BSIG2017-0008(760)776-9907
Llc. No.' 830131
----------------.-------------------------------------—-------------- ------------------ -- - - - -
LICENSED CONTRACTOR'S DECLARATION.
d hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, .
and my License is in full force and effect.
License CClas y'D'42 04455 License No.: 88330131
Date:`Y ✓ / Contractor/
W.
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).:
(_) 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:
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
oft e wjRrk for which this permit is issued.
*64 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9111087
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 withZ.;7/7___
sions.
r� Applicant:0
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-mfentined property for inspection purposes. .
Da ✓ / 7 Signature (Applicant or Agent).
78-495 CALLE TAMPICO.-
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: BSIG2017-0008
Owner:
Property Address: 78138 CALLE TAMPICO STE 130
ARMEN KARIMYAN
Q
APN: 770020037
78138 CALLE TAMPICO 130
O z v
Application Description: OLD TOWN/(2)BUILDING MOUNTED ILLUMINATED SIGNS "BLACKHAWK"
LA QUINTA, CA 92253
Property Zoning:
® g o
Application Valuation: -
Q o w
Applicant:
Contractor:
PD GROUP DBA SIGNARAMA
PD GROUP DBA SIGNARA
® o
41945 BOARDWALK SUITE L
41945 BOARDWALK SUITE L
PALM DESERT, CA 92211
PALM.DESERT, CA 92211
(760)776-9907
Llc. No.' 830131
----------------.-------------------------------------—-------------- ------------------ -- - - - -
LICENSED CONTRACTOR'S DECLARATION.
d hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, .
and my License is in full force and effect.
License CClas y'D'42 04455 License No.: 88330131
Date:`Y ✓ / Contractor/
W.
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).:
(_) 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:
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
oft e wjRrk for which this permit is issued.
*64 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9111087
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 withZ.;7/7___
sions.
r� Applicant:0
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-mfentined property for inspection purposes. .
Da ✓ / 7 Signature (Applicant or Agent).
FINANCIA •• •
' DESCRIPTIONACCOUNT QTY' AMOUNT
DEVICES, FIRST 20 101-0000-42403 0 $25.33
DESCRIPTION ACCOUNT QTY AMOUNT
DEVICES, FIRST 20 PC 101-0000-42600 0 $25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/AWNING SIGN,. EA ADDITIONAL
101-0000-42404
0 .
$25.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/AWNING SIGN, EA ADDITIONAL PC
101-0000-42600
0
$25.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/AWNING SIGN, FIRST
101-0000-42404
0
$25.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/AWNING SIGN, FIRST PC
101-0000-42600
0
$91.20
Total Paid for SIGN: $168.72
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
. $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
CHANNEL LETTER SECTION
LED. HALO ILLUMINATION
SO •
EAST ELEVATION
160.0"
Internally Illuminated
L AC
Reverse Channel Letters
�[ B
L K H AW K
Depth: 3.0
6 [_ F U N D I N G
Face Color: Black
Return Color: Black
RiQERffiD
Mounting: Back
Standoff: 1.5"
L.E.D. Color: White
MAY' 0 t `M7
OF L❑A�,
.
�pppC�i(TY /QUUINNpTAq��
Z.,T'TY-VP' CH C�ZUII'Vl'Fi
PLANNING DEPARTMENT
CHANNEL LETTER SECTION
LED. HALO ILLUMINATION
SO •
EAST ELEVATION
+ j fir
p���yy
"BLACK-�L's,
_
HLAC%HAW%
WALL
FUNDING 1�17nn11vt:
HOUSE--*
k �r�
POWER
p
S
i
age: 1near Fat
Customer: Telephone:760•xxx-loon
Jobalte:
S ITCH -w
South Frontage: 54 Linear Feet
Blackhawk Funding Fax:760-xxx-)om
Same
D
East frontage: 68 Linear Feet
Addreaa:
D•
�..
78138 Calle Tampico Suite 130
Each Elevation Total Signage 41.7 S.F.
La Quinta, CA 92253
Contractor's Lic # 8330131 C48, Ce1/042
DWg. No.: 83702 Rey,: 4
?i
Sig garama-
The way to grow your business..
