14-0779 (SIGN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 14-00000779
t� Property Address: 79700 HIGHWAY 111
APN: 649-020-014-4 -31143
Application description: SIGN
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 10000
T4&t 4 4 Q"
Applicant Architect or Engineer:
BUILDING &.SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C45 Li w3e No.: 718965
i— -/ Date: 14fiy 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.).
(_ 1 1, 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.).
(_ 1 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:
LQPERMIT
Owner:
DUNES BUSINESS PARK/ESF
3550 W. 6TH ST. #400
LOS ANGELES, CA -9002Q?:,'-'
Contractor:
UNITED SIGN SYSTEMS
5201 PENTECOST DRIVE
MODESTO, CA 95356
(2 09) 543 - 1320
Lic. No.: 718965
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
6/19/14
-----------------------------------------------
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 UNIGARD INS CO Policy Number CU015026
1 certify that, in the performance of the work for which this permit is issued, 1 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
37�0/0 of the Labor Code shall forthwith comply with thos rovisions.
(Date: 6I9 7 Applicant:
WARNING: FAILURE TO SECURE WOCERS' CO PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced -
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
/Date: 6 1 1 I Y Signature (Applicant or Agent):
Application Number . . . . . 14-00000779
Permit . . . ELECTRICAL 2013
Additional desc . .
Permit Fee . . . . 35.75 Plan Check Fee
.00
Issue Date . . . Valuation . . .
. 0
Expiration Date 12/16/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA ELEC SIGNS
35.75
----------------------------------------------------------------------------
Special Notes and Comments
ONE BUILDING- MOUNTED SIGN "DOLLAR TREE"
PER SPA 2014-1781.2013 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, BUILDING
1.00
PLAN CHECK, ELECTRICAL
47.67
PERMIT ISSUANCE M/P/E
90.57
Fee summary Charged Paid Credited
-----------------
Due
----------------------------------------
Permit Fee Total 35.75 .00 .00
35.75
Plan Check Total .00 .00 .00
.00
Other Fee Total 140.24 .00 .00
140.24
Grand Total 175.99 .00 .00
175.99
LQPERMIT
Bin.#
Qty. of LA Quinta
Building 8z Safety. Division
P.O. Box 1504,78-495 Calle Tampico
ia..Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
/
Project Address r-- L17O
, Owner's Name: r
Vj
A P. Number_Address: Q PL
cla f
Legal Description:City, ST, Zip: ,
Contractor: h —Telephone: � �r
• v
S p ,
Address: Project Description:j�
City, ST, Zip: S j A,, w
Telephone 14-010hU
State Lic. # : 6 City Lic. #;C v%►ti� '
Arcfi_, Engr., Designer.
Address:VV-
City., ST, Zip: L
Telephone: Construction Type:. Occupancy:
ma"61L
State Lic. #: , ir Project type (circle one): New Add'n Alter Repair Demo
/<ku
Name of Contact Person: J 1 Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: _ V Estimated Value of Project: 0&400,00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
'Reed
TRACKING
PERMIT FEES'
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Coles•
Called Contact Person
Plan Check Balance
Titie 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2iQ Review, ready for correctionsrmue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' 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
rl
P
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CAL.LL•' TAMPICO (760) 777-7000
LA QULN`f'A, CALIFORNIA 92253 FAX (760) 777-7101
May 27, 2014
Mr. David Glassman
1309 Post Avenue
Torrance CA 90501
SUBJECT: SIGN PERMIT APPLICATION, 2014-1781:
DOLLAR TREE AT DUNES BUSINESS PARS:
Ja r.ssm2n:
The Community Development Department has reviewed and approved your request for one
building -mounted business identification sign for "Dollar Tre'c3°, located at 79700 Highway 111,
within the Dunes Business Park. The sign is approved per the sign exhibits on file, and subject
to the following Conditions:
1. This sign permit grants one building -mounted illurnin.-ated business identification sign
reading ':Doilar.Tree", on the building's south elevation above theleasehold space. Ti.e
sign shall . not exceed 39.0 squ.ai;e feet; and t-iail .fie .designed and pia cein
coMormarice.- ith the.sign graphics on file with this <a 1pl;cation.,
2. The applicant is permittee: to install two (2) replacement monument panels or mit!,er Si -`..4L
of the existing monument sign, each panel not. to exceed 5 feet and placers within the
confines of the existing approved monument panel locations.
