591.9792 SP U� R3 e-mail: sales @nsme.com Designer: Du S. Scale: Noted Date: 03/03/2015 Date:r(o C� O ELECTRONIC SIGNS Lic# 745030 - Exp. 01/31/16 50 14 12 6 7 9 6 11 17 14 7 12 14 11 18 11 36.0w 10.1w 8.6w 4.3w 5.0w 6.5w 4.3w 7.9w 12.2w 10.1w 5.0w 8.6w 10.1w 7.9w 13.0w 7.9w 219 Modules: GOQ Samsung - KED WHITE 157.7 Watts 3 Power Supplies: 60w LE® LAYOUT SCALE: NTS National Sign thesequiretendedmheinonorfthe h FieV1510DS: Project: HalstromAcademy Client Approval: ihissignretendedtobeiedg0rdanc n, 'Revisions: Drawing Number, o��rn+s co• inucue� �� & MARKETING CORPCORPORATIONCORPORATIONAddress: 19620 Stevens Creek Blvd., Cupertino CA 95014National Eletlriml Code and/ar alhar applicahlelocal codes. This includes proper L�4®� 13580 5th St., Chino, CA 91710 Phone, Account Mgr. C. Tillery grounding and bonding of INS sign. F13 Tel 909.591.4742 Fax 909.591.9792 SP U� e-mail: sales @nsmc.com Designer: Duffy, S• Scale: Noted Date: 03/03/2015 Date: ELECTRONIC SIGNS r(fJ Lic# 745030 - Exp. 01/31/16 NEW ILLUM. LOGO AND CHANNEL LETTERS SIGN Northeast Elevation SCALE: NTS National SignThis sign inleaded to be in acmrdaocewith Revisions: _ = — s ®® = Project: HalstromAcademv Client Approval: iherequiremenlsofrUfide600ofihe Drawing Number A MARKETING CORPORATION Address: 19620 Stevens Creek Blvd., Cupertino, CA95014 appiicabelocaorml l(ocal Cedeand/dudesor 01W P applicable local codes. This includes proper 26488 'C A ®� 13580 5th St., Chino, CA 91710 Phone: Account Mgr. C. Tillery gmuacing aadbon ding ofthis siga - 2648 Tel 909.591.4742 Fax 909.591.9792 Sl1 R3 e-mail: sales @nsmc.com Designer: Duff`, S• Scale: Noted Date: 03/03/2015 Date: �= L ELECTRONIC SIGNS Lic# 745030 -Exp. 01/31/16 M lz:�4o STATE OF CALIFORNIA sF SIGN LIGHTING' CEC-NRCC-LTS-01-E Revised 06/13 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE— DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-LTS-01-E Sign Lighting (Page 1 of 4) Project Name: �A Date Prepared: Project Address: Location of Sign A Outdoor Signs ❑ Indoor Signs Phase of Sign Construction ❑ New Signs ❑ Sign Alterations Type of Lighting Control ❑ New Lighting 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 ❑ Specific Lighting Sources RECEIVRDJ DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I p 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature' Company: Signature Date: r Address:'/�p-y �ZB CEA/ HERS Certification Identification (if applicable): City/State/Zp Phone: 4 a / IC9PONSIBLE 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 specifications, 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. ResponsibDesignerN m �rq Responsible Designer Si Lure: ri e. A, 0AXA-1 Company : Date Signed- igned:s Address: License: City/ tate/Zip' / Phone: Zd _ 5nr lql-_ M -Y i COP F r"I L; - COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications %1JST be kept at the job site during col-Struction. It is unlawful to make any changes or alterations on sante, or to deviate therefrom, without approval from the Building Official. The Stamping of ;his plan and specinc;ations SHALL NOT be held to perp it or to be an approval of the violation f r,,,ic nnc of anv Citv Ordinance or State Law. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance 3Y _ J/ DATE�� PERMIT # 2013 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 06113 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE — DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-LTS-01-E Sign Lighting (Page 2 of 4) Pmject Name: 5 1 Date Prepared: D 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 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 1 §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical timd- responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign, N 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, g the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- 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 ❑ ❑ Yes, complete parts 3a and 3b of this form ZNo, complete part 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls Y ❑ Yes No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls ❑ '.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 ❑ Yes XNo the ability to automatically reduce sign lighting power by a minimum of 65 percent during nighttime hours. There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and someone 5 else will be responsible to install compliant sign lighting controls ❑ Yes jdNO 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 1 §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical timd- Y N NA switch control. ❑ ❑ g §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. ❑ ❑ 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. ❑ §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 ❑ ❑ 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. ❑ or §330.3(a)3. Demand Responsive Electronic Message Center Control. An Electronic Message Center (EMC) having a new connected lighting power load greater than 15 kW has a control installed that is capable of Y ❑ N ❑ N/A 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. ❑ �( Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2013 STATE OF CALIFORNIA SIGN LIGHTING GEC-NRCC-LTS-01-E Revised 06113 CALIFORNIA ENERGY COMMISSION —IKW- 4- CERTIFICATE OF COMPLIANCE — DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-LTS-01-E Sign Lighting (Page 3 of 4) P.Ject Name: S Date Prepared: 4: Maximum Allowed Lishting Power Method -of ompliance 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 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 ra Q C w j L ` y N +' w= O $ 70 N N M 3 i N I II Q z—Lu v O v ¢ y m C N 0 F 3 Q) vl N C 0 U ✓ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 I50/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 T 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. F 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 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 2013 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E(Revised 06113) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE— DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-LTS-01-E Sign Lighting (Page 4 of 4) Project Na.e: Date Prepared: S. Specific Lighting Source Method of Compliant 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 power method of compliance) A B C D E=: OPTIONAL Specific light source used for Symbol ENERGY VERIFIED compliance Fleld Inspector Check that Slgn or Description label Shall include only lighting Complies Code (see instructions technologies listed below below) List all that apply ��{ ream Sc ❑ ❑ p, ❑ p.. ❑ p A Symbol or code used on the plans (when plans are required) and other documents. B A narrative description of the sign, or location of sign on the building; and the location of sign on construction documents C OPTIONAL -Check this box only if this sign has a permanent, pre-printed, factory -installed ENERGY VERIFIED label, confirming that this sign complies with the Section 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 ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label, column 'D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance. An ENERGY VERIFIED label is not needed for compliance. Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies: List all applicable numbers (1 through 10) 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 3 a ballast that has a minimum efficiency of 80 percent. 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. 7 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 DC 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). g 1 Compact fluorescent lamps that do not contain a medium screw base sockets (E24/E26). E This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2013