Date: 05-03-2017
41945 BOARDWALK, SUITE L
Workers Comp. #19SBBOT
Designer: JT
PALM DESERT, CA 92211
PH 760.776.9907 / FX 760.776.9844
City Lic. #87006481
Salesperson. BS
- c t
CHANNEL LETTER SECTION
LED. HALO ILLUMINATION
1
_
WALL
HOUSE--*
POWER
i
DISCONNEC j
S ITCH -w
D
D•
12VOLT L.E.D.
?i
DRIVER
/3' ALUMINUM RETURNS
EACH LETO FAMED BY A
MINMtIM OF 4 N10 SCREWS
/j WITH STUCCO APPROVED
ANCHORS
063 ALUMINUM FACE
I.E.D. MODULES
3/16'POLYCAR80MATE
BACKS
— WIRE NUTS
LOW VOLTAGE WIRE
LETTERS PEGGED OFF WALL
WITH 1.1/2'SPACERS
ALL WALL PENETRATIONS TO TIE SEALED'ITN UL LISTED SWCONE SFALAW
U.L 48
NEC ELECTRICAL CODE 2014
TH15 SIGN 15 INTENDED TO BE INSTALLED IN ACCORDANCE WITH REQUIREMENTS OF
ARTICLE 600 ON THE NATIONAL ELECTRIC CODE AND OR OTHER APPLICABLE LOCAL CODES
THIS INCLUDES PROPER GROUNDING AND BONDING OF THE SIGN.
CHANNEL LETTER CONNECTION DETAILPOWER HOUSE
.TRANSFORMER
UCNRE
CWJ dfik CIW8EliE M I CWW&LEER I CIW atEMR CKWaUM
Ul, LISTED AND LABELED
COMPLIES WITH 2016 CA ELECTRIC CODE, ARTICLE 600
Landlord Approval:
YOUR SIGMA TURF ACKNOWLEDGES FULL APPROVAL OF DESIGN CONTENT
AND LAYO(M RELEASING SIGN'A'RAMA FROM RESPONSIBILITY IN REGARD
TO INCORRECT DESIGN AND /N
REPRESENTATIVEOFACTUAL P SVtC LO ILjj�� �� w
BEMATCHEDASCLOSEASPOSSI LE, 0 S 1>�SBp ® l/LA�
THIS DESIGN IS PROPRIETARY OPER D AY EBBE U O
THE EXPRESSED WRITTEN CON ENT l7FSSIt;W'AfRAfBA) f'—�, Q_ C A C LT\/ n C n -r Al
FORCONSTRUCTION
DATE I BY
Bin #
Permit ;;
Project Address: -/
a .
Qty-tof L,a Quinta
Building &r Safety Division
78-495 Calfe Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
— Owner's Name: t yl .e Y„ i ) 1
A. P. Number:
Address:6--D
79 1:16
Legal Description:
City, ST, Zip:
ontra r: LL ',
C ct 0 N
C f
Telephone:
Address:
Project Description: �. N
City, ST, Zip:
Telephone:
hone:
State Lie. # : O
�� (
City Lie'.
Arch.,'Engr., Designer: '
Address:
City, ST, Zip:.
Telephone:
ancY•
Construction Type: Occupancy:
i .#
State Lc
Project circle one): New Add'n Alter Repair Demo
Name of .Contact Person:
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
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
2.n° Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
II.O.A. Approval
Plans resubmitted
Grading '
IN HOUSE:-
Jrd 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.
tics of �gn` Outdoor Signs
e of Sign Construction C_New Signs
of Lighting Control ppclUCE(t [D New Lighting I
Certificate of Compliance Includes the following to
landatory Measures (Lighting Controls) O Maxi
13 fS cl�'
O I door Signs
O Sign Alterations
ontrols O Replaced Lighting Controls O Not Installing Lightii
nponents (Check Al that,apply)
num Allowed Lighting Power O Specific Lighting Sources
Controls
landatory Sign Lighting Controls
TES:
The some responsible person may install both the sign lighting power and the sign lighting controls, ora different responsible
person may install the sign lighting controls t ion the responsible person installing the sign lighting power.
The Mandatory Measures (sign lighting con rots) are required for compliance with the sign lighting Standards. If the person
responsible for installing the sign lighting poi ver is not also responsible for the sign lighting controls, then the owner of the sign,
general contractor, or architect sholl be responsible to have the sign lighting controls installed.
