B-2017-0506CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0506
10815 N WOLFE RD STE 104 CUPERTINO, CA 95014 (316 05 056) AMERICAN SIGN
INSTALLATION CO
LIVERMORE. CA 94550
OWNER'S NAME: CUPERTINO VILLAGE LP DATE ISSUED: 03/29/2017
OWNER'S PHONE: 415-656-6605 PHONE NO: (925) 454-3306
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C45 Lic. #860168
Contractor AMERICAN SIGN INSTALLATION CO Date 06/30/2017 X BLDG —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:
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
j I have and will maintain Worker's Compensation Insurance, as provided for by
v Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT NT RTIFI CATION
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 coWly with all non -point
source regulatiosper-thq Cupertino Municip_al-!ride, Section 9.18.
hereby affirm that I am exempt from the Contractor's License Law for one of the
ving two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
i. 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:
i. 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. 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 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 3/29/2017
T -MOBILE - INSTALL 1 ILLUMINATED WALL SIGN; 1 WINDOW
SIGN
Sq. Ft Floor Area: l Valuation: $3750.00
"N Number: Occupancy Type:
316 05 056
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: 03/29/2017
RE -ROOFS:
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: 3/29/2017
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(x) 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, Sections 25505, 25533, and 25534.
Owner or authorized agent
®ate: 3/29/2017
CONSTRUCTION LENDINGAGENCY
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 DF,CLARATiON
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 •'building(a�cupertino.org
PROTECT ADDRESS 10815 N Wolfe RD, SpAeLd,A7 t ®
APN #
V
OWNER NAME CUPERTINOVILLAGE LP
PHONE 415-656-6605
E-MAIL
STREETADDRESS 15 SOUTHGATE AVE SUITE 201
CITY, STATE. ZIP DAILY CITY CA 94015
FAX
CONTACT NAME AMERICAN SIGN
PHONE 92C--'454-3306
E-MAIL AMERICANSIGN@COMCAST.NET
STREETADDRESS 3831S OUTH I ST
CITY, STATE, Zlg. LIVERMORE CA 94550
FAX 925-606-9973
_J
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT I CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER❑TENANT
CONTRACTORNAME DAN TWOMEY
LICENSE NUMBER 860168
LICENSE TYPE C-45
BUS. LIC#
COMPANY NAME AMERICAN SIGN
E-MAIL AMERICANSIGN@COMCAST.NET
FAx 925-606-99733
STREETADDRESS 383 SOUTH I ST
cITY,sTwTE,zIP LIVERMORE CA 94550
PHONE 925-454-3306
ARCHITECTIENGINEER NAME
LICENSE NUMBER °
BUS. LTC it
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP -
PHONE
DESCRIPTION OF WORK INSTALL INTERNALLY ILLUMINATED WALL MOUNTED SIGN
USE OF ❑ 5FD or Duplex Multi-Fanllly
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: `® CommeIcial
(YIN)
(CODE)
SIGNS
(SQ. FT.)
(S)
SIGN TYPE CODES:
Y
W
1
24,2
3500
B - BANNER SIGN M - MONUMENT (GROUND) SIGN
N
VVI
1
.64
250
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
RECEIVED BY: 'vY
TOTAL VALUATION: 3750
By my signature below, I certify to each of the following: I am the property owner or authorized ageht to act our 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 uuldin construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 3/29/2017
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
X Site Plan
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
X Elevations
X Sign Details - including UL listing(S) applicable
❑ EXPRESS
❑ PLANNING PLAN REVIEW
N/A Structural Calculations (if applicable)
❑ STANDARD
❑' OTHER:
X Copy of Planning Approval Letter or Meeting with Planning prior to
❑ LARGE
submittal of Building Permit application.
