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BSIG2015-003111111111111111111111 75 78-495 CALLE TAMPICO D--� NNW VOICE (760) 777-7125 (760) 777-7011 LA QUINTA, CALIFORNIA 92253FAX OM DEVE[� PM T PARTMENT INSPECTIONS (760) 777-7153 B Nf-P I OCT U5 2015 Date: 10/5/2015. Application Number: BS162015-0031 Owner: Property Address: 78611 HIGHWAY 1 ��TYC OF L4 QUINTA THE MAGELLAN GROUP APN: 643220007 COMMUNITYp•'j/ 78611 HIGHWAY 111 Application Description: F LA QUINTA SQUARE/ IN- - MENT LA QUINTA, CA 92253 Property Zoning: Application Valuation: $22,000.00 Applicant: Contractor: PD GROUP DBA SIGNARAMA PD GROUP DBA SIGNARAMA 41945 BOARDWALK SUITE L 41945 BOARDWALK SUITE L PALM DESERT, CA 92211 PALM DESERT, CA 92211 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License C�llasy D42 C45 License No.: 83013 Date: ! Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( ) I am exempt under Sec. . B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: (760)776-9907 Llc. No.: 830131 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' 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 workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: _ Policy Number: _ 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 workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labo Code, I shall forthwith comply wit those provisions. Date: �� Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. 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 u on the above -me tioone /property for inspection purposes. 5 Signature (Applican Date: 10WI, t or Agent): k. DESCRIPTION.' CCOUNI- TY j" AMOUNT F PAID ��,.,...,.hQ �e x BSAS SB1473 FEEcY 101-0000-20306 0. $1.00 . 10/5/15 i..`{ "., v/�''-�'"u�..' Sx sy'"t��&S.. eu'�✓�" Y .w Sv�di'An�`N -. � PAID BY�METIiUD .� u$tz1..00 y�"��*i4i.i�'`n: �S' '"Y.'.�"�+�'.��'F. w•y'�`r�r RECEIPT # GHECKM# CL`^TD BY �. PD GROUP DBA SIGNARAMA. CHECK R9783 4180 MFA Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 " DESCRIPTION .�... ACCOUNT sur TY Q. AMOUNT Hr SAPAID PAID DATE ��r� DEVICES, FIRST•20 101-0000-42403 -0. $24.17 $24.17 10/5/15 h, PAID BYMETHOD G IFT$`# : CH CK#� CLTDxB PD GROUP DBA SIGNARAMA CHECK R9783 4180:. MFA , � UESCRIPT�ION ,f ACCOUNT F QTY AMOUNTy , PAID : r AID DATE DEVICES, FIRST 20• PC 101-0000-42600 0 $24.17 $24.17 " . 10/5/15 h rPAID :fffi`��. "» �aMETHQD " R E P.::. CHECKy CLTDruBY . PD GROUP DBASIGNARAMA CHECK. FR9783 I 4180 MFA .• .Total Paid for ELECTRICAL: $48.34 $48:34 DESCRIPT,IUN 4''':' �i'.73 r. >a.... i'izi..' Al.r� ACCOU4 QTY AMO. NT :tz,ti3h PAIDA iw.s`.a `'. r'r5 D DATE �t>✓x`.�'ru�.M, MONUMENT SIGN, EA ADDITIONAL 101-0000-02404 0 $49:32 .$49:32 10/5/15 aim PAID BY T �� s ��METHOD RECEIPT #: CHECK€#x' _ nes . 6-4101BY PD GROUP DBA SIGNARAMA CHECK R9783. 4180 MFA � � .. DESCRIPTION Qip-r ACCOUNT4 MEW AMOU P�AID�NT PAID DATE , MONUMENT SIGN, FIRST 101-0000-42404 0 $72.52 $72.52 ...: 10/5/15 , �PAIDrBY METHOD � x" ,�.ss`�%t.!:.;az, aFk;'k $.p, � -.9 RECEIPT # :.E `Y ,r CHxECK PD GROUP DBA SIGNARAMA CHECK R9783 4180 iMFA DESCRIPTIO [ . A ,.r.,�,✓.. ACCOUNT x-v: afna z .+. QTY AMOUNT ,, ,'i.�; PAID " _s:.a�a ...esti xPAID>DATE MONUMENT SIGN, FIRST PC 101-0000-42600- 0 $133.43 $133.43 10%5/15 _ S« PAID BY. � .fiv.'fia 3i'v: kf±Ca. M HS• � ":4 $ b _ REECgIPPT�# - - ? { h' 7Y. �;! s hh"-r CHEC-K #. , Sk J C, L,TD BY PD GROUP DBA SIGNARAMA CHECK R9783 4180 MFA Total Paid for SIGN: $25S.27. $25S.27 Description: LA QUINTA SQUARE / IN -N -OUT (3)MONUMENT SIGNS ADDITIONAL Type: SIGN Subtype: Status: ISSUED Applied: 9/16/2015 SKH Approved: 10/5/2015 BHA Parcel No: 643220007 Site Address: 78611 HIGHWAY 111 LA QUINTA,CA 92253 Subdivision: PM 18418 Block: Lot: 1 Issued: 10/5/2015 MFA Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $22,000.00 Occupancy Type: Construction Type: Expired: 4/2/2016 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: 3 QTY ILLUMINATED MONUMENT SIGNS (2 - IN -N -OUT; 1- LA QUINTA SQUARE) INCLUDES ENGINEERED FOUNDATION. 