B-2016-1818CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1818
10869 N WOLFE RD CUPERTINO, CA 95014-0614 (316 05 052)
K & K AMERICA INC
SAN JOSE, CA 95119
OWNER'S NAME: CUPERTINO VILLAGE LP
DATE ISSUED: 04/21/2016
OWNER'S PHONE:
PHONE NO: (408) 224-2800
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class SIGN INSTALLATION Lic. #889967
Contractor K & K AMERICA INC Date 01/31/2017
X BLDG ELECT —PLUMB
T
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
INSTALL (3) ILLUMINATED WALL SIGNS -
I hereby affirm under penalty of perjury one of the following two 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
Sq. Ft Floor Area:
Valuation: $8000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
316 OS 052
3 16
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this .permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applict hderstands and will comply with all non -point
source regulations pe the upertino Municipal Code, Section 9.18.
n
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/16/2016
ra ® fl
Issued by: ABBY AYENDE QIN
04/21/2016 �'� �t-C.
Date:
OWNER -Bibi DFRDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sce.7044, Business & Professions Code).
Date:/166 /2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Cade, for the
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
I have the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for by
read
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
Section 3700 of the Labor Code, for the performance of the work for which this
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
a. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Are Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cup r ' Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, S o s 2550_5, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
f
be deemed revoked.
"Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 6/16/2016
CONSTONEIN AGENCY'
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 6/16/2016
professional
Corporate Headquarters
1051 46th Ave.
Oakland, CA. 94601-4436
Phone 510.533.7693
Fax 510.533.0815
Subject: Substitution of Contractor of Record
Permit #B-2016-1818
10869 N Wolfe Road
City of Cupertino
Community Development Department
-B ui i d i ng-divi sion---
The
on --
Stockton
3133 North Ad Art Road
Stockton, CA 95215
Phone 209.931.5522
Fax 209.931.5844
05/20/2016
The project Owner and Arrow Sign Company respectfully request that the Contractor of Record
for the permit referenced above be substituted to another to the contractor below.
Signs Unlimited
6280 San Ignacio Ave., Suite K
San Jose, Ca 95119
408.224.2800
Thank You
r
Richard Luchini
Pecrnkl_Vlanager
Arrow Sign Company
(510) 715-5488
www.arrowsigncompany.com
State Contractors License: CA 314794, HI 24742, NV 53419
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1818
10869 N WOLFE RD CUPERTINO, CA 95014-0614 (316 05 052)
ARROW SIGN CO
OAKLAND, CA 94601-
4436
OWNER'S NAME: CUPERTINO VILLAGE LP
DATE ISSUED: 04/21/2016
OWNER'S PHONE: 206-264-2941
PHONE NO: (510) 533-7693
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-45 Lic. #314794
Contractor ARROW SIGN CO Date 10/31/2016
XBLDG _ELECT _PLUMB
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
INSTALL (3) ILLUMINATED WALL SIGNS -
I hereby affirm under penalty of perjury one of the following two 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.
-„. 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: $8000.00
permit is issued.
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
31605052,
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 Cupe ' a ainst liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may acerue against s K City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additi nally, the applican derstands and will comply with all non-point
source regulations per e C pertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED PECTION.
Signalu.rsa' \ Date 4/21/2016
Issued by: Alex Vallelung
w”-
Date: 04/21/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 4/21/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined b the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain complian a with the ul ti Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & afety Code, ti ns 5505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
r edi, " •� •��
APPLICANT CERTIFICATION
Date: 4/21/2016
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequ the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and w `comply wit o -point source regulations per the Cupertino Municipal
Code, Section 9.1
I understand my plans shall be used as public records.