❑ MAJOR
SignApp_2011.doc revised 03131111
TABLE OF CONTENTS
SIGN MANUFACTURER
CONTACTS
APPROVAL STAMP
ADDITIONAL INFORMATION:
GENERAL NOTES & PERMIT TIMES:
LOCAL CODE:
LOCATION:
PROJECT MANAGER:
LANDLORD CRITERIA:
ELECTRICAL ACCESS:SIGN TYPE SQ FT (CAL) SQ FT (PRO) MATERIAL COLOR
T-MOBILE MANAGER:
MAX ALLOWED TOTAL
STOREFRONT LENGTH:
MAX SIGN HEIGHT:
MAX SIGN LENGTH:
MAX # SIGNS:
COLOR VARIANCE:
PYLON AVAILABLE:
SUMMARY NOTES
SIGN SUBMITTAL PACKAGE
SAP
SIGN SUMMARY
SITE SUMMARY
OVERALL SIGN CALCS **SQ. FT. (CAL):
**SQ FT (PRO):
**COLOR:
**MATERIAL:
THE CALCULATED SQ FT OF A SIGN WILL MAXIMIZE ALLOWABLE AREA
AND MEET REQUIREMENTS
THE PROPOSED SQ FT OF THE SIGN THE SIGN MANF. IS PROPOSING
COLOR OF FACADE THAT THE SIGN IS BEING INSTALLED UPON
MATERIAL OF FACADE THE SIGN IS BEING INSTALLED UPON
CHANNEL: SCOPE:
www.mcsign.com
SERVICESERVICE
395D
TPR NEW
Mobile One
N Wolfe Rd & Homestead Rd+
10815 N Wolfe RD, Space A7
Cupertino, CA 95014
N/A
N/A
N/A N/A
N/A N/A N/A N/A
1 week, all applications must be submitted electronically
MSP: 1 sign per business frontage, max of 2 signs, 1 sf/lf of frontage, not to exceed
70% of storefront or building elevation, max logo height is 2' 6" and
max letter height is 2'; no cabinet or raceway signs, LED face lit or halo lit
See MSP above
TBV: MC Sign will connect to power within 6', provided access exists. Dealer
is responsible to run power and provide access.
Nora Diggins
440.2209.6200 x422
nora.diggins@mcsign.com
CHANNEL LETTER DETAILS
PROPOSED ELEVATIONS
VINYL WINDOW GRAPHIC
INTERIOR WALL PLAQUE
PAGE 2
PAGE 3
PAGE 4
PAGE 5
Jeremy Devlin
46’ 2”
122”
46’ 2”
2
No
No
2016 CBC
2016 CEC
2016 CALIF. ENERGY CODE,
CUPERTINO MUNICIPAL CODE
Arnold Hom
04/03/17
04/03/17
B-2017-0506
Kim Dunbar
1/4-INCH
DIAMETER,
3 PER LETTER
Arnold Hom
04/03/17
Arnold Hom
04/03/17
Arnold Hom
04/03/17
Arnold Hom
04/03/17
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E(Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 1 of 5)
Project Name: Date Prepared:
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
A. General Information
Project Address:
Location of Sign
Phase of Sign Construction
Type of Lighting Control
Outdoor Signs
New Signs
New Lighting Controls
Indoor Signs
Sign Alterations
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
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 (e.g. a C-10 contractor may complete parts 1a and 1b on one compliance document and a C-45
contractor may complete parts 2a and 2b on a separate compliance document – the Responsible Designer shall submit the two
compliance documents together for the same complete installation).
I have responsibility for installing the sign lighting controls:
Yes, I have responsibility for the sign lighting controls, and
will complete parts 1a and 1b of this compliance document
No, I do not have responsibility for installing the sign lighting controls.
Someone else will complete parts 1a and 1b of this compliance document.
1a. Check Yes or No for all of the following statements:
1 There are existing sign lighting controls that comply with the applicable provisions of §110.9 and §130.3
Yes No
2
There are no existing sign lighting controls and I will be installing sign lighting controls that comply with the applicable
provisions of §110.9 and §130.3
Yes No
3
There are existing sign lighting controls that do not comply with the applicable provisions of §110.9 and §130.3 and I will be
installing sign lighting controls aht comply with the applicable provisions of §110.9 and §130.3
Yes No
T mobile 3/3/2017
10815 N WOLFE RD, STE A7
CUPERTINO, CA 95014
x
x
x
xx
x
x
x
x
Arnold Hom
04/03/17
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E(Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 2 of 5)
Project Name:Date Prepared:
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
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
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-
switch control.
Y
N
NA
2
§130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time-
switch control, or an astronomical time-switch control.
Y
N
NA
EXCEPTION to Section 130.3(a)2A: Outdoor signs in tunnels, and signs in large permanently covered outdoor
areas that are intended to be continuously lit, 24 hours per day and 365 days per year.
Y
NA
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% during nighttime hours. Signs that
are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both day and
night.
Y
N
NA
EXCEPTION to Section 130.3(a)2B: Outdoor signs in tunnels and large covered areas that are intended to be
illuminated both day and night.
Y
NA
4
§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
reducing the lighting power by a minimum of 30% when receiving a demand response signal.
Y
N
N/A
EXCEPTION to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute,
ordinance, or regulation to be reduced by 30%.
Y
NA
Field Inspector Notes:
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x
x
x
x
x
x
x
Arnold Hom
04/03/17
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E(Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 3 of 5)
Project Name: Date Prepared:
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
2. Mandatory Sign Lighting Measures
I have responsibility for installing the sign lighting
Yes, I have responsibility for the sign lighting, and will complete
parts 2a and 2b of this compliance document
No, I do not have responsibility for installing the sign lighting. Someone
else will complete parts 2a and 2b of this compliance document.
