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BSIG2015-0010At 78-495 CALLE TAMPICO T"ty°P' jH'Quwo LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT U L f�R29 FISP CAb"11 BUILDING PERMIT �V CITY0QUINTA Application Number: BSIG2015-0010 COM MIiNITVDEVE pp lEENTDEPARTMENT Owner: Property Address: 79680 HIGHWAY 111 STE 102 CPMC REALTY APN: 600030016 42600 CAROLINE STE 102 Application Description: CALIFORNIA OCEAN GRILL PALM DESERT, CA 92211 Property Zoning: Application Valuation: $1,500.00 Applicant: NEW SIGN SOLUTION INC 9468 GARVEY AVENUE SOUTH EL MONTE, CA 91733 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: C45 License No.: 995307 /n� rDate: �R Contractor: *I,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 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 fora 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 Lender's Contractor: NEW SIGN SOLUTION INC 9468 GARVEY AVENUE SOUTH EL MONTE, CA 91733 (626)443-9288 Llc. No.: 995307 (760) 777-7125 (760)777-7011 (760) 777-7153 ate: 4/29/2015 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 those provisions. Date: 4912,4h!r —Applicant: kw iz-- 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 property for inspection purposes. Date: 0�1 `�1 Signature (Applicant or Agent) FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/29/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY NEW SIGN SOLUTION INC CHECK MR160 1421 MFA Total'Paid forBUILDING STAN DARDS'ADMINISTRATION BSA '$1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $24.17 $24.17 4/29/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY NEW SIGN SOLUTION INC CHECK MR160 1421 MFA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $24.17 4/29/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY NEW SIGN SOLUTION INC CHECK MR160 1421 MFA Total Paid for ELECTRICAL: $48.34 $48.34 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/AWNING SIGN, FIRST 101-0000-42404 0 $24.66 $24.66 4/29/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY NEW SIGN SOLUTION INC CHECK MR160 1421 MFA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WALL/AWNING SIGN, FIRST PC 101-0000-42600 0 $87.02 $87.02 4/29/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY NEW SIGN SOLUTION INC CHECK MR160 1421 MFA Total Paid forSIGN: $111.68 $111.68 TOTALS: Description: CALIFORNIA OCEAN GRILL CONDITIONS Type: SIGN Subtype: Status: ISSUED Applied: 4/29/2015 MFA Approved: 4/29/2015 MFA Parcel No: 600030016 Site Address: 79680 HIGHWAY 111 STE 102LA QUINTA,CA 92253 Subdivision: PM 31143 Block: Lot: 4 Issued: 4/29/2015 MFA Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,500.00 Occupancy Type: Construction Type: Expired: 10/26/2015 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 FAX Details:. ILLUMINATED LED CHANNEL LETTER SIGN "CALIFORNIA OCEAN GRILL" 2013 CALIFORNIA BUILDING CODE Approved to Issued CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT NEW SIGN SOLUTION INC 9468 GARVEY AVENUE SOUTH EL MONTE CA 91733 (760)341-5100 CONTRACTOR NEW SIGN SOLUTION INC 9468 GARVEY AVENUE SOUTH EL MONTE CA 91733 (760)341-5100 OWNER OWNER CPMC REALTY CPMC REALTY •. 42600 CAROLINE STE P� 102 PALM DESERT CA 92211 (760)341-5100 7 1 FINANCIAL INFORMATION Printed: Wednesday, April 29, 2015 12:44:16 PM 1 of 2 r :., SYSTEMS INSPECTIONS SEQID ANSPECTIONTYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES FINAL" BLD CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/29/15 MR160 1421 CHECK NEW SIGN`SOLUTION MFA Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: DEVICES, FIRST 20 101-0000-42403 0 $24.17 $24.17 4/29/15 MR160 1421 CHECK NEW SIG N SOLUTION DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $24.17 4/29/15 MR160 1421 CHECK NEW SIGN SOLUTION MFA INC Total Paid for ELECTRICAL: $48.34 $48.34 WALL/AWNING SIGN, 101-0000-42404 0 $24.66 $24.66 4/29/15 MR160 1421 CHECK NEW SIGN SOLUTION MFA FIRST INC WALL/AWNING SIGN, 101-0000-42600 0 $87.02 $87.02 4/29/15 MR160 1421 CHECK NEW SIGN SOLUTION MFA FIRST PC INC Total Paid forSIGN: $111.68 $111.68 TOTALS: $161.02 $161i02 INSPECTIONS SEQID ANSPECTIONTYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES FINAL" BLD BOND INFORMATION Printed: Wednesday, April 29, 2015 12:44:16 PM 2 of 2 C SYSTEMS Bin # City Of La Quinta Building 81• 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: ` 6 Q bZ Owner's Name: C P A. P. Number: Address: yz -600. Carol 4 Cou s4C (oz Legal Description: City, ST, Zip: W M ese - Ck q ZZ I I (� Contractor:N Telephone: e. �_ G 1I i�-I �v Address:6 V � Project Description:IU�i`ng7C%.... City, ST, Zip: v �I i�4)1� (.VO ���� L� t;n✓iPt !��?r- $i' Telephone: _ one• . 