If more than one person hos responsibility for compliance, each responsible person sholl prepare and sign a Certificate of
Compliance and an Installation Certificate a licoble to the portion of construction for which they are responsible; alternatively,
the person with chief responsibility for const action sholl prepare and sign the Certificate of Compliance Declaration Statement
for the entire construction. TE
Statements of Responsibility: Any person signing
the Certificate of Compliance Declaration Statement on this NRCC-L S O1
ill complete Part la. Check Yes or No for all of
he following statements:
I have responsibility for installing the sign lig
ting controls
[!�Yes, complete parts la and lb of this form
O No, complete part la of this form
There are no existing sign lighting controls a
d 1 will be installing compliant sign lighting controls
's Yes
There are no existing sign lighting controls a
I ONO
d someone else will be responsible to install compliant sign lighting controls
j,Yes
There are existing sign lighting controls that
ONO
Jo not comply with the applicable provision of §110.9 and §130.3 and I.will be
installing compliant sign lighting controls
O Yes
There are existing sign lighting controls that
,M No
Po not comply with the applicable provision of §110.9 and §130.3 and someone
else will be responsible to install compliant
Ign lighting controls
O Yes.
0. No
11
June zui4
3uilding Energy Efficiency Standards - 2013 Nonresid ntial Compliance
F
Aa..'.rr.um Allowed Lighting Power Method of ftmpliance f � ���� ate.
tificate of Compliance and Field Inspection Energy Checklist IJ
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
D E F G
H
I
i
embol
OPTIONAL— Energy
Complies
Filed Inspector
r Code
Description or the sign
Verified Label (se E.
Allotted Watts
Deslrn Waits
YIN
Check that sign
instructions below)
complies
O w
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V1ry
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O
N
M
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a
Q
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0
Hwy
t..,, a 4th �., S�
Lam. S�"v
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y 1.
i
► Z
tat , H
20 , o
y
❑ .
s�
❑
1,
T
►Z
va H
Za , o
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
1
❑
❑
❑
❑
❑
A
Symbol or code used on the plans (when pL ins 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 2013 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power
method of compliance. The only labels thal will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories (UL) or other Prc duct Certification Body accredited to ISO/IEC Guide 65 by the American National Standards
C
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 lie filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate
compliance. An ENERGY VERIFIED label is not needed for compliance.
D
The sign area in square feet.
E
List 'I" if the sign is internally illuminated. I ist 'E" if the sign is externally illuminated.
F
Allowed watts per square foot. Enter 12 if, he 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 0 tir ies the allowed Lighting Power Density (LPD = watts) in column F.
H
Show the total installed watts in the sign, a determined according to the applicable provisions of §130(c).
I
Enter Y if the number in column H is less th n or equal to the number in column G. Otherwise, the sign does not comply.
J
This page doubles as a field inspection chec dist.
I Inspector Notes:
uilding Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
.5pP.ri. c L. ghting Source Method of Complian, e �� A lL-- U rJ UJ r N
_•rdficate of Compliance and Field Inspection E ergy Checklist
Complete this part if there are signs using th Specific lighting source method of compliance. (Complete part 2 of this Certificate
of Compliance if there are signs using them ximum allowed lighting power method of compliance)
A B C D E
OPTIONAL Specific light source used for Field Inspector
ymbol ENERGY VERIFIED compliance Check that Sign
or Description label Shall include only lighting Complies
Code (see instructions technologies listed below Vol
below) List all that apply
❑ ❑
O ❑
Symbol or code used on the plans (when plans are required) and other documents.
A narrative description of the sign, or location of s ign on the building; and the location of sign on construction documents
OPTIONAL - Check this box only if this sign has a rmanent, pre-printed, factory -installed ENERGY VERIFIED label, confirming that this sign
complies with the Section 140.8 of the California 013 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. The
only labels that will be recognized for this purpos are ENERGY VERIFIED Certification Marks authorized by Underwriters laboratories (UL) or
other Product Certification Body accredited to IS IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC
17011. Surveillance by the Accredited Certificaticiii 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 uch 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 app y in column D above for each row.
1 High pressure sodium tamps
Metal halide lamps that are pulse start dr 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 -2C 05.
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
3 a ballast that has a minimum efficiency of 80 percent.