2013 CODES. Applied to Approved Approved to Issued Printed: Monday, October 05, 2015 4:06:30 PM 1 of 3 7 , SYSTEMS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES PLAN CHECK SUBMITTAL PLACED ON HOLD UNTIL PLANNING SUBMITTAL IS APPROVED STEPHANIE KHATAMI 9/16/2015 9/21/2015 RECEIVED AND STRUCTURAL CALCULATIONS. ADIVISED BILL ON 9/24/15 NOTIFIED BILL OF SIGNARAMA THAT PERMIT IS READY TO TELEPHONE CALL BURT HANADA 10/5/2015 10/5/2015 ISSUE. CONDITIONS ZIP PHONE FAX EMAIL NAME TYPE NAME ADDRESSI CONTACTS CITY STATE APPLICANT PD GROUP DBA SIGNARAMA 41945 BOARDWALK PALM DESERT CA 92211 SUITE L CONTRACTOR PD GROUP DBA SIGNARAMA 41945 BOARDWALK PALM DESERT CA 92211 SUITE L Printed: Monday, October 05, 2015 4:06:30 PM 1 of 3 7 , SYSTEMS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL ENGINEER Y.J. INC. SIGN ENGINEER 25379 WAYNE MILLS VALENCIA CA 91355 PLACE #272 OWNER THE MAGELLAN GROUP 78611 HIGHWAY 111 LA QUINTA CA 92253 'Printed: Monday, October 05, 2015 4:06:30 PM 2 of 3 - SYSTPMS FINANCIAL CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 10/5/15 R9783 4180 CHECK PD GROUP DBA MFA SIGNARAMA Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: DEVICES, FIRST 20 101-0000-42403 0 $24.17 $24.17 10/5/15 R9783 4180 CHECK PD GROUP DBA MFA SIGNARAMA DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $24.17 10/5/15 R9783 4180 CHECK PD GROUP DBA MFA SIGNARAMA Total Paid for ELECTRICAL: $48.34 $48.34 MONUMENT SIGN, EA 101-0000-42404 0 $49.32 $49.32 10/5/15 R9783 4180 CHECK PD GROUP DBA MFA ADDITIONAL SIGNARAMA MONUMENT SIGN, 101-0000-42404 0 $72.52 $72.52 10/5/15 R9783 4180 CHECK PD GROUP DBA MFA FIRST SIGNARAMA MONUMENT SIGN, 101-0000-42600 0 $133.43 $133.43 10/5/15 R9783 4180 CHECK PD GROUP DBA MFA FIRST PC SIGNARAMA Total Paid for SIGN: $255.27 $255.27 TOTALS:04 'Printed: Monday, October 05, 2015 4:06:30 PM 2 of 3 - SYSTPMS REVIEW TYPE REVIEWER SENT DATE' DUE DATE RETURNED STATUS REMARKS NOTES SUBDIR ETRAKIT ENABLED Attachment Type CREATED DATE ATTACHMENTS DESCRIPTION IST BLDG NS (1 WK) BUILDING 9/29/2015 10/6/2015 10/5/2015 APPROVED 10/5/2015 BURT HANADA - IN N OUT SIGNS.pdf BUCKET 1 APPROVED PLANS - 1ST BLDG STR (1 YOUNG 9/29/2015 10/6/2015 10/5/2015 INCOMPLETE MONUMENT SIGNS MONUMENT SIGNS WK) IENGINEERING. (3).pdf (3).pdf Printed: Monday, October 05, 2015 4:06:30 PM 3 of 3 Ce SYSTEMS BOND INFORMATION PATHNAME SUBDIR ETRAKIT ENABLED Attachment Type CREATED OWNER ATTACHMENTS DESCRIPTION 2ND SUBMITTAL PLANS 2ND SUBMITTAL PLANS DOC 10/5/2015 BURT HANADA - IN N OUT SIGNS.pdf - IN N OUT SIGNS.pdf 1 APPROVED PLANS - APPROVED PLANS - DOC 10/5/2015 BURT HANADA MONUMENT SIGNS MONUMENT SIGNS 1 (3).pdf (3).pdf DOC 10/5/2015 BURT HANADA APPROVED SIGN APPROVED SIGN 1 ENERGY FORMS.pdf ENERGY FORMS.pdf APPROVED APPROVED DOC 10/5/2015 BURT HANADA STRUCTURAL CALCS - STRUCTURAL CALCS - 1 TYPE l.pdf TYPE l.pdf APPROVED APPROVED DOC 10/5/2015 BURT HANADA STRUCTURAL CALCS - STRUCTURAL CALCS - 1 TYPE 2.pdf TYPE 2.pdf 1ST REVIEW - NEW CITY DOC 10/2/2015 KATHRYN SAMUELS STRUCTURAL TRANSMITTAL BSIG 0 TRANSMITTAL 2015-0031(lst).pdf Printed: Monday, October 05, 2015 4:06:30 PM 3 of 3 Ce SYSTEMS Rin # City of La Quin to Buifding &r Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 I Building Permit Application and Tracking Sheet Permit #. Sl Cs �pl�- Project Address: 61� W. Lj//� Owner's Name: /�Q V