6 6 G3 2 1 q ..................................::::::::.::::. / \ � \ Ca a I ry�i 'VCQL��1 r State Lic. # : qq S Q y-2. . Arch., Engr., Designer: Address: City., ST, Zip: Telephone: P o . Con tr s ucti n Type: e: occupancy: Y P State Lic. #: rJ ect type (circle one New Add'n Alter Repair Demo o Name of Contact Person: K h Sq. Ft.: 1 %S # Stories: I # Units: Telephone # of Contact Person: uj LI��J — q Estimated Value of Project: )�V�) APPLICANT: DO NOT WRITE BELOW THIS LINE ff Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for correctionslissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3' 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 Totai Permit Fees a r ' I � �. • !t Qumta April 24, 2015 Mr. Minh Cao New Signs & Printing 9468 Garvey Avenue South EI Monte,, CA 91733 SUBJECT: SIGN PERMIT APPLICATION 2015-0014 CALIFORNIA OCEAN GRILL Dear Mr. Cao: The Community Development Department has reviewed and approved your request for one permanent building -mounted internally -illuminated channel letter sign on the southern building elevation of California Ocean Grill, located at 79-680 Highway -111. The approval is subject to the following Conditions of Approval: 1. This sign permit grants one internally -illuminated building identification sign. The total square footage for the sign shall be no greater than 47.00 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 sign being started. 3. The signs shall conform to the approved sign program for the Dunes Business Park. Should you have any questions, please feel free to contact me at (760) 777-7067. Y ,CP Associate Planner C: Building & Safety Division 78-495 Calle Tampico La Quinta California 253 1 760.777.7000 1 www.La-Quinta.org ' C d D v_ �uz0 z 90 M �Q- 0rn� ® M C77 • Z°M� 5^ WALL L v _ r Trim Cap Existing J Box to Primary �— Discor�r►ecTSwith LEDs ..... —Power Supply RI I FEW 1111 159" 183" APR 16 2015 CITY OF LA QUINTA COMMUNITY DEVELOPMENT Backing 0.5" EMT Conducts Acrylic Face Letter to the Face Proposing: Internally illuminated LED channel letter sign. Mounting Screw (#1002") Face: 1/8" thk white acrylic with translucent vinyl (ARLON 169). Weep HoleLf Trim Cap: 3/4" wide black trim cap. DRYWALL/� TYPEwooO scREw 3re•TO ss•xrTO4• Letter Returns: 5" deep .040 aluminum black acrylic enamel finish. CONCRETE ANCHORMG 318-TXrTO4• Lighting: by LED, front lit. STUCCO/ SHEETROCK ANCHORMG 318' TOOWS' X T TO 4' STEEL BEAMS WW ANCH. 3W TO W X 7 TO 4• All assembly and electrical components to be U.L. listed and labeled. Total Sign Area: 47sf. ©2015 NEW SIGN SOLUTION INC. ALL RIGHTS RESERVED. USE OF THE IMAGE WITHOUT CONSENT IS AN UNAUTHORIZED USE OF NEW SIGNS AND PRINTING INC. G KwJOB LOCATION APPROVED 9468 Garvey Ave., So EI Monte, CA 91733 Tel: 626-443-9288 Fax: 626-443-9218 I 79680 Highway 111, La Quinta, CA www.NewSignsPrinting.com z a ® M C77 • 1 � z 1� G � V cy APR 16 2015 CITY OF LA QUINTA COMMUNITY DEVELOPMENT Backing 0.5" EMT Conducts Acrylic Face Letter to the Face Proposing: Internally illuminated LED channel letter sign. Mounting Screw (#1002") Face: 1/8" thk white acrylic with translucent vinyl (ARLON 169). Weep HoleLf Trim Cap: 3/4" wide black trim cap. DRYWALL/� TYPEwooO scREw 3re•TO ss•xrTO4• Letter Returns: 5" deep .040 aluminum black acrylic enamel finish. CONCRETE ANCHORMG 318-TXrTO4• Lighting: by LED, front lit. STUCCO/ SHEETROCK ANCHORMG 318' TOOWS' X T TO 4' STEEL BEAMS WW ANCH. 3W TO W X 7 TO 4• All assembly and electrical components to be U.L. listed and labeled. Total Sign Area: 47sf. ©2015 NEW SIGN SOLUTION INC. ALL RIGHTS RESERVED. USE OF THE IMAGE WITHOUT CONSENT IS AN UNAUTHORIZED USE OF NEW SIGNS AND PRINTING INC. G KwJOB LOCATION APPROVED 9468 Garvey Ave., So EI Monte, CA 91733 Tel: 626-443-9288 Fax: 626-443-9218 I 79680 Highway 111, La Quinta, CA www.NewSignsPrinting.com 79640 to 79700 Highway 111, La Quinta, CA BUILDING A Site Plan NlCluonHISN00 E10 -A IdW A -GA 'S 12 ON -mine dlNlno vi jo Am BUILDING B BUILDING C DErAIL VIEW Information has been secured from sources we believe to be reliable, however, WILSON JOHNSON cannot guarantee its accuracy. 45-445 Portola Ave, Suite aim Desert,,CA 92260 0:7.837.1880 F:760.837.0036 I . . 0 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E(Revised 06/141 f AI I�nowllw CERTIFICATE OF COMPLIANCE NOTES: -r�V 1 VVIVIIYIIJJIVIV NRCC-LTS Ol E Sign Lighting (Page 1 of 5) Project Name: t /) rj1 Date Prepared: 0 Project Address: 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 f AM Location of Sign ® Outdoor Signs ❑ Indoor Signs Phase of Sign Construction ® New Signs ❑'Sign Alterations Type of Lighting Control ❑ New Lighting Controls M Replaced Lighting Controls ❑ Not Installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) ❑ Mandatory 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 tif Compliance and an Installation Cericate 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 ComplionceDeclaration Statement for the entire construction. la. