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BSIG2014-1019 (SIGN)78-495 CALLE TAMPICO D VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/15/2014 Application Number: BSIG2014-1019 Owner: Property Address: 44025 JEFFERSON ST STE 103 REGENCY MARINITA LA QUINTA APN: 604521009 z Application Description: SIGN PERMIT FOR PALM NAILS 0 `—'--- Property Zoning: Application Valuation: $4,000.00 0 o [� (V � Q 5 Applicant: Contractor: w SIGNARAMA SIGNARAMA f— Q o 0 OUTSIDE CITY LIMITS 0 OUTSIDE CITY LIMITS U LA QUINTA, CA 92253 LA QUINTA, CA 92253 C:) Z (760)776-9910 Llc. No.: :LIC -0004466 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 Dat_. 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).: (_) 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 Addre: 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 ofhe 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 pr isions. '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 upon the above. mentioned p perty or inspection purposes. Dat /� 1S /� Signature (Applicant or Agent): 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 WALL/AWNING SIGN, EA ADDITIONAL 101-0000-42404 0 $24.66 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/AWNING SIGN, EA ADDITIONAL PC 101-0000-42600 0 $24.66 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/AWNING SIGN, FIRST 101-0000-42404 0 $24.66 $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 $87.02 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forSIGN: $161.00 $0.00 TOTALS:0• $0.00 Permit Details Enter Permit Number BSIG2014-1019 1-0 4 11 D of 2 D DI 6 100% L Find I Next g E l ^r IQ Page 1 of 1 <View Re Dort+ Permit Details PERMIT NUMBER ' City of La Quinta BSIG2014-1019 a or Description: SIGN PERMIT FOR PALM NAILS Type: SIGN Subtype: Status: APPROVED Applied: 10/13/2014 MFA Approved: 10/15/2014 SKH Parcel No: 604521009 Site Address: 44025 JEFFERSON ST STE 103 LA QUINTA,CA 92253 Subdivision: Block: Lot: Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $4,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CONTACTS Details: SIGN PERMIT FOR PALM NAILS (2) CHANNEL LETTER SIGNS. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES CHRONOLOGY INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE CONDITIONS NOTES FINAL** CONTACTS NAME TYPE NAME ADDRESS1 CITY STATE ZIP PHONE FAX EMAIL APPLICANT SIGNARAMA 0 OUTSIDE CITY LIMITS LA QUINTA CA 92253 CONTRACTOR SIGNARAMA 0 OUTSIDE CITY LIMITS LA QUINTA CA 92253 OWNER REGENCY MARINITA LA QUINTA 0 FINANCIAL INFORMATION DESCRIPTION ACCOUNT EL AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY LTD CBY BY BSAS SB1473 FEE 101-0000-20306 1 0 1 $1.00 $0.00 O Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: WALL/AWNING SIGN, 101-0000-42404 0 $24.66 $0.00 EA ADDITIONAL WALL/AWNING SIGN, 101-0000-02600 0 $24.66 $0.00 EA ADDITIONAL PC WALL/AWNING SIGN, 101-0000-02404 0 $24.66 $0.00 FIRST WALL/AWNING SIGN, 101-0000-42600 0 $87.02 $0.00 FIRST PC O Total Paid for SIGN: $161.00 $0.00 TOTALS: $162.00 $3.00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES FINAL** PARENT PROJECTS Printed: Wednesday, October 15, 2014 2:01:27 PM 1 of 2 CRW'srr- 1 http://laquinta.crw.comltrakit9lOpenPDF.aspx?&report=/Documents/PERMITS/Permit D... 10/15/2014 Bin -City of La Q uin to Building &r Safety Division Permit # o� P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address:1.1� 7l Jc rT VLSU-1~3 5-1 Owner's Name: A. P. Number..) '� 16F3 I /— P. 4 C�,, Address: Legal Description: Ci ST Zip: P= Contractor:(%�"�l— o� 01 Address. G�� S 0��w� b..�,�.�� Telephone: .........:. Project Description: �-� C City, ST, Zip: Telephone 7Gv �6 �7 U'7 ? wi!::: , • State Lie. #: F36 2.7 1 City Lip. #,.y tro S Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Construction Type: Occupancy: State Lie. ::::::•::::::::.:::> ............ Project type (circle one): New Add'n Alter Repair Demo lame of Contact Person: tib-e(S c�� Sq. FL: # Stories: # Units: Cc] hone # of Contact Person:-"' zP �%� Estimated Value of Project: CrTjp APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rcq'd Recd TRACKING PERMIT FEES. Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance, Title 24 Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical 'Grading plan 2"Review, ready for corrcctionsrissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. R.O.A. Approval Plans resubmitted Grading IN ROUSE:- 'rd Review, ready for correctionsrissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees October 10, 2014 Mr. William Sigurdsen Sign -a -Rama 41-945 Boardwalk, Suite L Palm' Desert, CA 92211 SUBJECT: SIGN PERMIT APPLICATION 2014-1047 PALM NAILS Dear Mr. Sigurdsen: The Community Development Department has reviewed and approved your request for two permanent building -mounted internally -illuminated channel letter signs on the southern and northern building elevations of Palm Nails, located at 44-025 Jefferson Street, Suite 103. The approval is subject to the following Conditions of Approval: 1. This sign permit grants two internally -illuminated building identification signs. The total square footage for the sign on the southern building elevation shall be no greater than 21 .00 square feet. The total square footage. for the sign on the northern building elevation shall be no greater than 21'.00 square feet. The materials for the sign are per the approved plans on file with the Community Development Department. 