I ) A. P. Number: (nj` CIZ.L�3 Address: J Legal Description: City, ST, Zip: L , A G-. Q 6Z> Contractor: w.. T ele hon � Address: 41 fi 4 `Bo �� ,l< J�� (� Project Description: rYl r7 NLAmfNT City, ST, Zip: T a—(- y,/N D -e. , CZ- � • a `L'7-1 1 S Tele h ne: 760-`7 1 6�O-l i State Lie. # D 13 % City Lie. #: 7 vo Sq of 1 Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ...................:.::.::....:. Construction Occupancy: TYPe .::::::::::..................... Lie. dd'n Alter Repair Demo New A Project type ne•Ne Name of Contact Person: 13 L L Ltn-k2fe d Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 6O- S71�-- 63 J .S Estimated Value of Project: 2 �� APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted bf Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN I{OUSE:- '"! Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub, Wks. Appr Date of permit issue School Fees, Total Permit Fees v Tdf 4 4Qur«rw LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS TAMPIco LA QUINTA, CALIFORNIA 92253 TRANSMITTAL ATTN: /y TODAY'S DATE: 20 - PERMIT NUMBER: PROJECT ADDRESS: 1 �) UI i l Hiq*�,t APPLICANT NAME: IqVI 0rlq 94C4. - SUBMITTAL ROUND: l INCLUDED HEREWITH: OPLANS ❑REDLINED PLANS 05TRUCT ❑REDLINED STRUCT ❑TRUSS ❑REDLINED TRUSS ❑SOILS ❑REDLINED SOILS ❑ENERGY ❑REVISED ENERGY ❑CORRECTION LIST ❑OTHER BUILDING & SAFETY DEPARTMENT (760) 777-7125 FAX (760) 777-7011 ❑COMPLETE PLAN CHECK/N/S-STRUCTURAL DUE DATE: BIN NUMBER: EC', ❑REVISED PLANS ❑REVISED STRUCT ❑REVISED TRUSS ❑REVISED SOILS []APPROVED PLANS []APPROVED STRUCT ❑APPROVED TRUSS ❑APPROVED SOILS ❑CUSTOMER RESPONSES -BUILDING DEPARTMENT USE ONLY - GREEN SHEET TO: ❑CDD ❑(w/Plans) ❑PUBLIC WORKS ASSIGN NON-STRUCTURAL TO: COMMENTS: ❑COVE CHECK (w/Application) September 24, 2015 0 Iii 1 I. I I r .Mr. William Sigurdsen Sign -a -Rama 41-945 Boardwalk, Suite L Palm Desert, CA 92211 SUBJECT: SIGN PERMIT APPLICATION 2015-0030 LA QUINTA SQUARE MONUMENT SIGNS Dear Mr. Sigurdsen: The Planning Divi.sion has reviewed and approved. your request for' three (3) monument signs, for the La Quinta Square commercial development. The approval is subject to the following. conditions of approval: 1. This sign permit grants three (3) internally -illuminated; monument signs to be located along Highway 111 and Simon Drive. The signs are subject to the approved sign program for La Quinta Square. 2. The approved sign design, materials and installation shall conform to the sign exhibits submitted as part of this application (SA2015-0030). The applicant is required to obtain any building permit as may be necessary prior to sign installation. The Building Division can be reached at (760) 777-71.25. Should you hpve any questions, please feel free to contact me at (760) 777-7067. Sincerely, JAY--/UU, AICP Principal Planner t 78-495 Calle Tampico I La Quinta I California 92253 1' 760.777.7000 1 www.La-Quinta.org Project iddres f P(A L-�, Location of,Signk Outdoor Sig -hs O Indoor Signs Phase of Sign Construction KNew Signs O Sign Alterations Type of Lighting Control flkcro121 New Lighting Controls O Replaced Ughdng Controls O Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) ?-'Mandatory Measures (Lighting Controls) O Maximum Allowed Lighting Power O Specific Lighting Sources 1. Mandatory Sign Ughting Controls NOTES: 1. The some responsible person may install both the sign lighting power and the sign lighting controls, or o 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 orchitect shall be responsible to hove 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 on 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 or the entire construction. Ia. 