2a. 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 2b 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 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
Sign Area (ft2)Internally (I) orExternally (E)IlluminatedAllowed LPD(I = 12 W/ft2)(E = 2.3 W/ft2)Allowed Watts(D x F)Total Installed Wattsfor SignComplies if H ≤ G
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 2016 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.
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 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:
T mobile
3/3/2017
C/L channel letters
24.2 i 12 290.4 120 y
Arnold Hom
04/03/17
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E(Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 4 of 5)
Project Name: Date Prepared:
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
2b. 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 2 of this Certificate of
Compliance if there are signs using the maximum allowed lighting power method of compliance)
A B C D E
Symbol
or
Code
Description
OPTIONAL
ENERGY
VERIFIED
label
(see
instructions
below)
Specific light source used for
compliance
Shall include only lighting
technologies listed below
(List all that apply)
Field Inspector
Check that Sign
Complies
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 2016 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.
D
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
2
Metal halide lamps that are pulse start or ceramic served by a ballast that has a minimum efficiency of 88% or 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.
3
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%.
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.
4
Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75% 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% tubing load.
5
Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68% 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% 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% or greater.
8
Single voltage external power supplies that are designed to convert 120 volt AC input into lower voltage DC or AC output, and have a
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).
E This page doubles as a field inspection checklist.
Field Inspector Notes:
3/3/2017
T mobile
c/l internally illuminated channel letters 7
Arnold Hom
04/03/17
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E(Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 5 of 5)
Project Name: Date Prepared:
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Company: Signature Date:
Address: CEA Certification Identification (if applicable):
City/State/Zip: 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.I 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.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 documentation the builder provides to the building owner at
occupancy.
Responsible Designer Name: Responsible Designer Signature:
Company : Date Signed:
Address:License:
City/State/Zip:Phone:
925-454-3306
3/3/2017
livermore ca
383 south i st
american sign
Michael twomey
T mobile 3/3/2017
Nora Diggins
MC Sign Company
8959 Tyler Blvd
Mentor, OH 44060
3.4.17
440.209.6200 x 422
Nora Diggins
Arnold Hom
04/03/17
CERTIFICATE OF COMPLIANCE– USER INSTRUCTIONS NRCC-LTS-01-E
Sign Lighting (Page 1 of 3)
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
NRCC-LTS-01-E User Instructions
A copy of this document must be submitted to the enforcement agency at the time of building permit application. With enforcement
agency approval, the applicant may use alternative formats of these documents (rather than the official Energy Commission
compliance documents), provided the information is the same and the format is similar.
Section A. General Information
• Project Address the address of the project where the sign is installed, as shown on the plans.
• Location of Sign – check the appropriate box to identify if the project includes Outdoor Signs, Indoor Signs, or both.
• Phase of Sign Construction – check the appropriate box to identify if the project includes adding or installing new signs,
altering existing signs, or both.
• Type of Lighting Control - check the appropriate box to identify if the project includes adding new lighting controls,
replacing existing lighting controls, or if the project does not include installing lighting controls.
Compliance Components – check the appropriate box to indicate if this job includes installing lighting controls that meet mandatory
requirements for sign lighting, uses the Maximum Allowed Lighting Power as the method to achieve compliance with the lighting
power requirements in the Standards, and/or uses Specific Lighting Sources as the method to achieve compliance with the lighting
power requirements in the Standards. (A project may include some signs that comply using the Maximum Allowed Lighting Power
approach and some that comply using the Specific Lighting Sources approach.)
Section 1. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on the last page is responsible for complying with the sign
lighting control requirements, that person shall answer all statement questions in Section 1a and 1b.
Section 1a. Statement of Responsibility
Check each box to indicate if the existing controls meet §110.9 and §130.3, if they fail to meet §110.9 and §130.3, or if there are no
existing controls.
Section 1b. Mandatory Sign Lighting Controls
Answer all statement questions by checking Yes (Y), NO (N), or Not Applicable (NA).
Field Inspector Notes: This space is provided on the document for the field inspector to make notes.
In addition to the mandatory sign lighting control requirements, there are two options for complying with the sign lighting power
requirements:
1. Maximum Allowed Lighting Power, which is documented on page 3; and
2. Specific Lighting Source, which is documented on page 4.
Section 2. Mandatory Sign Lighting Measures
If the person signing the Certificate of Compliance Declaration Statement on the last page is responsible for complying with the sign
lighting Control requirements, that person shall answer all statement questions in Section 1a and 1b.
