HomeMy WebLinkAboutPR15-1581u�VIOND litui
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 4,
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS
APN LOT TRACT
OWNER 7— 1
ADDRESS Zy G S Cm t,..m cA&ts I& AWL
CITY ZIP TEL.
APPLICANT et> t 6Arl trS TEL.
CONTRACTOR 1')0t -,XC 14 C.
ADDRESS C G.
CITY ZIP"MIS071 TEL. -7I!f `2TY-00099
ARCH/ENG/DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s)
indicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 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 from licensure 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).
U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions
of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds
or improves the property, 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 it was not built
or improved for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section
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 licensed Contractor pursuant to the Contractors' State
License Law.).
U I am exempt from licensure under the Contractor's State License law for the following reason(s):
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one
year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an
owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable
law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at
the following Web site: http/www.loginfo.ca.gov/calaw.html.
DATE: SIGN:
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 Cade, and my license is in full force and effect.
LICENSE CLA : G 10 UC. NO.:
DATE: I CONTRACTOR: b N
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 Worker's Compensation, as provided by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
CARRIER S
POLICY NUMBER 1 I 45SA I — y
(THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS).
I certify that in the performance of the work for which this permit is issued, hall not employ any person in any manner so as to
become subject to the Worker's Compensation Laws of Califo�la. And ag a that if should became subject to the Worker's
Compensa' n p inions of Section 3700 of thr�gGe de, {all forthwi complyith those provisions.
DATE: I APPLICANT: C
WARNING: Failure to secure Worker's on verage 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 cast of the compensation,
damages as provided for in section 3708 of the labor code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that them 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:
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 -mentioned property for inspection purposes.
PERMITTEE N INT) _ r
SI URE RJITTEk DA
IJ
PRESS
FIRMLY
APPLICATION DATE: tJ� fOl IS P/C# +
ISSUE DATE: ���S PERMIT# PP�►S '� X58
TYPE CONST. OCC GROUP:
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW [:L—
SIDE SIDE ❑
PROPOSED USE
X � IL_wM\tye�L� L�
GAi" tV eL.
If DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
rn
w
Patio/Deck
LL
Pool/Spa
ZRe
-Roof
O
�
Commercial
m
Valuation: 00 Adj. Area:
QUANTITY DESCRIPTION FEE t
a
C_\ .) -Cys LJs
U
J
ILA
cv
I
rz
U
L)
�
CONSTRUCTION: , �� _aq
PLAN REVIEW: 1 . aAi
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMTP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE: ao
PRE -ALT FEE:
BSAF: �0
TOTAL FEES Sq C
COMMENTS:
RECEIPT # y z y PAID BY: UISO 2/ VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy
SEWER LATERAL
MAIN WATER LINE
SEWER CLEANOUT
ROOF SHEATHING
FLOOR SHEATHING
INSULATION WALL
INSULATION CEILING
DRYWALL
LATH (PRE)_
LATH EXTERIOR
LATH INTERIOR
GAS TEST_
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTION
NUUU MAKY I
of�OGCUPANCYE �,�,
COMMENTS:
CITY OF DIAMOND BAR
INSPECTION RECORD
a
TRACT AND LEDGER
�
SWITCH GEAR
COMMERCIAL HOOD
,.
T—BAR
INTERCEPTER
HOT MOP/SHOWERPAN
_
SEPTIC/CESSPOOL
�—
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
+POOL/SPA°
RQUGH'PLUMBING
_r
ROUGH- ELECTRICAL m-
ROUGHNECHANICAL `._�r_�.
� �, � , � �
GAS TEST
�
fit'..
"�
✓a 9..X n
C!� ..«e: dv
PRE GUNITE - �,. ,,. ...,. .^x >< a==, a .: ,.
POOL PRE DECK BONDING
q,
P TRAP
FENCE 7 GATE/ALARM
---
—
--
FINAL FOOL
,-
WALLS:
WALL FOOTING/STEEL
WALL STEEL 1ST( ) 2N°( ) LIFT
_
WALL BOND BEAM
WALL DRAIN/ SEAL
WALL FINAL
R0: FRAMING PLANNINGAPPROVAI.
ROUGH FIRE APPROVAL,
FINAL FIRE DEPARTMENT
FINAL PLANNING . .,
V— ...ti
FINAL ENGINEERING/ PW, -
CITY OF DIAMOND BAR
Planning Division Plan Check Approval
Case/file num,m' er. _ -Lo [� • ?�14
Date: �S
Approved. by:
With Condi'Ions as Listed:
1. This ap^rov 'is for:_.
2. No other approval is impiiec by this one.
3. This approval is valid for.-- —year(s).
4. Shall comply with Planning, co; fling,
Engineering, and Bldg. & Safety requirements.
