The URL can be used to link to this page

BCOM2016-0031• e I T� D VOICE (760) 777-7125 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT ' Date: 9/7/2016 t Application Number: BCOM2016-0031 Owner: Property Address: 78825 HIGHWAY 111 RM LA QUINTA APN: 643020065 5319 UNIVERSITY STE 236 Application Description: T1 MAXX/ULTA�/ SHE— LTIMPROVEMENTS TO CREATE MULTIPLE SUITES IRVINE, CA 922538 Property Zoning: , Application Valuation: $400,000.00 FICY ¢ w �UJ 2 Applicant: - Contractor: - JOHN DEENHAN B DAVIS INC ® LL 213 W ALAMEDA AVE 203 1441A TERMINAL AVENUE rclf a- oj BURBANK, CA 91502 SAN JOSE, CA 95112-4314 �j w � v - z (408)436-4800 o Uc. No.: 773316 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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: Bim} License No.: 773316 vt� 9• / ' Contra „y.� OWNER -BUILDER DECLA ATION 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 of the or which this permit is issued. have and will maintain workers' compensation insurance, as required by 21 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: 9153908 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. Da •' L�Applicant WARNING: FAILURE TO SECURE WORKERS' COMNSATIO COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINNALTIES 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 pon the above-mentioned property for inspection purposes. Dat ' 7 -� Signature (Applicant or Agent G Date: 9/7/2016 Application Number: BCOM2016-0031 Owner: Property Address: 78825 HIGHWAY 111 RM LA QUINTA APN: 643020065 5319 UNIVERSITY STE 236 Application Description: TJ MAXX/ULTA / SHELL IMPROVEMENTS TO CREATE MULTIPLE SUITES IRVINE, CA 92253 Property Zoning: Application Valuation: $400,000.00 Applicant: Contractor: JOHN DEENHAN B DAVIS INC 213 W ALAMEDA AVE 203 1441A TERMINAL AVENUE BURBANK, CA 91502 SAN JOSE, CA 95112-4314 (408)436-4800 --------------------------------------------------------------------------------------------- Llc. No.: 773316 Detail: SHELL IMPROVEMENTS TO DIVIDE EXISTING SHELL BUILDING INTO TWO (2) SUITES [ENGINEERED] DEFERRED SUBMITTAL OF PROPOSED CANOPY DESIGN IS REQUIRED. THIS PERMIT DOES NOT INCLUDE SUITE OCCUPANCY OR ADDITIONAL BUILDING SQUARE FOOTAGE. 2013 CALIFORNIA BUILDING CODES. • i' J 0 FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT ART IN PUBLIC PLACES - COMMERCIAL REMOD 270-0000-43201 0 $1,500.00 Total Paid forART IN PUBLIC PLACES - AIPP: $1,500.00 DESCRIPTION ACCOUNT QTY AMOUNT AWNING/CANOPY 101-0000-42404 0 $14.50 DESCRIPTION ACCOUNT QTY AMOUNT AWNING/CANOPY PC 101-0000-42600 0 $205.94 Total Paid for AWNING/CANOPY: $220.44 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES ADMINISTRATIVE STAFF 101-0000-42600 0.5 $20.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES PRINCIPAL/STRUCTURAL ENGINEER 101-0000-42600 0.25 $37.50 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER 101-0000-42600 1.5 $142.50 Total Paid for BLDG CITY STAFF - PER HOUR: $200.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $16.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $16.00 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES 101-0000-42403 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES PC 101-0000-42600 0 $12.09 Total Paid for ELECTRICAL: $84.60 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR - 101-0000-42402 0 $145.04 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $96.68 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $4.83 Total Paid for MECHANICAL: $258.64 DESCRIPTION ACCOUNT QTY AMOUNT PARTITION 101-0000-42400 0 $145.04 DESCRIPTION ACCOUNT QTY AMOUNT .PARTITION PC 101-0000-42600 0 $266.86 Total Paid for PARTITION: $411.90 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 DESCRIPTION t ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT .WATER HEATER/VENT 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.25 DESCRIPTION ACCOUNT QTY AMOUNT , WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT •WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 Total Paid for PLUMBING FEES: $103.95 DESCRIPTION ACCOUNT QTY AMOUNT SMI - COMMERCIAL 101-0000-20308 0 $112.00 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $112.00 J I r Total Paid for STRONG MOTION INSTRUMENTATION SMI: $112.00 J I �S►taL ahhy /. Bin.# C4"41- RAW � 0� LQ uinta City., 90dmg er Safery Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 -(760) 777-7012 3: Building Permit •Application and Tracking Sheet Permit # (Cm IM. at) — project Address: V • $ZAwyl l ( Owner's Name A P. Number. Address: '�' DZ ' eL (AM"SV Legal Description: Contractor. . 0V IS I v e. City, ST, zip:d%IVA 6LEAAe '1GL15a� TelephonefAff • 41M - 4. Address: Project 7?escription: pL City, ST, 'Lip: 450A' " f S��'L• %il" MI Tel440 R Fatly W7. V State Lie. # : Lie'. fie Arch, Engr., DesignerLp- �, � Address: MW •ij6CVh% At City, ST, zip:. Telephone: ." •� ?