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BSIG2014-103178-4 A TAMPIC LA QUINTA, CALIFORNIA 2253 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: SIGNARAMA OUTSIDE CITY LIMITS LA QUINTA, CA 92253 j. Q BSIG2014-1031 79410 HIGHWAY 111 102 600390006 (1) SIGN FIT GAL'S CLOSET $4,200.00 4 4v Qumro., COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT D � a DrEC 17 2014 CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT 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 Class: Li ense No.: :LIC -0004466 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 Divisio 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 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 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 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/17/2014 Owner: E&DD 2114 ARI LN LOS ANGELES, CA 92253 Contractor: SIGNARAMA OUTSIDE CITY LIMITS LA QUINTA, CA 92253 (760)776-9910 Llc. No.: :LIC -0004466 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 Labor Code, I shall forthwith comply with t ose p visions. a pate: /7 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 upon the above- mentioned pr perty or inspection purposes. ate: 12111711'1Signature (Applicant or Agent):A_ 4Z Ji FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY _ ",METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT. PAID PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forELECTRICAL: $48.34 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT 1PAID PAID DATE WALL/AWNING SIGN, FIRST 101-0000-42404 0 $87.02 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/AWNING SIGN, FIRST PC 101-0000-42600 0 $24.66 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forSIGN: $111.68 $0.00 TOTALS:00 Description: (1) SIGN FIT GAL'S CLOSET Type: SIGN Subtype: Status: SUBMITTED Applied: 12/17/2014 PJU Approved: Parcel No: 600390006 Site Address: 79410 HIGHWAY 111 102 LA QUINTA,CA 92253 Subdivision: PM 31172 Block: Lot: 6 Issued: Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $4,200.00 Occupancy Type: Construction Type: Expired: No.. Buildings: 0 No. Stories: 0 No. Unites: 0 CA Details: ONE PERMANENTINTERNALLY ILLUMINATED SIGN SA -2014-1069 CBC 2013 CODE ADDITIONAL CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT SIGNARAMA OUTSIDE CITY LIMITS LA QUINTA CA 92253 CONTRACTOR SIGNARAMA OUTSIDE CITY LIMITS LA QUINTA CA 92253 OWNER E & DD 2114 ARI LN LOS ANGELES CA 92253 TD DESCRIPTION I ACCOUNT I QTY I AMOUNT I PAID I PAID DATE I RECEIPT # I CHECK # I METHOD I PAID BY I CL BY BSAS SB1473 FEE 1 101-0000-20306 1 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: Printed: Wednesday, December 17, 2014 5:11:42 PM 1 of 2 CRWYSTEMs INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES DATE DATE FINAL" PARENT PROJECTS REVIEWS REVIEW TYPEREVIEWER SENT DATE DUE DATE RETURNED STATUS -77REMARKS NOTES DATE BOND INFORMATION CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT #'. CHECK # ,_ METHOD PAID' BY BY DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 Total Paid for ELECTRICAL: $48.34 $0.00 WALL/AWNING SIGN, 101-0000-42404 0 $87.02 $0.00 FIRST WALL/AWNING SIGN, 101-0000-42600 0 $24.66 $0.00 FIRST PC Total Paid forSIGN: $111.68 $0.00 TOTALS:• • 00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES DATE DATE FINAL" PARENT PROJECTS REVIEWS REVIEW TYPEREVIEWER SENT DATE DUE DATE RETURNED STATUS -77REMARKS NOTES DATE Printed: Wednesday, December 17, 2014 5:11:42 PM 2 of 2 CRWYSTEMS BOND INFORMATION ATTACHMENTS Printed: Wednesday, December 17, 2014 5:11:42 PM 2 of 2 CRWYSTEMS Bin tf ; .. City of La Q rain to . Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico. La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: ��' 7�"� 1 t Owner's Name: a f1-,— A. P. Number: �n Z Address: -70) If Legal Description: City, ST, Zip: Contractor: v�) .� -a Te h Address: Z-1 / q 14_5�c>-fJ v,,uv,s— L Project Description: City, ST, Zip: �' -Z't.� ff h�� Wit, ' S Telephone: p •7 -7 6 6 `State Lic. # : d / CityLie. #.