The construction documents submitted for plan check
and/or subsequent development shall be in substantial
compliance with the architectural nlanc ?pproved by the
(Planning Commission/Pl ,r�ning Division r ministrative
Hearing Officer/City Councl n rl e with the Planning
Division, as modified pursuant to the conditions noted, and
thereafter maintained in conformance with such approval.
IS- 15l&\
rc. HALL NOT BE
dy VIOLATION
THIS CITY.
HEJOd
FQRALL RE(dUiJ t �v try :_�6TIAN»
SignResource 800.423.4283
Fax 323.560,7743 '- �� ' � LN
ASE 206 S DIAMOND ;A' BLVD DIAMOND ;A' A E
C F O I. P Website: wwwsignresource.com 4
SCOPE ' WORK
36" TRI STRIPE CHANNEL LETTER SIGN 3
®
36" TRI STRIPE CHANNEL LETTER SIGN
4
36" TRI STRIPE CHANNEL LETTER SIGN
5
36" TRI STRIPE CHANNEL LETTER SIGN
6
CITY OF DIAMOND BAR
Planning Division Plan Check Approval
Case/file num,m' er. _ -Lo [� • ?�14
Date: �S
Approved. by:
With Condi'Ions as Listed:
1. This ap^rov 'is for:_.
2. No other approval is impiiec by this one.
3. This approval is valid for.-- —year(s).
4. Shall comply with Planning, co; fling,
Engineering, and Bldg. & Safety requirements.
The construction documents submitted for plan check
and/or subsequent development shall be in substantial
compliance with the architectural nlanc ?pproved by the
(Planning Commission/Pl ,r�ning Division r ministrative
Hearing Officer/City Councl n rl e with the Planning
Division, as modified pursuant to the conditions noted, and
thereafter maintained in conformance with such approval.
IS- 15l&\
rc. HALL NOT BE
dy VIOLATION
THIS CITY.
HEJOd
FQRALL RE(dUiJ t �v try :_�6TIAN»
SignResource 800.423.4283
Fax 323.560,7743 '- �� ' � LN
ASE 206 S DIAMOND ;A' BLVD DIAMOND ;A' A E
C F O I. P Website: wwwsignresource.com 4
EXISTING
0ITy (; 11, 0 1, p
SignResource
:
PROPOSED - STONE WALL FACADE IS 15.75' WIDE
36" TRI STRIPE CHANNEL LETTER SIGN
- 14'-6" CHANNEL LETTERS
3'-11 5/16" 2'-4 1/8" LOGO r 3'-11 5/16"
5 3/8
H
w 8 7/81
ELEVEIIM_ W-1
Z s�
U
S/F INTERNALLY ILLUMINATED REMOTE CHANNEL LETTER STYLE TRI -STRIPE SIGNS
3/16" THICK WHITE ACRYLIC FACES W/ TRANSLUCENT VINYL GRAPHICS APPLIED FIRST SURFACE. 4" DEEP ALUMINUM RETURNS PRE -PAINTED WHITE.
1" WHITE (JEWELITE) TRIM CAP. LETTERS TO BE INTERNALLY ILLUMINATED W/ WHITE LEDS.
ATTACHMENT METHOD TO BE DETERMINED BY THE INSTALLER.
FRONT VIEW
SCALE 3/8" = V
111 pow,
800.423.4283 • Fax 323.560.7143 - ' ' go
Website: wvrnsignresource.com
PART #
SE30ILRT
PQG�E# 3of8
IT
1t
Zv�� iid^ � �• "taS �i 5y F "� ��
ti
- j � ( 3 '. t f. k� � 1 1 ,,FLS .. .,�'. t • � a � s j4i- ��- '� � ,r- a � —�`•_.
++yl
■ q-�-•--•--.•,.�„_r, fa 1�; � y ��'+r �, fay \ � !�r � ' � - '" � "��_ ; - -.
rm
ELEVATION SE 206 S DIAMOND BAR BLVD DIAMOND BAR CA—E
36" TRI STRIPE CHANNEL LETTER SIGN
17315/16"
47 5/16" � �- 261/4" � � 47 5/16"
v.
2913/16" AELEYEII 36
.p
79 3/8"
FRONT VIEW
SCALE 3/8" = V
PROPOSED
EXISTING
SignResource 500.423.4283 •Fax 323.560.7143---�-8,01
— SE 0•DAO/ : •D DAOD : •AWebsite: www.signresource.com� 'A I) P \' ( IY G i 0 I. P
. �r.,,. ;it '�1#.Rt�-�-.dv.,."sL�bC'�_c"S: ted; � P`.�_"�T"�'^mr—"'-=•� 4u '� ��� ' � •".
.�,.. a�-��F ;'�-L-�"s'�.-"I?�a-i• ter. v
' � ' d ar �r .f t. er }:.;t {vfi �d-�',r+• �{ �� 'x-�. n ,..^��f Lr,�"�.r
40.