>� ( Construction Type: •� Occupancy: . . State Lie. #: (circle one): New Add'a Repair Demo Name of Contact P=0M- jp t)EA*-� 1 } 4,*.Z4 Sq. Ft.: M414 1 # Stones: I g Units: I Telephone 0 of Contact Person Loo Estimated Value of Projecti4ccew. LA 'A00PUCANT: DO NOT WRITE BELOW THIS UNE M Submittal Req'd Recd TRACMG PERMITFEFS- Plan Sets Plan Cheek submitted Item Amount Strudatat Cabs. Reviewed, ready for corrections Plan Check Deposit. . Taus Calcs. Called Contact Person Plan Check Balance Title 24 Calm Plans picked up Construction Flood plain pian Plans resubmitted ' . Mechariicsl Grading plan Z'! Review, ready for eorreetiow✓cssue Electrical Subeoetactor Ust Called Contact Person Plumbing " Grant Deed Plans picked up SAWL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' RcVIew, ready for corrections/issue Developer Impact Fee Planning Approval, Caged Contact Person A.I.P.P. Pub. Wka Appr " Date of permit Issue School Fees Total Permit Fees C4"41- RAW • 9 � .C✓ � `� � ��:a � �''d a� �� 4�x r"°it? .¢ �. � ��`t" k; .0 '`�" � ,�anf,�.,,, s ' sof' ,.b n � x ,� � �+gUy�,u,. ..�� +.� OFa;I13 Permit Number: BCOM2016-0031 Description: TI / ULTRA"BEAUTY Applied: 7/15/2016 Approved;Site Address:.78825 HIGHWAY 111 Issued: Fir.aled:• City, State Zip Code: LA QUINTA, CA 92253 = Status: UNDER REVIEW Applicant:JOHN:DEENHAN; Parent Permit: Owner: RM LA QUINTA Parent Project: Contractor. <NONE> Details:. . L,rs�-`" ra3� '+.�%-w q,,a� ..;��• tri "lz,`«c� �` �n�r� �`?�u s�`' A • t i,Y�' ,;ps � Pb� �� #?• e �A a R✓...z� +`^Q�rr.4 '� �iv,` , Y/e •'f. `i5z. ��y` fb. M1. yy D.Y . f , �l .. ..�.6 E z tp< C'Rl'9'zfkSt3:ubk =Q�M } @ % $� 13M�MACFT 1 11 s r STAST i ' REMAIL KS' Review Group: AUTO 7/15/2016 7/27/2016 1ST BLDG NS (7 WK) BUILDING BUCKET _ � Notes:v �{S7./,15/2016 �"` 7/27/'2016 1ST PLANNING ('2,WK) PLANNING BUCKET Review Group: BLDG IST (2WK) 7/15/2016 7/27/2016 `,' 1ST BLDG STR (2 WK) BROW YOUNG ' NO s , Printed:. Friday, 15 July 2016,' I-of 1�- . SY57iM$ YOUNG ENGINEERING ° ` ° p ° 6 r •'S E R V. E .� E...... .. u Letter of Transmittal „ r 'To:. City of La Quinta Today's Date: 8-31-16 - 78-495 Calle Tampico City Due Date: - 9-7-16 La Quinta, CA 92253 Project Address: 78825 Highway 111. . Attn: Ramses Sevilla Plan Check #: BCOM2016-0031 Submittal: ❑ 1st ❑ 4u, - ® .2nd ❑ 5'" 0 3rd' ❑ . Other: We are forwarding: ® By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup Includes: , Descriptions: ", Includes: # Of Descriptions: Copies:, ElStructural Plans `, ❑ Revised Struct. Plans ❑ Structural Calculations ❑ Revised Struct. Calcs ❑ Truss Calcs ❑ Revised Truss Calcs ❑ Soils Report Update ❑ Revised Soils Report ❑ Structural P/C Comments ® Approved Structural Plans -41 ❑ Redlined Structural Plans ® Approved Structural Calcs ❑ Redlined Structural Calcs ❑ Approved Truss Calcs b ' ❑ Redlined Truss Calcs ❑ Approved Soils Report ❑ Redlined Soils.Reports ® Other:,Previous submittals Comments: Structural content is approvable. Transit Per Diem= Admin Time =.5 HR • - Structural Engineer/Principal Review Time = 1 HR }} Plan Review Engineer Time = HR This Material Sent for: QYour Files ® Per Your Request ❑ Your Review ❑ Approval ❑ Checking ❑, At the requestof: Other:❑ _ ��/ •� C+� 8 -@f' fly. dam- ,. By: Bronz Young . Office: ® (760) 772-5107 AUG 5 1 .2.016 Other: ❑ CITY OF LA QUINTA i , COMMiJNITY DEVELOPMENT December 9, 2016 Mr. Jason Shipman .Carey Signs. 2871 Blue Star St. Anaheim, CA 92806 SUBJECT:. SIGN PERMIT APPLICATION 2016-0031: ULTA Dear Mr. Shipman: The Design and Development Department has reviewed and approved your request for two illuminated signs at "Ulta", located at 78825 Highway 1.11. The sign is approved per the sign exhibits on file, and subject to the following Conditions: 1. This sign permit grants two individual illuminated signs to be designed and located per the approved plans on file (attached). 2. The applicant is required to obtain a building permit prior to the placement of this sign. Should you have any questions or need additional information please feel free to contact me at (760) 777-7069. Sincerely, 1411< Carlos Flores Associate Planner 78495 Calle Tampico I La Quints I California`92253 -1 760.777.7000 1 wwwlo- ui taro . STATE OF CALIFORNIA SIGN LIGHTING ry CEC-NRCC-LTS-01-E(Revsed 08115) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Name: Date Prepared: A. General Information Project Address: Location of Sign rlOutcloor Sighs ❑ Indoor Signs Phase of Sign Construction ONew Signs ❑ Sign Alterations Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls Not Installing Lighting Controls This Certificate of Compliance includes the following components (check allthat 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 hove 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. 