12-0101 (SIGN)78075 Main St Ste 106
12-0101
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-06000101
Property Address:
78075. MAIN ST .STE 106
APN:
770-121-0,11- -
Application description:
SIGN
Property Zoning:
VILLAGE COMMERCIAL
Application valuation:
0
Applicant: Architect or Engineer:
(,,NTAAreslu(L
-
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Professionals Code, and my License is in full force and -effect.
License Class: D42 C45 L' ense No.: 830131
Date: i C Z Contractor:
OWNER -BU ER 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.).
(_ 1 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 -
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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/03/12
Owner:
OLD TOWN LA QUINTA
78015 MAIN ST #205
LA QUINTA CA
LA QUINTA, CA 92253
r99 Dit..._..__.... ,
Contractor: i 1
r 9
S IGNARAMA
N
.;
,,
41945 BOARDWALK, "L"
PALM DESERT, CA' 922.11
(760),776-9907
Lic. 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 HARTFORD CO Policy Number 198607
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 Labor C h I with comply those provisions.
(Dater 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 Director of Building and Safety 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 county to enter upon the above-mentioned propett for' spection pur oses. ..
(Date: Signature (Applicant or Agent):
r
'Application Number . . . . . .12-00000101
Permit ELEC-ELECTRICAL SIGN
Additional desc .
Permit Fee . . . . 33.00 Plan Check Fee..
.00
Issue Date Valuation
0
Expiration Date.. 8/01/12
Qty Unit Charge Per
Extension ,
BASE FEE
15.00
1.00 15.0000 EA ELEC SIGN 1ST CIRCUIT
15.00
1.00 3.0000 EA ELEC SIGN ADDITIONAL CIRUITS
3.00
-----------------------------------------------------------------------------
Special Notes and Comments
(2) CHANNEL LETTER LED SIGNS [SOLANO'S:
A WEST COAST BISTRO] SIGN PERMIT NO.
2012-1589 [JW] 2008 ENERGY, 2010
CALIFORNIA BUILDING CODES.
February 3, 2012 1:50:43 PM AORTEGA
Fee'summary Charged Paid Credited
Due
,
----------------- ---------- ---- - -------------------------
Permit Fee Total 33.00 .00 .00
33.00
Plan Check Total .00 .00 .00
.00
Grand Total 33.00 .00 .00
33.00
LQPERMIT
#
C[/ Of ..Qurnta
ButUng 8z Safety.DiWon . .
P.O. Box 1504, *78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Bonding PermitApplication and Tracking Sheet
Permit #
Project Address: L Ga, -Lin
I.A-P.*Nurnber.
Name:.
iob
Address: 7k — 07 5 T
Legal Description:City,
Contractor. i G _,— a
ST, Zip: a u, U ,
Telephon 760 s78— 7
Address: L / 91 "Qea n ! Wn (.)L
Project Description: 2 L' jCj G
City, ST, Zip: - ,Crn (Scz1
\1
Telephon476 0-) 7 7(— q q D
City Lie fi 9 j D0 y9.%
State Lie. # : d 3 D I.
Asch.; Engr., Designer
Address:
City., ST, Zip:
Telephone: a
State Lie. #:
Construction Type:. Occupancy:
Project type (circle one): New ' Add 'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Name of Contaq Person: i LL 6 &\ .< -2J
Telephone # of Contact Person(T6 Cj J 5'
Estimated Value of Proj arlb
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Plan Sets
Req'd
Reed
TRACKNG
Plan Check submitted
PERMIT FEES
item Amount
Strgctnral Caltc
Reviewed, ready for corrections
Plan Check Deposit. .
Ttau Calcs•
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plana picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plea
V Review, ready for correctionVissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ML
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"` Review; ready for correctionstissue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
cei,--4 JA Q"
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-150.4
78-495 CALLE TAMPICO (760) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX' (760) 777-7101
February 2, 2012
Mr. Bill Sigurdsen
Sign -a -Rama
41-945 Boardwalk, Suite L
Palm Desert, CA 92211,
SUBJECT: SIGN PERMIT APPLICATION 2012-1589
SOLANO'S: A WEST COAST BISTO
Dear Mr. Sigurdsen:
The Planning Department has reviewed and approved your request .for two building -
mounted, illuminated channel letter ("SOLANO'S") and dimensional letter ("A
WEST COAST BISTRO") signs,. located at 78-075 Main Street, in the Old Town
commercial center. The approval is subject to the following Conditions of
Approval:
1.. This sign .permit grants two permanently:mounted building identification
signs. The total square footage for the south -facing building -mounted sign
will be no greater than approximately 17.00- square feet. The total square
footage for the. north -facing building -mounted sign will be no greater than
approximately .15.00 square feet.
