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B-2017-1577 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1577 19770 STEVENS CREEK BLVD CUPERTINO,CA 95014(369 06 012) ALLEN SIGNS INC SAN JOSE,CA 95125 OWNER'S NAME: EVERSHINE VI,LP DATE ISSUED:09/14/2017 OWNER'S PHONE:408-343-1088 PHONE NO:(408)280-6500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-45 Lic.#834580 Contractor ALLEN SIGNS INC Date 03/31/2018 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: AFFICIENT-SIGN ILLUMINATED(1) 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 I.' Compensation,as provided for by Section 3700 of the Labor Code,for the `'LJJJ 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 • permit is issued. Sq.Ft Floor Area: Valuation:$2580.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 06 012 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 applicant understands and will comply with all non-point source regulations per the Cu Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. A Signatur Date 09-14-2017 Issued by:Kim Dunbar Date:09/14/2017 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 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 of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:09-14-2017 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 by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections.5533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. �— , Owner or authorized agent: _ ,`_ APPLICANT CERTIFICATION Date:09-14-2017 ", I certify that I have read this application and state that the above information is CONST7 CTION 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 consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used aspublic records. Licensed Signature Date 09-14-2017 Professional \\ / SIGN PERMIT APPLICATION _.(iii& COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 44,st,19,, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ' S CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq PROJECT ADDRESS 16 1 P 1 (/O 4— ,et/n,_6 Cy_n _k APN#. 3(09 - 0 (_ �„O 1 ,2_ OWNER NAME ke..,g, r . �� r� � L PHONE 1/��n (//,.��r1) Q2 E-MAIL STREET ADDRESS ,/ I CITY, STATE,ZIP (� l/ o FAX P [�e� } (7e U(Z O engin CONTACT NAME .OSS )�` ( ' //I, 1 PHONE �v¢P l ✓``D�$ RSftl�i✓p�hllo'�c STREET ADDRESS (/ C� V`�fJ�.J CITY,STATE,ZIP U I .FAX ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME /Yf rero ` LICENSE NUMBER git..g/!�-�f0 LICENSE TYPE c, /;c 'BUS.LIC# COMPANY NAME 1 1 \1/1 S E-MAIL a'(e��ll-7 l et •0 S /1��( D 0,cow\ FAX / ' STREET ADDRESS ?q�� LO� /� ,� CITY,STATE,ZIPC�� )C /� I/� t- PHONE ��Q , / T ARCHITECT/ENGINEER NAME ,I (1 r ' ," LICENSE NUMBER BUS.LIC# V COMPANY NAME 1/ E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ('A ...cisttwe f LtoplTe_p 4(6k) USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: EllCOmInerCial (YIN) (CODE) SIGNS 2.4 �-(SQ.FT.) ($) SIGN TYPE CODES: Y (/�/ 1 r ¢�t1� ZI 500,P- 13 - 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 1 WINDOW SIGN k/4:).ize.4.,ozjL.,, RECEIVED BY: TOTAL VALUATION: 'it-a0, 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 correc 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 co n. I authorize representatives of Cupertino to enter the above-iden ified property for inspection purposes. i Signature of Applicant/Agent: Date: q- I ,_111 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY Site Plan PLAN CHECK TYPE ROUTING SLIP Elevations ❑ OVER-THE-COUNTER 0 BUILDING PLAN REVIEW Sign Details-including UL listing(s)applicable ❑ EXPRESS ❑ PLANNING PLAN REVIEW Structural Calculations(if applicable) 0 STANDARD 0 OTHER: Copy of Planning Approval Letter or Meeting with Planning prior to 0 LARGE submittal of Building Permit application. ❑ MAJOR SignApp_2011.doc revised 03/31/11 STATEF CALIFORNIA SI(` :LIGHTING CE -� CC4/ -01-E(Revised 04/16) CALIFORNIA ENERGY COMMISSION `. CERTIFICATE.OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Name: r Date Pre A rIiGeiu-r `rfl:5-17 A.General Information • Project Address: ; _1grfq° 4fef Ceek .tf is Location of Sign Di Outdoor Signs '0 Indoor Signs ' Phase of Sign Construction - - ISI New Signs - - - 0 Sign Alterations • Type of Lighting Control ' ' ❑New Lighting Controls V 0 Replaced Lighting Controls V 0 Not Installing Lighting Controls - This Certificate of Compliance_includes the following components(check all that apply): 0 Mandatory Measures(Lighting Controls) 0 Maximum Allowed Lighting Power 0 Specific Lighting Sources 1.Mandatory Sign Lighting Controls NOTES:' . 1. The same responsible person may install both the sign lighting power and the sign klighting 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'Statem'ent for the entire construction (e.g. a`C 10 contractor may`complete parts la 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 0 No,Ido not have responsibility for installing the sign lighting controls .• •- will complete parts la and lb of this compliance document Someone else will complete parts la and lb of this compliance document - la.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 lYes No There are no existing sign lighting controls and I will be installing sign lighting controls that comply with the applicable 2 provisions of§110.9 and§130.3 ❑Yes ❑No There are existing sign lighting controls that do not comply with the applicable provisions of§110.9 and§130.3 and I will be 3 installing sign lighting controls aht comply with the applicable provisions of §110.9 and§130.3 ❑Yes ❑No CA Building Energy Efficiency Standards-2016 Nonresidential Compliance - • April 2016 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: lb.