-.1717 61) �ry q( Arch., Engr., Designer:- esigner: Address- Address:City, City.,ST, Zip: Te]ephone:. Construction Type: Occupancy: Lic. # Project type (circle one) •New dd n Alter Repair air Demo Name of Contact Person:81 �� • Sq. Ft.: . # Stori s: # Units: Telephone #,of Contact Person: `76 Dy' Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES. Plan Sets Plan Check submitted Itcm Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan f j "'J 2"Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans lucked up S.M.I. H.O.A. Approval - Plans resubmitted Grading- radingIN INIiOUSE:- 'rd Review, ready -for correctionstissue Developer m•pact'Fee Planning Approval Called Contact Person A!i.P.P. Pub. Wks. Appr Datc of permit issue School Fees Total Permit Fees PROUDLY SERVING THE UNINCORPORATED AREAS OF RIVERSIDE COUNTY AND THE CITIES OF: BANNING BEAUMONT CALI M ESA CANYON LAKE COACHELLA DESERT HOT SPRINGS EASTVALE INDIAN WELLS INDIO JURUPA VALLEY LAKE ELSINORE LA QUINTA MENIFEE MORENO VALLEY NORCO PALM DESERT PERRIS RANCHO MIRAGE RUBIDOUx CSD SAN JACINTO TEMECULA WILDOMAR BOARD OF SUPERVISORS: KEVIN JEFFRIES DISTRICT 1 JOHN TAVAGLIONE DISTRICT 2 JEFF STONE DISTRICT 3 JOHN BENOIT DISTRICT 4 MARION ASHLEY DISTRICT 5 RIVERSIDE COUNTY FIRE DEPARTMENT IN COOPERATION WITH THE CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION 77-933 Las Montanas Rd., Ste. #201, Palm Desert, CA 92211-4131 • Phone (760) 863-8886 • Fax (760) 863-7072 www.rvcfire.org April 25',2014 RE: TENANT IMPROVEMENT PLAN CHECK -Non Structural LAQ-I4-TI-031 Lomi Lomi Massage 79410 Hwy 111 Ste#102, La Quinta, CA You have been issued a release for a tenant improvement on an existing building. THIS IS NOT AN OCCUPANCY PERMIT. It is prohibited to use/process or store any materials in this occupancy that would classify it as a "H" occupancy per Sec. 307 of the 2013 CBC. THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO INSPECTION: Install door hardware and exit signs as per Chapter 10 of the 2013 CBC. A minimum 2A10BC Fire Extinguisher, (State Fire Marshal Approved) must be mounted in a visible location within 75' walking distance from any point in your building or suite. Fire extinguishers can be installed by a licensed extinguisher company with a State Fire Marshal service tag attached to the extinguisher, or purchased from a retail store with a sales receipt attached. A licensed fire extinguisher company must service extinguisher yearly. All breakers must be labeled and a clearance of 36 inches must be maintained around the panel at all times. Approved suite addresses shall be placed in such a position to be plainly visible and legible from the street. Said numbers shall contrast with their background. An approved audible interior notification alarm device shall be provided in approved location. A C- 10 licensed contractor must submit plans, designed in accordance with NFPA 72 to the Fire Department for review and approval prior to installation A durable sign stating "This door to remain unlocked during business hours" shall be placed on or adjacent to the front exit door. The sign shall be in letters not less than one inch high on a contrasting background. Provide key(s) to the tenant space for inclusion in the main building Knox Box. Key(s) shall have durable and legible tags affixed for identification of the correlating tenant space. Key(s) shall be provided at time of final inspection. As may be necessary to maintain proper fire sprinkler protection due to constructions changes, fire sprinkler system plans for the tenant improvement area may be required to be submitted to the Fire Department for review. Applicant/installer shall be responsible to contact the Fire Department to schedule inspections. A re - inspection fee will be required if more than one (1) inspection is necessary. Requests for inspections are to be made at least 72 hours in advance and may be arranged by calling (760) 863-8886. All questions regarding the meaning of these conditions should be referred to the Fire Department Planning & Engineering Staff at (760) 863-8886. Sincerely, By: Lisa Nottingham Fire Safety Specialist Project Name' / 1 � Phase of Construction O New Construction O Addition O Alteration 6 �i -� t S C' C k 1 Function Tl -TS J90utdoor Signa 0 Indoor Signs Proj0.M Addles: ' ^"' Compliance Method Used ®'Maximum Allowed T7q -7o S ��G✓y 11 /� S% v �� -7111) Lighting Power O Alternate UYhdng Sources Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and complete. Name S I 0L 0sE Signature Company A7 Date 2-11 7 Ill Address If applicable: 1-s �0P1a-A V-3 Act_ SU I -f-F- L-- CEA E CEPE aY City/Stnte/Lip �Ar SE 2� C R Z Phone: 46 O - }ice -9 9 O Principal Lighting Designer's Declaration Statement • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. • This Certificate of Compliance idctttifies the lighting fcaEurcs and pertormanrc specifications required for compliance with Title 24, Pages 1 and 6 of the California Code of Regulations. • 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 application. None:_5S Signature Compnn)' : SI t., l4 Phone - 3aia -9 0 Address: 1 S License $1 O 13 City/Statc/Zip: 2PK OAT gaze %2/) - 1 H Sign Mandatory Measures Indicate location on building plans of Mandatory Sign Measures Note Block: Mandato Sign Lighting Controls Yes No §133(&)1. All signs with permanently connected lighting are controlled with an automatic time switch control 1 that complies with the a livable requirements of 119.PK O §133(a)2. All outdoor signs are controlled with a photo control or outdoor astronomical time switch control. O 2 Exception to §133(x)2. Outdoor signs arc in tunnels or large covered areas that require illumination during daylight hours. 