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 1 have responsibility for Installing the sign lighting controls OYes, complete parts la and lb of this form O No, complete part la of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls Yes O No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls �RjYes O No I There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and l will be ' 4 installing compliant sign lighting controls O Yes No 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 O Yes gNo CITY OF LA QUINTA BUILDING: & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE �slG�lr'• o03I 1t Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014 611 14m„ Y Y I/ 1b. Mandatory Sign Lighting Controls If the per$on 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 followins questions: If there are construction documents, indicate where on the building plans the mandatory measures (sign lighting control) note block can be located: 1 §1303(a)1. All Indoor sign lighting is controlled with an automatic time -switch control or astronomical time- Y I N I NA switch control. ❑ 9 ❑ §1303(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 Y NA areas that are intended to be continuously lit, 24 hours per day and 365 days per year. O §130.3(a)28. 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 O ❑ day and night. EXCEPTION to Section 130.3(a)28: Outdoor signs in tunnels and large covered areas that are intended to be Y NA illuminated both day and night. ❑ §1303(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 O N 114 N/A 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. O. Field Inspect r Notes: A Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014 Z_ Marimum 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 3 of tms t-eraticate oT Lompuance It there are signs using the Specific lighting sources method of compliance) A B C D E F G H 1 1 Symbol Or Code Description of the Sign OPTIONAL- Energy Verified Label (see instructions below) Allotted Watts Design Watts CoY/Nies Filed Inspector Check that sign complies N O W —'_ o Ca10C E a V K C W— •• X33 3i _o I n Q %` 3LL 3�a, p Q C o off° �3 H E 0 U �Yl a win I`� �.r� 1 ❑ q, 060 .0 �o ❑ yylaNu. `_. ❑ o ❑ ❑ ❑ ❑ p ❑ ❑ ❑ ❑ ❑ ❑ A Symbol or code used on the plans (when plans are required) and other documents. 8 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 Ughting 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 insquare feet. E Ust "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. =ield Inspector Notes: A Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 `:i SpPdfic Lighting Source Method of Compliance Certificate of Compliance and Feld 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 13 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 oN e 61`3cn --� 1 below) List all that apply Vol ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ AlSymbol 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 Vis 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: Lis; all applicable numbers (1 through 9) that apply in column 0 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 082.6-2005. 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 a ballast that has a minimum efficiency of 80 percent. 3 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 S 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. Fluorescent lighting systems meeting one of the following requirements: A. Use only lamps with a minimum color rendering Index (CRI) of 6 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). 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: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014