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: I have responsibility for installing the sign lighting controls 1 O Yes, complete parts 1a and 1b of this form ' No, complete part 1a of this form There are no existing sign lighting controls and I will installing compliant sign lighting controls 2 O' Yes No There are no existing sign lighting controls and someo a else will be responsible to install compliant sign lighting controls 3 ja Yes O No There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and I will be 4 installing compliant sign lighting controls O Yes 1) No There are existing sign lighting controls that do not c .mply with the applicable provision of §110:9 and §130.3 and someone S else will be responsible to install compliant sign lighting controls O Yes No CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance August 2015 . > 1 STATE OF CALIFORNIA, SIGN LIGHTING , s° CEC-NRCC-LTS-01-E(Revised 08115) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) Project Name: Date Prepared: I �� q -v 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: §130.3(a)i. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time- Y N N 1 switch control. 0 §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N NA switch control, or an astronomical time -switch control. 010 2 EXCEPTION to Section 130.3(a)2A: Outdoor signs in tunnels, and signs in large permanently covered outdoor Y areas that are intended to be continuously lit, 24 hours per day and 365 days per year. 0 §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 O O 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. 0 §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 NA 4 reducing the lighting power by a minimum of 30 percent when receiving a demand response signal. EXCEPTION to.Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, Y NA ordinance, or regulation.to be reduced by 30 percent. 0 Field Inspector Notes: 9 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance August 2015 STATE OF CALIFORNIA\ SIGN LIGHTING� CEC-NRCC-1-TS-01-E(Reviseti 08/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPL fiNCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) Project Name: - Dale Prepared: i 2. Maximum Allowed Lighting Power Method of Compliance Certificate of Compliance and Field Insp tion Energy Checklist Complete this part if there are si s using the maximum allowed lighting power method of compliance. (Complete part 3 of this Certificate of Compliance if the are signs using the Specific lighting sources method of compliance) A B C\ D E F G H I J Field Symbol OPTIONAL —EneTy Design Complies Inspector or Description of the Sign . Verified Label (see Allotted Watts Watts Y/N Check that Code instructions below) sign complies \\ ' V 0-14+ VI ? N\ to C M -O X Q c u E 3^' 3 ° C m 'o. tL0 v +� u u o in w= Q z_ w Q m 3 0 v/ ✓ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 0.00 ❑ ❑ 00 ❑ ❑ 0. ❑ 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 con ruction documents. OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed, E RGY VERIFIED label, confirming that the sign complies with the Section 140.8 of the California 2013 Title 24, Part 6 Standards, using the aximum Allowed Lighting Power method of compliance. The only labels that will be recognized for this purpose are ENERGY VER IED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 6by the American National Standards C Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall a an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with s h an ENERGY VERIFIED label, columns 'D' through 'I' are not required to be filled out. Note: Using an ENERGY VERIFIED label is an o tional 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). I Enter Y if the number in column H is less than or equal to the number in column G. Otherwise, the sign does no comply. J This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance August 2015 STATE OF CALIFORNIA SIGN LIGHTING CEC- NRCC-LTS-01-E Revised 08/15 CALIFORNIA ENERGY COMMISSION „Aw' CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 4 of 5) Project Name: Date Prepared: 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 Field Inspector Symbol ENERGYVERIFIED compliance Check that Sign or Description label Shall include only lighting . Complies Code (see instructions technologies listed below below) List all that apply ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 a ballast that has a minimum efficiency of 80 percent. 3 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 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 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 LI ht emitting diodes (LEDs) with a power supply having an efficiency of 80 percent or greater; Ingle 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 1 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 August 2015 STATE OF CALIFORNIA SIGN LIGHTING CEC- NRCC-LTS-01-E(Revised 0g/15)' CALIFORNIA ENERGY COMMISSION '440" CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 5 of 5) Project Name: � ^ � v Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: C Documentation Author Signature: ( Company: Signature Date: Address: % Z25 CEA Certification Identification (if applicable): 7 City/State/Zip: �'�,/ Phone' 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 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 a building owner at occupancy. Responsible Designer Name: _ / Responsible Designer Signatu Company! Date Signed: Address: ✓ License: City/State/Zip: Phone: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance August 2015