Licensed
Signature Date 4/21/2016
Professional
CUP ERT I ISI O
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building@cupertino.org
Fj- 20 16- 17 [ E
PROJECT ADDRESS 4 ;� �
APN #
V
WNER NAME 1
11REESS
.PHONE?:
'HONE - Z 64 — Z 11 L1 A
E-MAIL
STREE A e q
ITYC,�S,TATE ZP N
FAX
CG SAME ��� �
� j
E-MAIL
T T ADDRESS
CITY STATE, ZIP
FAX
s"
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT (NIRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER . ❑ TENANT
C M TOR NAME
1 E NUMB R
E
BUS. LIC # 3
CoMPt�NY NAME `
E-MAIL
C.®rnPd�tw
FA
vo OW S';1.N o
��
STREET ADDRESS -�
TY, STATE, ZIP
PHONE
`
�l0
S oLl
0
'k
a
ARCHITECT/ENGINE R NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NA
E-MAIL
FAX
STREET,. DRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
❑ SSFD Duplex ❑ Multi
USE OF or -Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: � -tom ommercial
(YIN)
(CODE)
SIGNS
(SQ. FT.)
(S)
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
pthnri7pd ma.gent'to
By my signature below, certify to each t following: I am the property owner or on the property owner's behalf. I have read this
application and the infokation I have prov ed 's 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 re ting t , i i nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature Applicant/Agent:Date:
of
SUPPLEMENTAL INFORMATION REQUIRED,,
-_r
PLAN,CHECKTYFE _, .t
f _{ I;i;OLTTING`SLIP,- nom:
_ Site Plan_
_. Elevations
❑ a r
EXPR 8S t s
.6W. .
BUILDIIQG PIAN REVIEW?
b.
_ Sign Details - including UL listing(s) applicable
❑ sTAxIDaxD`
PLAIVNI1VGiPLAxREvw = °'
L j l
4 iZ Yh
Structural Calculations (if applicable)
❑gLARGE
❑ oT>x�
_
-
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ nLAJOg c
a c k
_
submittal of Building Permit application.
ya
3
r
SignApp_2011.doc revised 03/16/11
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MOD
Site Plan
NORTH WOLfE ROAD
:levation
`j
[Amrj:
Scale: V%740W By.-
III- .4 a 16
TRUE PLAN
NORTH NORTH
TUBE ART GROUP
sc:=-'a oiflca
117L5 SE Sth Street
Bellevue, WA 93005
206.223.1122
300.562.2354
F3:( 205.223.1123
Th;s original artworlt is protected
und ar Federal Copyright La,.-js.
Nlalc2 no reproduction of this
design Concept -,1141'zout permission
From Tuba Art Group,
9076
customer .1111olzier
126022
Quote Numoe,
MODCupertinaCA022RI4
File plarne
Jeff Kehm
sateinersol;
Kay Rice
Drdvn Ey
checkad By
May 20, 2015
Date
June 9,2015 KR
July 27, 2015 KR
July 23, 2015 MR
August 20, 2015 KR
December 8, 2015 IM
Re-)isioiis
I Approved
I Approved With Changes Noted
Customer Siqitatorr-.
Date
Landi).-d Signature
Dare
10869 N.Wolfe Rd
Cupiirtlno, CA 95014
'is br 0,ze,Cpa
2 of 4
1
%D
N
56'-4"
-
f10DAlign bottom of copy
to top of. support plate ( -
I •
r ,
1
North Elevation
Scale: T. =1'-0"
- Lease line
48'-2"
Sign #2
io
N
East Elevation
tale:1/8" = 1'-0"
L Lease line
Sign #3 r
I
B.' ME
7
9
Align bottom of wortlbox
1
to top of support plate
r�
---- -- --------- ---- -- , — -- -. _ - ' - t Uli4!ns D`perrrlent
REVIEWED FOR CODE C01"APL! ,RICE
-- ----- - --------- - -- -- -- - - Revie`'ved B y. -
West
Nest Elevation I
Scale: 1/8" =1'-01'
TUBE ART GROUP
La.1-:= OME;r:
11715 SE 5th Streat
Batlevue. 11L1 93005
2015.223.1122
300.562.2354
Fax 205-223.1123
This Original 3,^h`ror;r is Frct2U.:j
under F,_dar3i Cpayright L 3.eis.