2. The signs will be mounted on the south and north building elevations as
shown on the exhibit.
3. The signs shall conform to the approved sign program for Old Town La
Quinta.
Should you have any questions or 'need additional information please feel free to
contact me at.(760) 777-7125.
Si
v
\Y UU
Associate PlaFrn`er
C:. e epartment
73:0"
Illuminated (Solano's)
Dimensional Reverse Channel Letters
Letter Depth: 3
33.3"
ot NOS,
Face Color: Antique Brown
Return Color: Antique Brown
6(%st LfoQst 8 stAo
>
_
,4
L.E.D. Color: White
t.
Mounting: Back911
t
?P
rVa
- Standoff: 3/4 ,
. ..
~, __y✓tP• * [ 479 C"ut 3" ....'+'Iwl*1 s.Y +l.. P;r:. y t. "1
r
- - -
Non -Illuminated (A West Coast Bistro)
-
Dimensional Letters
* tp k*.y .`s w r ooarrslrGo`. ..s#?t-►ne
.01
t-• tF
-
Material: 1/4„ Flat Cut Aluminum
M H
Face Color:Antique Brown .
Return Color: Antique Brown
Mounting: Back
Standoff: 3/4”
•
-
Sign Description: - Non -Illuminated (AWestCoas[Bistro) .
Customer: , Telephone: 760•. •
Jobsito: - Customer'Approval:
-
•
.Illuminated trsSolano0 Dimensional Letters
Dimensional Revee Channel Letters - Letter Depth: 3' Material: I/4'Flat Cut Aluminum -
Solano's Felt: 760•
Address:
Same + -
_
• -
- -
' -
Face Color. Antique Brown Face Color: Antique Brown
RemrnCobr.AntiqueBrownReturnColor.MtiqueBrown Frontage is
LE.D.Color.White-Mounting. Back -Standolr:3/4' Mounting: Back - Standoff: 3/4' Total Signage16.88$.F.
+
78075 Main St
LaQUinta,CA92253' South ELEVATION_-
V ,
Landlord Approval:
°
* *
SIGN A RAMA
Contractor's Lic # 830191 C45,C61/D42
Ow IVo.. 51833 Rev: 1S1
g•
NT
YOUR SIGNATURE ACKNOWLEOGESFULLAPPROVALOESPOFDESITYINREGN AR
- AND LAYOUT, RELEASING SIGN •A•RAMA FROM RESPONSIBILITY IN REGARD
• +
41-945 Boardwalk, Ste. L
workers Comp. #11936807 '
Date: 01-17-12
TO INCORRECT DESIGN AND INFORMATION. THE COLORS SHOWN ARE ONLY
REPRESENTATIVE OF ACTUAL PMS COLOR CALL OUTS. FINAL COLOR WILL
i-_
Palm Desert CA. 92211Clty
LIc. #87005491
-
Designer: JT
BE MATCHED AS CLOSE AS POSSIBLE, COMMENSURATE WITH MATERIALS USED.
THIS DESIGN IS PROPRIETARY PROPERTY AND MAY NOT BE USED WITHOUT
-
PH 760-776-9907' FX 760-776-9844
THE EXPRESSED WRITTEN CONSENT OF SIGN•A•RAMA.
•
APPRO D Y PLANNING DEPARTMENT
:. i
i :r-
BY DATE: t2
EXHiiW
CASE NO._Q-P,.cZ- cS G1
67.4" Illuminated (Solano's)
Dimensional Reverse Channel Letters
Letter Depth: 3"
30.7" O Os Face Color: Antique Brown
Wert G OQSt 8 st o Return Color: Antique Brown
L.E.D. Color: White
Mounting: Back r;
' _- `pr• ' Standoff: 3/4 =
wl` ` • , , 'ifs!• , -
, .
Non -Illuminated. (A West Coast Bistro)
Dimensional Letters
4S0rr" 0w a-^" Material: 1/4"Flat Cut Aluminum
Face Color: Antique B.
uerown
- -
Rr Return Color: Antique Brown
Mounting: Back
Standoff: 3/4"
Sign Description: '
Non -Illuminated (AWestCo..IBhh")
Customer:
Telephone: 760-
Jobsite: Customer Approval:
Illuminated Solano's)
Dimensional Letters
Solano's
Fax: 760-
Same -
DimensionalBeverceChannelLetters- Letter Depth: 3'
Face Color.Antique Brown
Material: 1/4'Flat Cut Aluminum
- Face Calor. Antique Brown Frontage is 75 linear feet
Address:
78075 Main St
landlord Approval: -
Retum color: Antique Brown
L.E.D. Color.White - Mounting: Back - Standoff: 3/4'
Return Color: Antique BrownNOrth
Mourning: Back -Aandolfa/4- Total Signage 14.37 S.F.