3. The applicant is required to obtain, a building permit p icr.to the placerinent. of this sign
The Building Division can be reached at (760) 777-7012.
Should you have any questions or need additional information ,release feel free to contact me at
(760) 777-7125.
Sincerely,
Wallace Nesbit
Principal Planner
c: Buiiding Division
Code Compliance
(field check req'd for exact measurements)
5'-0"+- (reface) -I
T
12 DOLLAR TREET
Sign B: (reface)
DIF Illuminated Mmmnt Sign
cabinet: existing Q site (no work req'd)
tenant panel: white lexan with vivid green #156 vinyl bkgd overlay
(weed -away white "DT" copy)
PHOTO ELEVATION (mmmnt/reface)
5201 Pentecost Or.
SIGN 9 Y B T E M B Modesto, Ce. 95356
1 -800 -481 -SIGN
C.S.C.L. # 718965 FAX (209) 543-1326
DESIGN MANUFACTURING INSTALLATION MAINTENANCE
APPROVED BY PLANNING DEPARTMENT PARTMENT
BV,�— DATE y
EXHIBIT /4"' rr vN
C.;@:�FNO. sa r4-o-af
SITE PLAN
JOB INFOI FILE ELECT. SPECIFICATIONS c1TY co0E:
JOB #:15299 DEAL #8082 REVISIONS: SCALE: 120 Volt I= See Drawing for Specificationsbei eramd eMbe sign
CLIENT. DOLLAR TREE SALESPERSON: DAVID RANDOIPH 3-14 bam NOTED
DRAWN BY: BAANAD 277 Volt [� .1p8:— J.
CONTACD PAGE 4OF4 FILENAME: Other
DATE: 3.5-14
PROJECT LOCATION: - - - DOLLAR TREE.
DUNES CENTER
•cUENr APPROVAL DAZE la QVlnta oneEu"E"u�
79640-79700 HWY 111 MUSIb NxRM
LA QUINTA, CA LANOLORDAPPROVAL ... DATE Prbrro r9'"Ir
12'-4"
total., 39 sq. ft.
APPROVED BY PLANNING DEPARTMENT
24^ BYDATE �h a //Y
i
EXHIBIT
QutL.er..� rig. -i
—"-R CASE NO. �A fsa/ -
24" ---- ----------------
;
Sign A: Led Illuminated Pan Channel Sign
ELECTRICAL REQUIREMENTS: (/unction boxes located ® center of each sign) _
24" OT: 2 amps (x2power supplies with (1) 120 volt 20 amp circuit req'd)
Photo Elevation (front)
Building Elevation (front) / Scale 3/32"=1'-0"
JOB INFO
LOB N:15289 DEAL 18082 SALESPERSON: DAVID RANDOLPH
►� 5201 Pentecost Dr. CUENT. DOLLAR TREE DRAWN BY: BAWAD
BION SYSTEMS ModB6to, Ca. 95356 DATE: 35.14 PAGE 3 OF 4
1-900-461-61GN pROIECT LOCATION:
C.S.C.L. t 718965 FAX(209)543-1326 DUNES CENTER cuDn APPROM DAW
79640.79700 HWY 111
DESIGN MANUFACTURING INSTALLATION MAINTENANCE LA QUINTA, CA LANDLORD APPROVAL DA7T
.040 aluminum
return
#IOX 2"mounting
scmws with shields
(min. 4 per letter)
3/16"acrylic
/ace
e
12 volt wiring
12 volt ul spprov.
led Illumination
power suppl),(-/
(ul approved)
disconnect switch)
120 v. to bldg
Ithacan —
building fascia
Led Pan Channel Letter Detail
SITE PLAN
120 volt O Sipn A: Led Illuminated Pen Channel Sipn tm. emmb anu.e aan
REnslor45: SCALE: m1.n.La.sow.R
347.14 bam NOTED 277 Volt O
white evylk wiN vivid green #156 Nnyl ovedey, ul approved Led 111-1 flon sy>,A ao LOA.