A13'ta no reuroda=tion of this
design colrc•apt vithotlt pato tsii.7i:
From Tui32 Art Group,
9076
126022
¢!.Ince %umt3e,
IF70DCupertinoCA022R14
F•Ia Naae
Jeff Kehm
3aleaoefsrlr
Kay Rice
Oram B•;
Chzc�es &,
may 20, 2015
Data
July 9,2015 KR
July 27, 2015 KR
July 28, 2015 KR
August 20, 2015 ECR
December 8, 2015 KR
December 24, 2015 KI'
March 4,2016 K11,3115/16ECR
April 1,2016 KR, 4-11-161M
4-12.16((R
Rall, -ads
[ ] Approved
[ ] Approved With Changes Noted
Ctwtonl_f S,glt3±.lr
lau.:i :r:i S; �nl Utra
Dsr.,
10869 N. Wolle Rd
Cupertino, CA 95014
s::cla�: Culurs
3of4
Front View
Scale: 112" =1'-0"
9-21/8"
P Di
j
1 Ul - _L _____ 1
Sign #1, Sign #2 & Sign #3
Manufacture and install three (3) sets of roasted face letters backed with acrylic with
cutout non illuminated "Superfast" copy to the side
"Mod Pizza" letters will be fabricated aluminum letters, that have been painted black, semi gloss finish.
Aluminum faces will be routed out and backed with white acrylic.
Illuminate internally with 7100 white GE LEDs.
Mount flush to fascia wall.
"SuperFast" will be cut out of 1/2" acrylic and pin mounted 1/2" off of fascia, paint teal PMS 326C, semi gloss finish.
Mount 1/2" off of fascia wall.
Sign Area: 27.5 square feet (calculated by boxing entire sign).
Note: Each sign is under 250 lamberts (12.82 output)
End View
Scale: 1/2" = 1'-0"
Alum returns & lettei
paint black, semi -gloss
Back with white
Aluminum backs, inside to bl
7100k GE whi
Weep holes with light
Section View
Scale: 1 1/2" = 1'-0"
@`
'�
1 _Ty.�.IN0
�
�
l- u iding De p-,Ftment
�s
•.r.
-rad
1 r
REVIEWED 1 OR CODE COMPLIANCE
Reviewed By: �
To remote
power supply
tt
3
►G-1i,�,��. \301` �
qb
TUBE ART GROUP
Z -2=1a of ica
11715 SE 5th Street
Bellevue, !N,1 98005
206.223.1122
300.502.2354
Fax 206.223.1123
This original a.htork is protected
under Fedaral Copyright La' 'S.
Ma%e no reproduction of this
design concept ,•.tithout permission
From Tube Art Group.
9076
C:ulomer Numbet
126022
quote Yumber
147 OD Cupertino CA022R14
File Name
Jeff Kehm
Sate;vjrson
Kay Rice
Drawn By
Checked By
May 20, 2015
Date
July 9, 2015 KR
August 20,2015 KR
December 8, 2015 KR
December 24, 2015 ICF
March 4, 2016 FCR
3115116KR,3116116 KR
April 11, 2016 KR z2, 4-12-16KR
Revisions
I ] Approved
I ] Approved With Changes Noted
caStOo,ef' Sfgn3tnre
Date
Lan;SIord Signature
Date
:MOD
10869 H. Wolfe Rd
Cupertino, CA 95014
^n SJ:'.th lu f�tir ;erR: ,ltt�•,: JI t.•-• r'r,1�
4 of 4
J I t1 I C•ur UMLIr VI'QVIH
SIGN LIGHTING
CEC-NRCC-1-TS-01-E(Revised 05/15) CALIFORNIA ENERGY COMMISSION h�
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 1 of 5)
Project Name: �^ Da[e Pre ar
A. General Information
NOTES:
Project Address:
person may install the sign lighting controls than the responsible person installing the sign lighting power.