La QUlnta, CA 92253
ELEVATION
'
*A * RAMA
Contractor's LIC # 830131 C45, C61/D42
D„, No,; 51833
9•
Rev.: 1st
YOUR SIGNATURE ACKNOWLEDGES FULL APPROVAL OF DESIGN CONTENT
S FULL
AND LAYOUT, RELEASING ACKNOWLEDGES
FROM RESPONSIBILITY IN REGARD
SIGN
Workers Comp. #1938807
Date: 01-17-12
TO INCORRECT DESIGN AND INFORMATION. THE COLORS SHOWN ARE ONLY
REPRESENTATIVE OFACTUAL PMS COLOR CALL OUTS. FINAL COLOR WILL
41-945$oardwalk Ste.L
BE MATCHED AS CLOSEAS POSSIBLE, COMMENSURATE WITH MATERIALS USED.
Palm Desert CA. 92211City
DeSlgllef: JT
THIS DESIGN IS PROPRIETARY PROPERTY AND MAY NOT BE USED WITHOUT
PH 760-776-9907 • FX 760-776-9844
LIC. #97005491
THE EXPRESSED WRITTEN CONSENT OF SIGN'A'RAMA.
APPROVED 13Y PLANNING DEPARTMENT
Ry DATE Z
EXHIBIT
CASE NO.
r
APPFI !; 8PLANNING DEPARTMENT
BY Z DATE' 117
' 1=XIi1P11T
CASE NO.
EXISTING WALL
.063" ALUMINUM RETURNS
#10 HEX HEAD SCREWS
AND WALL ANCHORS
NEON TUBES
.063" ALUMINUM FACE
3/16" LEXAN BACK
GTO WIRE
PRIMARY ELECTRICAL
TRANSFORMER
W/ DISCONNECT SWITCH
A INTERNAL GFI
WATER PROOF CONDUIT
ALUMINUM STAND OFF
BONDING WIRE
STANDARD GLASS STANDS
1/4" DRAIN HOLES
HALO ILLUMINATED
NEON CHANNEL LETTER-.
(TYPICAL CONSTRUCTION)
COMPLIES WITH 2007 CA ELECTRICAL CODE,.ARTICLE 600
U.L. LISTED& LABELED
Drawing No.: ED10012
Revision: B S GN•A'RAlyq
Date: 3-22-11 SA 7*A * RAMA
^«.•' '°" THE COACHELLA VALLEY'S FULL SERVICE SIGN CENTER
Drawn By: RA 41-945 Boardwalk. Ste. L. Palm Desert. CA 92211 .Ph. 760-776-9907
Approved By: FH
Certificate of Compliance (Sign Lighting)
Pae 1 of 4 SLTG-IC
Project Name://
v L• Oj N D S Lvt s G o a ST l is
Date: .
0 - D 1
Project Address: --7S — O i -5, , t>J J "1- . /
L 9Gt N rw>
Phone 16o) _ D -7
• 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
a
Location of Sign [&,eru-tdoor Signs 0 Indoor Signs
Address:License
Phase of Sign ConstructionCris i Signs 0 Sign Alterations
of Lighting Control ew Lighting Controls 0 Replaced Li htin Controls
0 Not InstallingLighting Controls... .
This Certificate. of Compliance includes the following components (check all that apply)
rT
• 1 certify that the requirernents detailed on this Certificate of Compliance have been met.
0 Mandatory Measures (Lighting Cbntrols) 13 Maximum Allowed Lighting Power
Specific Lighting Sources
1. Certificate of Compliance Declaration Statement (this may be a c 10. C45 or other eligible person)
1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
correct. _ . .
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24, Parts 1 and 6 of the California Code of Regulations.
a The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this building permit appli rI-
Name: J rZIA,f
Permit number
Signature
Company :
Erf cement Agency Use),
Phone 16o) _ D -7
• 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
a
• 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
Address:License
• 1 certify that the installed features, materials, components, or manufactured devices identified on this certificate conforms to a
number (may be con tP s.
'•
City/State/Zip:
• 1 certify that the requirernents detailed on this Certificate of Compliance have been met.
Date
2. Installation Certificate (to be signed by responsible person after installation)
Permit number
coed by/Date
Agency Use
Erf cement Agency Use),
Installation Declaration statement
• 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
correct.