FILENAME: other S*deep bronze retumewith bronze l•bimcap
0LLARTREE•
la Quinta anrtw,em.
Certificate of Com liance Si n Lighting) (Page 2 of 4 SLTG-1C
Project Name: Dollar Tree
Date:
5/28/14
3. 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 Mandatoty 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,-
esponsible,alternatively;
alternatively;the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance
Declaration Statement or the entire construction.
3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1. of
4 on this SLTG-1C shall complete Part 3a. Check Yes or No for all of the following statements:
1
1 have responsibility for installing the sign lighting -controls
§133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo
❑ Yes com tete parts 3a and 3b of this form 13No complete part 3a 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
Exception to §133(x) 2. Outdoor signs in tunnels or large covered areas that require illumination during
There are existing sign lighting controls that'do not comply with the applicable provision of. §119 and §133 and I will be
4
. installing compliant sign lighting controls
daylight hours.
❑ Yes 13 No
91
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and someone else
5
will be responsible to install compliant sign lighting controls
❑ Yes ® No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration. Statement on page 1 of 4 of this SLTG-1C.is responsible for
complying with 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
mandatory measures (sign lighting control note block can be located:
1
§133(a)l. All indoor sign lighting is controlled with an automatic time switch control that complies with the
Y
N
NA
applicable requirements of 119.
❑
❑
§133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo
Y
N'
NA
control or an outdoor astronomical time switch, that comply with the applicable requirements of § 1.19.
13
❑
❑
2
Exception to §133(x) 2. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
❑
91
§133(a)3. All outdoor signs'are controlled with a dimmer that provides the ability to automatically reduce
Y
NA
sin ower b a minimum of 65 ercent'durin ni httime hours.
❑
IN
®
❑
Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours.
Y
❑
NA
3
Exception 2 to §133(x)3. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
❑
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for
Y
NA
illuminating signs or parts of signs.
❑
In
§133(x)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than
Y
N
N/A
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when
0
4
receivin a demand response signal that is sent out by the local utility.
❑
❑
Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including
Y
NA
but not limited to exit signs and traffic signs.
❑
.12
Field lgtpector Notes:
2008 Nonresidential Compliance Forms October 2010
Certificate of Compliance (Sign Lighting)
(Pae 1 of 4) SLTG-1C
Project Name:
Dollar Tree
Datc: 5/28/14
Project Address:
Title 24, Parts I and 6 of the California Code of Regulations.
79700 Hwy 111
this design on the other applicable compliance forms, worksheets, calc tions, ans and pecifications s miffed to the
Location of Sign ® Outdoor Signs ❑ Indoor Signs
Name:
Phase of Sign Construction CJ New Signs 15 Sign Alterations
April DePew
Type of Lighting Control 0 New Lighting Controls ❑ Replaced Lighting Controls
IN Not Installing Lighting Controls
This Certificate of Compliance includes the following components (check all that apply)
United Sign Systems
❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power
❑ Specific Lighting Sources
1. Certificate of Compliance Declaration Statement (this maybe a CIO, C45 or other eligible person)
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
correct.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the,lighting design.
• This Certificate of Compliance identifies the lighting features and performance specifications required for co pliance with
Title 24, Parts I and 6 of the California Code of Regulations.
0 The design features represented on this Certificate of Compliance are cons' ent th the information prov' ed to document
this design on the other applicable compliance forms, worksheets, calc tions, ans and pecifications s miffed to the
enforcement agency for approval with this building permit applicatio .
Name:
Sign ure rI
April DePew
enforcement agency.
Company:
Phone
United Sign Systems
916-361-3200
Address: 8950 Cal Center Drive, Suite 135
License number (may be contractor's tic 4)
United Sign Systems
718965
City/State/Zip: Sacramento, CA 95826
Date
5/28/14
2. Installation Certificate (to be signed by responsible person after installation)
Permit number.