2. If necessary, a building permit shall be obtained prior to any work on the signs being started. 3. The sign shall conform to the approved sign program for the Jefferson Plaza. Shouldy u have any questions, please feel free to contact me at (760) 777-7067. Sinherel . J\/WJ U Zsociate Planner C: Building & Safety Division 78-495 Calle Tampico I La Quinta California 92253 1 760.777.7000 1 www.La-Quinta.org -A a NAILS 15 11 s Both Elevations Same Signage APPRO D BY PLANNING DEPARTMENT BY DATE EX.11IBIT CASE NO. SOUTH Illuminated Acrylic Faced Channel Letters Depth: 5" $ M Face Color: Red M Return Color: Black Workers Com # 1938807 p' Trim Cap Color: Black = Mounting: Back HOUSE---► Standoff: Flush POWER L.E.D. Color: Red I NORTH CHANNEL LETTER & LIGHT BOX SECTION INTERNALLY ILLUMINATED L.E.D. co WALL C YOUR SIGNATURE ACKNOWLEDGES FULL APPROVAL OF DESIGN CONTENT► -1 o 1 1 1 AND LAYOUT, RELEASING SIGN A-RAMA FROM RESPONSIBILITY IN REGA rO N >rp Workers Com # 1938807 p' � z = 41-945 Boardwalk Ste. L 4 ' HOUSE---► 90 POWER 1011 ;T PALM NAILS ALM NAILS . '. Pr. _ `fir I 1 �_E'E�,�i � >t. •.. � �� rte. ` + �. �At�� 1 i m CHANNEL LETTER & LIGHT BOX SECTION INTERNALLY ILLUMINATED L.E.D. co WALL C YOUR SIGNATURE ACKNOWLEDGES FULL APPROVAL OF DESIGN CONTENT► -1 o 1 1 1 AND LAYOUT, RELEASING SIGN A-RAMA FROM RESPONSIBILITY IN REGA rO N >rp Workers Com # 1938807 p' � z = 41-945 Boardwalk Ste. L 4 ' HOUSE---► 90 POWER WITH MATERIALS U D 'PH 760-776-9907 • FX 760-776-9844 City LIC. # 97005491 OT DISCONNECT SWITCH—o.O m 0 f 12VOLT L.E.D. DRIVER — 5" ,040 ALUMINUM i RETURNS — TRIMCAP — ACRYLIC FACES —L.E.D. MODULE — LOW VOLTAGE WIRE WIRE NUTS EACH LETTER FASTENED BY A MINIMUM OF 4 #10 SCREW WITH STUCCO APPROVE ANCHORS —#8 SHEET METAL SCREW t ALL WALL PENETRATIONS TO BE SEALED WITH UL LISTED SILICONE SEALANT r _ U.L. 48 NEC ELECTRICAL CODE 2010 THI5 51GN 15 INTENDED TO BE INSTALLED IN ACCORDANCE WITH REQUIREMENTS OF ARTICLE 600 ON THE NATIONAL ELECTRIC CODE AND OR OTHER APPLICABLE LOCAL CODE5. TH151NCLUOE5 PROPER GROUNDING AND BONDING OF THE SIGN. CHANNEL LETTER CONNECTION DETAILPOWER HOUSE TRANSFORMER - ----- MOUMING TUCTURE 11 11 11 11 CHANNEL LETTER CIUINNEL LETTER CNlwNEI LERER CHANNEL LETTER CHANNEL LETTER R U.L. LISTED AND LABELED - COMPLIES WITH 2013 CA ELECTRIC CODS ARTICLE 600 South Frontage: 21 Linear Feet Customer: Telephone: 760-xxx-xxxx Jobsite: Customer Approval: 3 North Frontage: 21 Linear Feet Palm Nails Fax: 760-xxx-xxxx Same C Address: Landlord'Approval: South Total Signage 12.2 S.F. 44025 Jefferson, Suite 103 a �x North Total Signage 12.2 S.F. La Quint CA. 92253 I SIGN*A*RAMA Contractor's Lic # 830131 C45, C61 /1)42 DWg. No,: 68215 Rev.: 2 YOUR SIGNATURE ACKNOWLEDGES FULL APPROVAL OF DESIGN CONTENT► -1 o 1 1 1 AND LAYOUT, RELEASING SIGN A-RAMA FROM RESPONSIBILITY IN REGA rO N Workers Com # 1938807 p' Date: 09-29-14 TO INCORRECT DESIGN AND INFORMATION. THE COLORS SHOWN ARE O ti,, REPRESENTATIVE OFACTUAL PMS COLOR CALL OUTS. FINAL COLOR WI.0 Z BE MATCHED AS CLOSE AS POSSIBLE, COMMENSURATE —f 41-945 Boardwalk Ste. L 4 ' Designer: JT Palm Desert CA. 92211 WITH MATERIALS U D 'PH 760-776-9907 • FX 760-776-9844 City LIC. # 97005491 Salesperson: BS p THIS DESIGN IS PROPRIETARY PROPERTY AND MAYNOT SE USED WITH THE EXPRESSED WRITTEN CONSENT OF SIGN•A'RAMA. Z M SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Name: f, ` Date Prepared: Project Address: til Ll "L S �� re s �� y�� 1 ' J0 3 Location of Sign XO tdoor Signs ❑ Indoor Signs Phase of Sign Construction Lff New Signs ❑ Sign Alterations Type of Lighting Control 4ity C[—LL 9New Lighting Controls ❑ Replaced Lighting Controls ❑ Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) XMandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power ❑ Specific Lighting Sources 1. Mandatory Sign Lighting Controls NOTES: 1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible person may install the sign lighting controls than the responsible person installing the sign lighting power. 2. The Mandatory Measures (sign lighting controls) are required for compliance with the sign lighting Standards. If the person responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign, general contractor, or architect shall be responsible to have the sign lighting controls installed. 