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E shall complete Part 1a. Check Yes or No for all of the following statements: 1 1 have responsibility for installing the sign lighting controls ® Yes, complete parts la and 1b 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 ® Yes ❑ No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls ❑ 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 ❑ 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 ® No CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CERTIFICATE OF COMPLIANCE Sign Lighting Project Name: ^ I a , , Date Prepared: O MISSION NRCC-LTS-01-E Page 2 of 5) lb. Mandatory Sign Lighting Controls . If the person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-Ol-E is responsible for complpng 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: 7 1 §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time -FY N NA switch control.❑§130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- N 2switch control, or an astronomical time -switch control. ® NA ❑ 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. 11 91 §130.3(a)26. 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. 11 0 §330.3(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 N/A 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, r regulation to be reduced by 30 percent. Field Inspector Notes: g uicigY unuencY )canoaras - ZU15 Nonreslaential Compliance June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-0I-F/Revis i nwi Ai June 2014 CALIFORNIA ENERGY CONWISSION CERTIFICATE OF COMPLIANCE SNflCC-LTS 01-E Sign Lighting (Page 3 of 5) Project Name: 7 ( Date Prepared: r�,� ©c 2 s 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 Symbol Description of the Sign OPTIONAL — Energy Verified Label (see Allotted Watts Design Watts Compliesinstructions fflnspectorOrCode below) Y/N w m NA a E v.£ r-4 vo O O a, 00 M X I n in Uj _ a Z_ v a ate+ 3 O. E (1)Internally-illuminated LED Channel Letter Si ns ® 25.25' (1) 12 Watts 132 60 Watts Yes ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ El❑ ❑ 0 A Symbol or code used on the plans (when plans are required) and other documents. A description of the sign, or location of sign on the building; and the location of sign on construction documents. B 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 C 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, 'D' columns 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. 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. F 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. J This page doubles as a field inspection checklist. Field Inspector Notes: June 2014 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 06/14 CALIFORNIA CERTIFICATE OF COMPLIANCE Sign Lighting Project Name: r , t , n � „ 1. "_ /! `\ Date Prepared: n . _ L )WISSION 0 N RCC-LT�&5) (Page r.r; -1- ,plcLlwU vt wmpndnce 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 U E s. OPTIONAL Specific light source used for Symbol ENERGY VERIFIED compliance Field Inspector or Description label Shall include only lighting Checkthat Sign Code (see instructions technologies listed below Complies " below) List all that apply 3 A ❑ 0. ❑ ,o x . . ❑ n`.`", 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. D 4 Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 percent 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. 5 Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68 percent when the transformer or power supply rated output current is 50 mA or The greater. 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 8 a nameplate output power less than or equal to 250 watts, shall comply with the applicable requirements of the Appliance Efficiency egulations (Title 20). ompact fluorescent lamps that do not contain a medium screw base sockets (E24/E26). 4This Ege doubles as a field inspection checklist. Field Inspector Notes: 5 —1-5y L11MICIR.y 3Ld11UdFU5 - ZU16 INonresiclentlal Compliance June 2014 STATE OF CALIFC)RMA SIGN LIGHTING Aak CEC-NRCC-LTS-01-E(Revised 06/14) CALIFORNIA ENERGY COWISSION �� CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 5 of 5) Project Name: ^ f w Date Prepared: A t xv;tti fit) C-, r\1 2 Is - DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author.Name: Minh Cao Documentation Author Signature:,p2r✓/t � Company: New Signs Signature Date: 01/05/15 Address: 9468 Garvey Ave. , CEA/ HERS Certification Identification (if applicable): city/State/Zip: So. EI Monte, CA 91733 Phone: (626) 443-9218 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. lam 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 orsystem 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 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: }M q Minh Cao � .!r✓ � Company:gns New Si Date Signed: 01/05/15 Address: 9468 Garvey Ave. License: 995307 city/state/Zip: So. EI Monte, CA 91733 Phone: (626) 443-9218 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014