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- Y• N NA switch control. ❑_ ❑ l r §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time-. :Y'' N 't-NA,. 2 switch control,or an astronomical time-switch control. -- ' " Di 0 0 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%during nighttime hours.Signs that Y N NA 3 are illuminated at night and for more than 1hour during daylight hours shall be considered ON both day and; 0 0 El night. EXCEPTION to Section 130.3(42E1i Outdoor signs in tunnels and large covered areas that are intended to be Y NA illuminated both day and night. ' 0 Di §130.3(a)3. Demand Responsive Electronic Message Center Control.An Electronic Message Center(EMC) Y' N N/A ;having a new connected lighting powerload greater than 15 kW has a control installed that is capableof o ❑ ® I 4 reducing the lighting power by,a minimum.of 30%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%. 0 Field Inspector Notes: ' __ _+ 1. 1- I I, • CA BuildingEnergy Efficiency Standards-2016 Nonresidential Compliance - ., Apri1;20161' ; STATE OF CALIFORNIA SIGaMTING CEC--:vRCC-L1-01-E(Revised 04116) - • CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE .,. NRCC-LTS-01-E _ (Page 3 of 5) Sign Lighting ' Project Name: "" Date Prepared: 2.Mandatory Sign Lighting Measures ', . have responsibility for installing the sign lighting I:1 Yes,I have responsibility for-the sign lighting;.and.will complete;, .0 No,I do not have responsibility;for installing the sign lighting-Someone parts 2a and 2b of this compliance document ,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 I F G H . I J OPTIONAL— Filed Symbol or Energy Verified • Design Complies Inspector Code Description of the Sign Label(see Allotted Watts Watts Y/N Check that r instructions Sign Complies below) Z fC -0 2 •-•=-* ,a m C C m a X. m N t.- . _ _ .-.,1 C..C El epi N ...a) N �— ._ W O C N +-'+ 2 O ii ii O C 4 a - L = Q W N C S a . 0 ' U ❑ 1! . ' ❑ ' ; - 0 • ❑ ' ❑' p .❑ ❑; , .❑. ❑ . . . 0 ❑ • , 0 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: • 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 C National Standards Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification,Body shall bean 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‘r 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 isinternally 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 23 if sign is listed as"E"in column E. G Multiply the square footage in column Dtimes.the allowed Lighting Power Density(LPD=watts)in column F: H Show the total installed watts in the sign;,as determined"according to the applicable provisions of§130(c). I, . • Enter Y if the number in column H is less than or equal to the number in column G. Otherwise,the sign does not comply. , J This page doubles as a field inspection checklist. , Field Inspector Notes: CA Building Energy Efficiency Standards 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E(Revised 04/10 CALIFORNIA ENERGY COMMISSIt"SJ"'� ' CERTIFICATE OF COMPLIANCE . '' ' NRCC-LTS-01-E. Sign Lighting (Page 4 of 5) Project Name: Date Prepared: 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 , .._ p E . OPTIONAL • ENERGY 'Specific light source'Used for Symbol I " VERIFIED = compliance Field Inspector or - Description - label Shallinclude only.lighting ' Check that Sign Code V (see technologies listed below Complies instructions (List all that apply) below) _ O 7 0 ❑ ❑ ❑ 0 0 ❑ ❑ ;❑ 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 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 thatwillbe recognized for-this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters,Laboratories _ C (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 anoptional 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%or greater. 2 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 s_maller,are,not 250 watt or 175 watt lamps,and are • ' 3 served-by a ballast that has a minimum:efficiency of 80%: i ;,•- • • Ballastefficiency 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%when D 4. the transformer or power supply rated output'current is less than 50 mA.The ratio ofthe`output wattage to the input wattage is at 100%tubing load. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68%when - 5 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. .. `;. • • 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). - 9 Compact fluorescent lamps that do not contain a medium screw base sockets(E24/E26). . . • r •• - E This page doubles as a field inspection checklist. - Field Inspector Notes: - - - - - CA-.Building Energy Efficiency Standards-2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA SIGN LIGHTING CEUNitCC-LTS-01-E(Revised 04116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 5 of 5) Project Name: - - Date Prepared: 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: _ - /1. (F! js/] Allen Signs,Inc "( Address: CEA Certification entification(if applicable): 1982 Stone Ave City/State/Zip: Phone: San Jose,CA 95125 408-280-6500 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,andmade 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: Allen Signs,Inc - - I Address: i License: 1982 Stone Ave 834580 C-45 City/state/Zip: Phone: San Tose,CA 95125 408-280-6500 CA Building Energy Efficiency Standards-2016 Nonresidential Compliance; , April 2016