0 §133(a)3. All outdoor. signs arc controlled with a dimmer that provides the ability to automatically reduce sign power by a minimum of 65 percent during nighttime hours. O Exception I to §133(&)3. Signs are illuminated for less than one hour per day during daylight hours. O 3 Exception 2 to §133(&)3. Outdoor signs arc in tunnels or large covered areas that require illumination durin da li t hours l7 Exception 3 to §133(&)3. Only metal halide, high pressure sodium, cold cathode, or.neon lamps are used to illuminated signs or paru of signs. O § 133(a)4. An Electronic Message Center (F --MC) having a new connected lighting power load greater than 15 kW has a control installed is capable of reducing the lighting power by a minimum of 30 percent when Y N N/A 4 1 receiving a demand response signal that is sent out by the local utility. O O Exception to §133(&)4. The EMC is required by a health or life safety statue, ordinance, or regulation, Y N N/ includingbut not limited to exit si ns and traffic signs. O O 2008 Nonresidential Compliance Fornis Augiut 2009 ?roject Address: e �. i Gvi ' S G� S ovation n of'Sign Location �4utdoor Signs O Indoor Signs L Phase of Sign Construction ' j=New Signs O Sign Alterations T of Lighting Control Nr, CC -{i. ®-New Lighting Controls O Replaced Lighting Controls O Not Insta This Certificate of Compliance includes the following components (check all that apply) FYMandatory Measures (Lighting Controls) 13 Maximum Allowed Lighting Power O Specific Lighting Sources Controls 1. Mandatory Sign Lighting Controls NOTES: 1. The some responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible person may instoll the sign lighting controls than the responsible person installing the sign lighting power. Measures (sign lighting controls) ore required for compliance with the sign lighting Standards. if the person 2. The Mandatory responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign, general-controctor, or architect shall be responsible to hove the sign lighting controls installed. responsible person shall prepare and sign a Certificate of 3. If more than one person has responsibility for compliance, each Compliance and an Installation. Certificate applicable to the portion of construction for which they are responsible, -"Olt emotively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement or the entire construction. 1a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E shall complete Part la. Check Yes or No for all of the following statements: 1 have responsibility for installing the sign lighting controls 1 Oyes, complete parts la and lb of this form O No, complete part la of this form There are no existing sign lighting controls and I will be installing compliant sign lighting controls 2 Yes O No I There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls 3 Yes ❑ No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and I will be 4 installing compliant sign lighting controls 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 No CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 L S Lam.-ir. '7 If i r�J f'� w ' ' / f s [-� 1b. Mandatory Sign Ughting Controls If the signing the Certificate of Compliance Declaration Statement on this.NRCC-LTS-01-E is responsible for complying with person the sign lighting control re uirements, that person shall answer all of the following questions: if there are construction documents, indicate where on the building plans the i mandatory measures (sign lighting control) note block can be located: §1303(a)1. All Indoor sign lighting is controlled with an automatic time -switch control or astronomical time- YY NN NOA 1 switch control. §1303(a)2A.' All outdoor sign lighting is controlled with a photocontrol in.addition to an automatic time- Y N NA switch control, or an astronomical time -switch control. a 0 0 Z 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. 0 AL §1303(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. be ON both Y 0 N 0 NSA' Signs that are illuminated at night and for more than 1 hour during daylight hours shall considered l� 3 day and night. to Section 130.3(a)26: Outdoor signs in tunnels and large covered areas that are intended to be Y NA EXCEPTION illuminated both day and night. 