Checked by/Date 3°. ?
(Enforcement Agency Use -
Enforcement Agency Use
Installation Declaration statement
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction.
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate conforms to all
applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I certify that the requirements detailed on this Certificate of Compliance have been met.
• 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building
permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the
building owner at occupancy.
Company Name:
United Sign Systems
Responsible Person's Name:
Responsible Person's Signature:
April DePew
License number (may be contral!)
ctor's lic
Date Signed:
Position With Company:
718965
Project Manager
2008 Nonresidential Compliance Forms October 2010
Certificate of Compliance (Sign Lighting) Pa n 3 of 4 SLTG-1C
Project Name: Dollar Tree
Date: 5/28/14
4. 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 5
of this Certificate of Compliance if there are signs using the S ecific lighting sources method of com liance
A
B
C
D E F G
H
I
t. ; .:J
Allowed Watts
Design
Complies?
A
Watts
Y / N
�? r
CZ
,o
0
a
Field
sr
C7
:-his�ypyctor
w
ax
p,'
w
3
x
};Check that`:
co
c .�
3
3 k
sign
a
E
¢
n
3 N N
3
°—yo
Complies
>,
yy
�, "
o II II
o II
0.
L
U
OC �
c�
o
Description
❑
❑
O
❑
❑
❑
*
❑
❑
❑
❑
A
Symbol or code used ori the plans when plans
are required)and other documents.
B
A narrative description of the sign, or location of sign on the buildin ; and the location of sign on construction documents.
OPTIONAL - Check this box only if this sign has a permanent, prc-printed, factory -installed, ENERGY VERIFIED label, confirming that
'the sign complies with the Section 148 of the California 2008 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power
method of compliance. The only labels that will be recognized for this purpose arc ENERGY VERIFIED Certification Marks authorized
C
by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISOAEC 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 `1' 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 insquare feet.
E
List "1". if the sign is internally illuminated. List "E" if the sign is externally illuminated.
F
Allowed watts per square foot. Enter 12 if the sin is listed as "I" in column E. Enter 2.3 ifsign is listed as "E" in column E.
G
Multi l the square foots a 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 S 130 d ore).
1
Enter Y if the number in column li 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:
2008 Nonresidential Compliance Forms
October 2010
Certificate of Compliance (Sign Lighting) (Page 4 of 4 SLTG-1C
Project Name: Dollar Tree
Date:
5/28/14
5. Specific Lighting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are signs using the maximum allowed iphting power method of compliance)
A
B
C
D
E
OPTIONAL
Field
ENERGY
Specific light source used for
Inspector
Symbol
VERIFIED
compliance
Check that
or
Description
label
Shall include only lighting
Sign
Code
(see instructions
technologies listed below
Complies
below)
List all that apply
A
24" led illuminated channel letters
a
7
❑
❑
❑
❑
❑
❑
❑
❑
❑
A
Symbol or code used on the plans (-,% *n plans are required) and other documents.
B
A narrative description of the sin 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 148 of the California 2008 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 technologies:
List all applicable numbers 1 through 10 that apply in column D above for each row.
/
High pressure sodium lamps
2
Pulse start or ceramic metal halide lamps served by a ballast with >_ 88% efficiency
Pulse start metal halide lamps that are <_ 320 watts, are not 250 watt or 1.75 watt lamps, and are served by a ballast
3
with > 80% efficiency
4
Neon or cold cathode lamps with transformer or power supply efficiency>_ 75% with rated output current < 50 mA
5
Neon or cold cathode lamps with transformer or power supply efficiency>_ 68% with rated output current > 50 mA
D
Fluorescent lamps with a minimum color rendering index (CRI) of 80
G
(Note: when using electronic ballasts for compliance, lamps with a CRI < 80 may be used
7
Light emitting diodes LEDs with a power supply with 2: 80% efficiency
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8
output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations Title 20
9
Com act fluorescent lamps that do not contain a medium screw base sockets jE24/E26
10
Electronic ballasts with a fundamental output frequency >_ 20 kHz
E
This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms
October 2010