'\
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign,
Location of Sign tdoor Signs
❑ Indoor Signs
Phase of Sign Construction �jew Signs
Type of Lighting Control ❑ New Lighting Controls
❑ Sign Alterations
❑ Replaced Lighting Controls t 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. Mandatory 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; 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 la. Check Yes or
No for all of the following statements:
1
I have responsibility for installing the sign lighting controls
❑ Yes, complete parts la and 1b of this form ®° No, complete part 1a of this form
2
There are no existing sign lighting controls and'l will be in alling compliant sign lighting controls
N
❑ Yes o
3
There are no existing sign lighting controls and someone Ise 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
A
❑ Yes No
areas that are intended to be continuously lit, 24 hours per day and 365 days per year.
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
§130.3(a)2B. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides
es ❑ No
JIHIC Ur' l"HLIrVr(IVIH
SIGH! LIGHTING
CEC-NRCC-1-TS-01-E Revised 05/15 CALIFORNIA ENERGY COMMISSION .
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 2 of 5)
Project Name: Date Pr par d: � �'\ \
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 plans the 7
mandatory measures (sign lighting control) note block can be located:
1
§130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time-
Y
N
A
switch control.
❑
❑
§130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time-
Y
N
NA
2
switch control, or an astronomical time -switch control.
❑
❑
EXCEPTION to Section 130.3(a)2A: Outdoor signs in tunnels, and signs in large permanently covered outdoor
A
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
3
Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both
❑
❑
day and night.
EXCEPTION to Section 130.3(a)2B: Outdoor signs in tunnels and large covered areas that are intended to be
Y
A
illuminated both day and night.
❑
§130.3(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
aN/A
Nk_
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
WA
ordinance, or regulation to be reduced by 30 percent.
❑
Field Inspector Notes:
8Wl��in p
H ePartrnent
6
REVIEVVEp FOR CODE COMPLIANCE
Reviewed By.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015
JIHIC Ur I,HLIrUrCNIH
SIGN LIGHTING
'>.t JIHIC ur L,HLIr V r<N IH
"y CRC;I� 11C:PT1F%1C4
CEC-N RCC-LTS-01 -E (Revised 05115) CALIFORNIA ENERGY COMMISSION ¢ `
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 5 of 5)
Project Name: \\N
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate
Docu nt onAuthor Name:
7Docum!enta4tiuor Si�nat�e:
A
B
Company
2
ure D
� 1 Z- -\, — \ �
Address:��
�-
CEA Certification Identification (if applicable):
Cil to Ip:
Phone:
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 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.
S. I 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 documen tion the biOxler provides to the building owner at occupancy.
Responsibl esi ner Name:
Respo i le- e i Signa:
Complies
Company:
Date Signed `
Addriso \ �
License:3 \ �_\ 0\��
CityM �� ��1 1���Q\1—\¢n
V
Phone: O 1
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance
CEC-N RCC-LTS-01 -E Revised 05/15 CALIFORNIA ENERGY COMMISSION _qZii�
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 4 of 5)
Project Name: ^ n Date Pr 'pN are :
3. Specific Lighting Source Method of Compliance
Ma
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
E
OPTIONAL
Specific light source used for
Symbol
ENERGY VERIFIED
compliance
Field Inspector
or
Description
label
Shall include only lighting
Check that Sign
Code
(see instructions
technologies listed below
Complies
below)
List all that apply
El
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 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
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 cl gg �);conv 1 0 volt.�C i ,� nto lower voltage DC or AC output, and have a
%�
Ov �'
8
s
nameplate output powerless than or equal to 2 p v�.atts shall o' p Ywith t e �p'IP ble requirements of the Appliance Efficiency
fi i � 1
Regulations (Title 20).;111iS' DOPs@rtMent
9 rCompact
fluorescent lamps that do not containi%5'ed)un'screw base sockets (E24/E26).
s«,.: -a
E
This page doubles as a field inspection checklist. e,:r
Field Inspector Notes:
REVIEVVED FOR CODE COMPI I NCE
T—
vievved By. ::7E—
May 2015 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance
May 2015