0 §1303(a)3. Demand Responsive Electronic Message Center Control. An Electronic Message Center (EMC) Y N N/A having a new connected lighting power load greater than 15 kW has a control installed that is capable of 0 4 reducing the lighting power by a minimum of 30 percent when receiving a demand response signal. EXCEPTION to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, Y NA ordinance, or regulation to be reduced by 30 percent. O Field Inspector Notes: CA Building Energy Efficiency Standards - 200 Nonresidential Compliance June 2014 r 2 Maximum Allowed LiF t -niz 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 this Certificate of Compliance if there are. signs using the Specific lighting sources method of compliance) A B C 0 E F G H' I 1 Symbol Or Code ' Description of the Sign OPTIONAL— Energy Verified Label (see instructions below) Allotted Watts Design Watts Complies YEN Filed Inspector Check that sign complies o m 0 b to C fp C X 3 w— CL \ 0v N ~ n Q=w x (U p Q v o o a r; V1 N Cl E U l L t� ❑ 1 1��.� , a ❑ .J yw ' � ❑ ❑ ❑ O ❑ ❑ ❑. r ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 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 signswith 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 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 orequal to the number in column G. Otherwise, the sign does not comply. i This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy- Efficiency Standards - 2013 Nonresidential Compliance June 2014 3. Specific Lighting Sourcd 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 B C D E OPTIONAL Specific light source used for Symbol ENERGY VERIFIED compliance Feld Inspector or Description label Shall include only lighting Check that Sign Code (see instructions technologies listed below Complies. .. '�/,u below) List all that apply ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ A Symbol or code used on the plans (when plans are required) and other documents. e A narrative description of the sign, or location of.sign on the building; and the location of sign on construction documents C OPTIONAL- Check this box only if this sign has a permanent, pre-printed, factory -installed ENERGY VERIFIED label, confirming that this sign complies with the Section 140.8 of the California 2013 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in'accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label, column 'D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance. An ENERGY VERIFIED label is not needed for compliance. Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies: List all applicable numbers (1 through 9) that apply in column 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 C82.6-2005. Metal halide lamps that are pulse start that are 320 watts or smaller, are not 2SO watt or 17S watt lamps, and are served by 3 a ballast that has a minimum efficiency of 80 percent. Ballast efficiency is the measured output wattage to the lamp divided by the measured operating input wattage when tested according to ANSI C82.6-2005. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 percent D 4 when the transformer or power supply rated output current is less than 50 mA. The ratio of the output wattage to the input wattage is at 100 percent tubing load. Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68 percent 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. 6 Fluorescent lighting systems meeting one of the following requirements: A. Use only lamps with a minimum color rendering index (CRI) of 80; or B. Use only electronic ballasts with a fundamental output frequency not less -than 20 kHz. 7 Light emitting diodes (LEDs) with a power supply having an efficiency of 80 percent or greater; Single voltage external power supplies that are designed to convert 120 volt AC input into lower voltage OC 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 DOCUMNTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Compliance documentation is accurate and coni fete. Documentation Author Name: Documentation Author Signature: Company: 1 G 4 Pt rLA-VV%1N' Signature Date: ) ),)-Z / Address: lq S (3o>aQp SurTC L— CEA/ HERS Certification Identification (if a plicable): Cicy/State/tip: DES60-1 CAI gzzt � Phone: 7&6-7X9-9 0 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 Californla Code of Regulations, 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. S.. 'I will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: j Company; Date Signed: Z/ Address:Ucense: 1-4 '13()?RP, t,.��Llc svI TE L 8301 . City/State/Zip:' PA l^ pE s c2T e 14 Z. Z t 1 Phone: -1 Lo C) - CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014