Ballast efficiency is the measured outpu wattage to the lamp divided by the measured operating input wattage when tested
according to ANSI 082.6-200S. I
Neon or cold cathode lamps with transform r or power supply efficiency greater than or equal to a minimum efficiency of 75 percent
e when the transformer or nower supply rate' output current is less than SO 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
5 when the transformer or power supply rate) 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 f ndamental 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 '9 re 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 1 o 250 watts, shall comply with the applicable requirements of the Appliance Efficiency
Regulations (Title 20).
9 Compact fluorescent lamps that do not cont fln a medium screw base sockets (E24/E26).
This page doubles as a field inspection checklist.
field Inspector Notes:
lune Lula
k Building Energy Efficiency Standards - 2013 Nonresidential Compliance
iAanda`tdry SigrAighting Controls
:he person signing the Certificate of Compliance
Declaration Statement on this NRCC-LTS,-01-E is responsible for complying with
e sign lighting control requirements, that person
shall answer all of the following questions:
:here are construction documents, indicate where
on the building plans the.
indatory measures (sign lighting control) note I
ilock can be located:
§1303(a)l. All Indoor sign lighting is control
ed with an automatic time -switch control or astronomical time-
Y
N
NA
switch control.
❑
❑•
§1303(6)2A. All outdoor sign lighting is conrolled
with a photocontrol in addition to an automatic time,;
Y
N
NA
switch control, or an astronomical time -switch
control.
❑
❑
EXCEPTION to Section 130.3(a)2A: Outdoor
igns in tunnels, and signs in large permanently covered outdoor
Y
NA
areas that are intended to be continuously I
t, 24 hours per day and 365 days per year. ,
❑
§130.3(a)26. All outdoor sign lighting that i
ON both day and night is controlled with a dimmer that provides
the ability to automatically reduce sign lighti
g power by a minimum of 65 percent during nighttime hours.
Y
N
NA
Signs that are illuminated at night and for m
re than 1 hour during daylight hours shall be considered ON both:
❑
❑
day and night.
EXCEPTION to Section 1303(a)2B: Outdoor
igns in tunnels and large covered areas that are intended to,be
Y
NA
illuminated both day and night.
❑
§130.3(a)3, Demand Responsive Electronic
Message Center Control. An Electronic Message Center (EMC)
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N A
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having a new connected lighting power load
greater than, 15 kW has a control installed that is capable of�'
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reducing the lighting power by a minimum o
30 percent when receiving a demand response signal.
EXCEPTION to Section 1303(a)3: Lighting for
EMCs that is not permitted by a health or life safety statute,.
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NA
ordinance, or regulation to be reduced by 30
percent
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jg
Id Inspector Notes:
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uilding Energy Efficiency Standards.- 2013 Nonresic ential Compliance
June 2014
LA - rJ C>
) V—M .'NTATION ALITNOR'S DECLARATION STATEMENT
L, 9 certify that this Certificate of Compliance Jocumentation
is accurate and complete.
Incumentation Autho- Name:
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Documentation Author Sign ure:
.ornpany: ^ ^ -
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Signature Oate: - 3
tddress:
lgyS (3Ur42p:�Ak-1 Su
TE
CEA/ HERS Certification Identification pr a piicabiel:
PR'y Des6elT LA. CqA
Z t 1
Phone:
q&0 -71 - 9 C
RESPONSIBLE PERSON'S DECLARATION STAT�MEN
a
I certify the following under penalty of perjury, under
the laws of the State of California:
I. The information provided on this Certificate of Compliance
is true and correct.
2. 1 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 (res
onsible designer).
3. The energy features and performance specifica
ions, materials, components, and manufactured devices for the building design or system
design identified on this Certificate of Compliar
ce 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 all
plication.
5. 1 will ensure that a completed signed copy of t
s Certificate of Compliance shall be made available with the building permit(s) issued for the
building, and made available to the enforceme
t agency for all applicable inspections. I understand that a completed signed copy of this
Certificate of Compliance is required to be incIL
ded with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
ZOVEYL �CtJt.
-
Responsible Designer Signature:
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Company :
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J
Date Signed:------G
Address:license:
Lr(Qas' c3o�R,�t,:��Jc
v;TG L
/
830 .
Citv/State/Zlp: PA (. K ()E S GP- l C AZ
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Phone:
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Building Energy Efficiency Standards - 2013' Nonres
I
dential Compliance June 2014