Section 2a. Maximum Allowed Lighting Power Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
This page is for documenting compliance when using the maximum allowed lighting power method. A sign which complies with the
specific lighting source method is not required to comply with the maximum allowed lighting power method.
Fill out a separate row for each sign as follows:
Column A. List the symbol or code used to identify the sign on the plans (when plans are required) and other
documents.
Column B A description of the sign, or location of sign on the building; and the location of the sign on the
construction documents.
Column C OPTIONAL – this is an optional, voluntary method for documenting that a sign complies with the lighting
power requirements.
Arnold Hom
04/03/17
CERTIFICATE OF COMPLIANCE– USER INSTRUCTIONS NRCC-LTS-01-E
Sign Lighting (Page 2 of 3)
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
Check this box only if the sign has a permanent, pre-printed, factory-installed, ENERGY VERIFIED label,
confirming that the sign complies with the Section 140.8 of the California 2016 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 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.
Column D The sign area in square feet.
Column E List “I” if the sign is internally illuminated. List “E” if the sign is externally illuminated.
Column 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. These two numbers are the only numbers which can be used when using the maximum
lighting power method of compliance.
Column G Multiply the square footage in column D by the allowed Lighting Power Density (LPD = watts) in column F.
Column H Show the total installed watts in the sign, as determined according to the applicable provisions of
§130.0(c).
Column I Enter ‘Y’ if the number in column ‘H’ is less than or equal to the number in column ‘G’. This entry is a
declaration that the sign complies with the sign lighting power requirements by using the maximum
lighting power method of compliance. Otherwise, the sign does not comply.
Column J This page doubles as a field inspection checklist.
Field Inspector Notes: This space is provided for the field inspector to make notes.
Section 2b. Specific Lighting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
This page is for documenting compliance when using the specific lighting source compliance method. Watts per square foot are not
required to be calculated when signs consist solely of one or more of the specified lighting technologies listed on this page.
Fill out a separate row for each sign as follows:
Column A. List the symbol or code used to identify the sign on the plans (when plans are required) and other
documents.
Column B A narrative description of the sign, or location of sign on the building; and the location of the sign on
construction documents.
Column C OPTIONAL – this is an optional, voluntary method for documenting that a sign complies with the lighting
power requirements.
Check this box only if this sign has a permanent, pre-printed, factory-installed, ENERGY VERIFIED label,
confirming that the sign complies with Section 140.8 of the California 2016 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,
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.
Column D Specific Light Source Compliance Method.
List one or more of the following numbers to identify which of the specified lighting technologies are used
to comply with the sign lighting power requirements:
1 High pressure sodium lamps
2 Metal halide lamps that are pulse start or ceramic served by a ballast that has a minimum
efficiency of 88% or 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.
3 Metal halide lamps that are pulse start that are 320 watts or less, are not 250 watt or 175 watt
lamps, and are served by a ballast that has a minimum efficiency of 80%.
Arnold Hom
04/03/17
CERTIFICATE OF COMPLIANCE– USER INSTRUCTIONS NRCC-LTS-01-E
Sign Lighting (Page 3 of 3)
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
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.
4 Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to
a minimum efficiency of 75% 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% tubing load.
5 Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to
a minimum efficiency of 68% 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% 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% or greater.
8 Single voltage external power supplies that are designed to convert 120 volt AC input into lower
voltage DC or AC output, and have a 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).
Column E This page doubles as a field inspection checklist.
Field Inspector Notes: This space is provided for the field inspector to make notes.
Documentation Author’s Declaration Statement
The “documentation author” is the person who prepares a Title 24 Part 6 compliance document that must subsequently be
reviewed and signed by a responsible person (see below) in order to certify compliance with Part 6. Subject to the requirements of
§10-103(a)1 and §10-103(a)2, the person who prepares the Certificate of Compliance documents (documentation authors) shall sign
a declaration statement on the documents they prepare to certify the information provided on the documentation is accurate and
complete.
A documentation author may have additional certifications such as a Certified Energy Analyst certification number. Enter number in
the CEA# field provided, if applicable.
The person’s telephone number is given to facilitate response to any questions that arise.
Responsible Person’s Declaration Statement
The “responsible person” signing the Certificate of Compliance is required to be eligible under Division 3 of the Business and
Professions Code to accept responsibility for the building design, to certify conformance with Part 6. If more than one person has
responsibility for the building design, each person (such as an eligible lighting designer) shall sign the Certificate of Compliance
document(s) applicable to that portion of the design for which the person is responsible. Alternatively, the person with chief
responsibility for the building design shall prepare and sign the Certificate of Compliance document(s) for the entire building design.
Arnold Hom
04/03/17