3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement for 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 1 have responsibility for installing the sign lighting controls Yes, complete parts 1a and lb of this form ❑ No, complete part la of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls Q Yes ❑ No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls IR 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 ❑ Yes IR 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 ❑ Yes ONo CA Building Energy Efficiency Standards -2013 Nonresidential Compliance June 2014 SIGN LIGHTING M9 -EC -NRCC-LTS-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) Project Name: L yy' �� `✓ Date Prepared: po / 1b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E is responsible for complying with the sign lighting control requirements, that person shall answer all of the following questions: If there are construction documents, indicate where on the building plans the mandatory measures (sign lighting control) note block can be located: 1 §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time- Y N NA switch control. ❑ 06 ❑ §130.3(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. U ❑ ❑ 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. ❑ AS) §130.3(a)2B. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides the ability to automatically reduce sign lighting power by a minimum of 65 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 ❑ ❑ day and night. EXCEPTION to Section 130.3(a)2B: Outdoor signs 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) having a new connected lighting power load greater than 15 kW has a control installed that is capable of Y ❑ N El4 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. ❑ ¢� Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 SIGN LIGHTING [WINO CEC-NRCC-LTS-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) Project Name: yy\ vs a. ` Date Prepared: / O / / 2 Maximum Allowed Lighting Power Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 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 1 Symbol Or Code Description of the Sign OPTIONAL — Energy Verified Label (see instructions below) Allotted Watts Design Watts Co Y/Nlies Filed Inspector Check that sign complies _W/a fD 4% C tto in ° w v T f0 C f6 C y 7 3 c w= D r � 41 N t+'1 ° Q"� LL -° X N v 5p rp •vf �•+ L C H O vi = !� of 41 E g ✓ ,� ❑ i . Z l 2 y� . W 20 ❑ ❑ ❑ ❑ ❑ 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 Lighting Power method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American 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 in square feet. E List "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). 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. 1 This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 SIGN LIGHTING WWI CEC-NRCC-1-TS-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 4 of 5) Project Name: e? -_L V'V'� h%G=; Date Prepared: /o 3. Specific Lighting Source Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 2 of this Certificate of Compliance if there are signs using the maximum allowed lighting power method of compliance) A B C 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 below) List all that apply C b, j 0..c 1x.1 w 51 i� ❑ L c d A Symbol or code used on the plans (when plans are required) and other documents. B A narrative description of the sign, or location of sign on the building; and the location of sign on construction documents 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 D above for each row. 1 High pressure sodium lamps Metal halide lamps that are pulse start or ceramic served by a ballast that has a minimum efficiency of 88 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 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 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 5 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 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 June 2014 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Company: (V11 PC Signature Date: ! 0 Address: n r ` ('L'i J� Q01'�Q..QI).i � sC1(� CEA/ HERS Certification Identification (if a plies le): City/State/Zip: PA� PES60-T CIA, 9 ZZ (\ Phone: %o--71 ' -- 2 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. 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 (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the'California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement r agency for approval with this building permit application. 5. 1 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:1� 2Ci�LiZ �o�i Responsible Designer Signature: Company : Date Signed: O Address: 6 0 A R p U—) A-L,jC SV lTLs L License: City/State/Zlp: Pfd LVV, I06-5G� T Q-� Z A(I Phone: -� LIP d — CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014