• 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction.
• 1 certify that the installed features, materials, components, or manufactured devices identified on this certificate conforms to a
applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the'""
enforcement agency.
• 1 certify that the requirernents detailed on this Certificate of Compliance have been met.
• 1 will ensure that a completed, signed copy of this installation Certificate shall be posted, or 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 signed copy of this Installation Certificate is required to be included with the documentation the builder providei to the
building owner at occupancy.
Company Name:
Responsible Person's Name:
Responsible Person's Signature:
License number (may be contractor's lic #)
Date Signed:
Position With Company:
2008 Nonresidential Compliance Forms
hdy 2010
r:. fit.
un
Certificate Of Compliance Project Name: (Sign Lighting.) Pa e 2 of 4 SI,TGIC .
Q L R " e Date:
3. Mandatory Sian Lighting Controls
NOTES. -
The Alandutory 1lecuures (sign lighting controls) are required for compliance ►vith the sign lighti►rg Stunclards. The snnie
responsible person ►nay install both the sign uthJ the sign lighting controls. or u Ji JfBrent responsible
.sign lighting controls than the responsible person installing the sign. person' may rnstu -the
Z. IJ'the person responsible for installing the sign is not also responsible Jvr the sign lighting c•untrols, then the owner of the
sign, general contractor, or architect shall be responsible to have the sign lighting controls installed.
3. ff more than one person has responsibility Jor compliance, each person shall prepare and sign a Certificate of Compliance
and an Installation Certificate applicable to the portion of c•onstritction for which they are responsible: alternatively,.. the
person with chief responsibility for constriu•tion shall prepare and sign the Certificate OJ* Compliance Declaration •Statement
or the entire constnnction.
3a. Statements of Responsibility:
The erson si nin the Certificate of Compliance Declaration Statement shall check Yes or No for all of the followingstatements:
1 I have responsibility for installing the sign lighting controls
O Yes, com lete arts 3a and 3b of this form !'U
o. cam fete art 3a of this form
2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls `
O Yes
3
There are no existing sign lighting controls and someone else will be res ❑ Yes ponsible to install compliant sign lighting controls.
There are existing sign lighting controls that do not comply with the applicable provision of §119 and §133 and 1 will be
4 installing compliant sign lighting controls
O YesNo
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and stitiieoae —els-
5 5 will be responsible to install compliant sign lighting controls
O Yes
3b. Mandatory Sign Lighting Controls
The person signing the Certificate of Compliance Declaration Statement shall answer all of the following questions if they are
res onsible for com I in with the si li htin control requirements.
If there are construction documents, indicate where on the building plans the s l
mandato measures si li tin control note bloc k can be located:
1 §133(a)l. All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA
applicable r uirements of § 119.
9133(a)I and Z. All outdoor sign lighting is controlled with an automatic time switch control plus a photo
tch co r
2 control or an outdoor astronomical time switch, that
Y N NA
comply with the licable r of 119.
Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination
da It ht hours.
13
O
Burin g
§133(a)3. All outdoor signs are controlled with a dimmer that
Y
O
NA
O
provides the abilityto automatically reduce
si n wer b a minimum of 65 ercent duringnighttime hours. y
Y N
NA
Exception t to §133(x)3. Signs illuminated for less than one hour per day during daylight hours.
3
O 13
Y
O
::NAI
Exception 2 to §133( U.S. Outdoor signs in tunnels or large covered areas that require illumination Burin
da li ht hours.
O
g
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode,
illuminatin
Y
O
NA
O
si s or acts of signs or neon lamps used for
§133(9)4. An Electronic Message
Y
NA
Center (EMC) having a new connected lighting
15 kW has a control installed capable of reducingthe lighting g g power load greater than
O
"N/A
4 receivin a demand res onse signal that is sent out b the 1 aj ilil by a minimum of 30 percent when
Exception to §133(a)4.
Y N
OY Q
EMC required by a health or life sately statue, ordinance, or regulation, including
but notlimited to exit si Yns and traffic signs.
o
Field inspector Notes:
O
O
21)08 Nonresidential Compliance Forms
July 2010
i.
Certificate of Compliance Sin Lighting) Pa e 3 of 4 SL C- C
Project Name: n1 Datc:
. imp N O 1 S 1 o Z o -L
4. Maximum Allowed LiehtinQ 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. (Com lp!sg rt 5
of this Certificate of Comnliance if there are cine nein. tt.n —U -A ,.c ----.
A
B
C
D E F G
H
I
J.
Allowed Watts
Design
Complies?
Watts
Y / N
GI. -
` `'"'
43
5 3
y
..Field
U
^'
o —'
. •
`o .
v
, -
r
,
v
Inspector
L I
-
o
=
-- ''
°r
"1 3
w
3
b
a;
Z
4,
Check that
Sign
E
S/ 5 .s
a u
Z g
.lV
C
3
` M
3 ry
N _
_
.y
h
H
Complies
rn
5
q
ep
E " ^
x
.2 Irl 11
a v w
O II
Q
c
----
Description
./
FU
1p rac::ry
2vvtsc L c v,sc.L UT
❑t'Z F'
`r
❑ ..
/6NS
!
6'T13
❑.._..
❑
❑
❑
---
❑
❑
❑
❑
A
I Symbol or code used on the plans when plans arerequired) and other documents.
B
A narrative description of the sign. or location of sign on the buildin • and the location of sign on construction documents.
OPTIONAL - Check this hnx only iFrhia .G.,.. t...... -- _ --- I .. _
• - -----•-. r - r• ......,.Y-msmucu laud, nsteo wim unaerw iters 1-00 atm,
(UL) or other testing laboratory accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) or International
Standards Organization (ISO) 17025 in accordance with ISO/!EC 17011 with the products produced under an ongoing inspection program
C carried out by a Type A inspection body in accordance with ISO/IEC 17020, confirming that the sign complies with the Section 148 of the
California 2008 Title 24. Part 6 Standards, using the Maximum Allowed Lighting Power method of compliance. For signs with sucha
label, columns 'D' through 'I' are not required to be filled out. Note: Using a label is an optional method to validate compliance. A label is
not needed for compliance.
'T' if the sign is internally i
.•. .. y.y u.c nyuarc rootage in colum
Show the total installed watts in the s
Enter Y if the number in column H is
This page doubles as a field insnectin
Field
ited. List "E" if the sign is externally ilb
2 if the sign is listed as " T' in column -E.
D times the allowed Lighting Power Det
;n, as determined according to the applic•
:ss than or equal to the number in calami
checklist.
2.3 if sign is listed as "E" in
f§130(_dore)._
the sign does not
2008 Nonresidential Compliance Forms
July 2010
E.
Certificate of Compliance (Sign Lighting) (Page 4 o"4 SLTG-IC
Project Name:Date:
))
5. 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 4 of this
Certificate of Compliance if there are signs using the maximum allowed lighting ower method of compliance)
A g C U
OPTIONAL
UL Specific light source used for Field
Symbol or other compliance Inspector
or Description label Shall include only lighting alr'that
Code (.%vSi
gn
instructions technologies listed below
Wow) List all that apply Com lips
❑ ❑
❑ ❑
A Symbol or code used on the Plans when plans are re wined and other documents.
B A narrative description of the sign. or location of sign on the buildin • and the location of signon construction documents
C OPTIONAL -Check this box only if this sign has a permanent, pre-printed, factory -installed label, listed with Underwriters;L libiri r.
(UL) or other testing laboratory accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) or International
Standards Organization (ISO) 17025 in accordance with ISO/IEC 17011 with the products produced under an ongoing inspection program
carried out by a Type A inspection body in accordance with ISO/IEC 17020, confirming that this sign complies with the Section 148 of the
California 2008 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. For signs with such a label; column
D' is not reauired to be filled out. Note: Using a label is an olptional method to validate compliance. A label is not needed for corn liance.
Specific Light Source Compliance Method. The signs) identified above use only the following lighting technologies:
List all a licable numbers ! throw 10 thnt a 1 in column D above for each row.
rurse star or ceramic metal halide lamps served by a ballast with _> 88% efficient
j Pulse start metal halide lamps that are < 320 watts, are not 250 watt or 175 watt lamps. and are served by a ballast
with 2.'80% efficient
4Neon or cold cathode lam s with transformer or power supply efficient >_ 75% wi
5lampsth rated output current < SO trlA
D
Neon or cold cathode with transformer or Power su 1 efficient > 68% with rated ou ut current > 50 rtrA
b Fluorescent lamps with a minimum color rendering index (CRI) of 80
Note: when usin electronic ballasts for corn liance, lam s with a CRI < 80 ma be used
7 Li t emittin diodes LEDs with a power supply with >80% efficient
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8 output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as
cum l in with the a licable re uirements of the A liance Efficient Re Mations Title 20
9 Com ci fluorescent lam s that do not contain a medium screw base sockets E24/E26
Electronic ballasts with a fundamental ourt. t vim,.....-
2008 Nonresidenliol Compliance Forms
July 2010