15;` .,. r, .f'� • C. z. .. NPS t#_ ... a tf -.
!]Lq9!JIJ!ffr!Ii\ill 1►\.1Nm■:2013 �
G ELEVATION SE 206 S DIAMOND BAR BLVD DIAMOND BAR CA -E
12V DRIV
120V DEDICATED CIRCUIT
TO 20AMP DEDICATED BREAKER
F
Donco & Sons, Inc.
Signs • Lighting • Electrical
4582 E. Eisenhower Cir., Anaheim, CA 92807
Ph: (714) 779-0099 Fx: (714) 779-0198
CA St. Lic. #435616 C10 -C45 -C61
CUSTOMER:
IM. RETURNS S'Resource
ornr:.:� rtT) c110UrP
SIGN RESOURCE
6135 DISTRICT BLVD.
VHITE BACKS MAYWOOD, CA 90270
ATTN: CHRIS CRAWFORD
1-800-423-4283
SIGN PLAN
PROJECTADDRESS:
7 -ELEVEN #39755
206 S. DIAMOND BAR BLVD.
DIAMOND BAR, CA 91765
ITE CONDUIT DATE: 5-19-15
REVISION DATE
WHITE LEDS 1
2
3
4
SCALE: NTS
I SHEET NUMBER
ITE TRIM CAP 1 OF 1
WEEP HOLES i DRAWN: A.S.
ALL RIGHTS RESERVED
CITY OF DIAMOND BAR
THESE P NS AN. DETA S
All designs & prints are the
NG BUILDING WALL SPP
exclusive property of
BY
"Donco & Sons, Inc." And
— - - ®- --
may not be copied,
distributed, modified,
reused, reposited,
reproduced or otherwise
THETRUEDTCAPPROVAL G �'�- ?! �3' ; KHt1Ll id8T B6
used without express
CONSTRUEDEG S A PEP :ill' 1 L-A ,NY VIOLATION
9F
written permission.
ANY COLE 0P�:� I is .h z OF THIS CITY.
Any un -authorized use or
"EbE P'=A4JS'0' = 3� Y�� THE 408
FN,LREQUESTEDin6etiij--y
®R
duplication will result in a
20% charge per occurrence
per the value of the display.
Standard Wall Sign Attachment: SIGN LETTERS
Sign Area=
A.1 Wind Load: 85 MPH Exp C ( 3 sec Gust) Max. ht = 20 ft above grade 10 sq. ft.
DL = 5 PSF = 50 lbs ♦ Approx. 50% void
V= 85 mph KZt = 1.00 Kz = 0.9 (Expo C Table 6-3, ASCE 7-05) KZt = 1.00 Kd = 0.85
1 = 1.00 G = 0.85 (Section 6.5.8.1 ASCE)
Cf = 1.8 Fig 6-20, ASCE Method 2: h=20, s=5, B =5, Therefore s/h = .3, B/s =1
Wind Load: 0.00256 (Kj(KZ,)(Kd)(V12) (1) (G) (Cf) (Af) 21.64864 Say 21 psf
Use 21 psf as wind design load.
A.2 Wind Load / sign = 21x10 =210 lbs —► Dead Load/ sign = 50 lbs
Resultant =216 lbs
A.3 Connection of Sign Letters to Wood Studs:
Try 1/4" Diam. Lag Bolt w/ 3" lag or Embedment:
Withdrawal resistance = 100 lbs per inch = 300 lbs > 216 lbs
Use minimum 4 screws . No special inspection required.
Reference: Page VIII -36 Timber Fasteners, Western Wood Use Book.
A.4 Connection of sign letters to Masonry Wall:
Use 1/4" Kwik Bolt II Expansion Anchors (Hilti or Equal)
Minimum Embedment = 2 inches. Use minimum 3 bolts per sign letter.
Tension / withdrawal per bolt = 325 lbs. Reference Hilti Design Book
No Special Inspection required.
A.5 Connection op Sign letter to Concrete (Hollow or Non Hallow) wall:
Same as A.4 above.
A.6 Connection of Sign letters to Metal / Steel or ACM wall:
Use Kwik # 12 Self Drilling Screws. Use minimum 4 screws per sign letter.
A.7 Connection of Sign letters to Stud Wall with Plywood Sheathing:
Use 1/4" diam. Toggled Bolts: Shear per bolt = 85 lbs.
# of bolts needed = 216/85 =2.54
Use minimum 4 bolts per sign letter.
Design Criteria
Kumar Engineering
6871 East Kentucky Ave
Anaheim, CA 92807
PH/Fax (714)281-7286
Each Sign Letter is about 10 sq ft (with 50% Void)
Letters weigh 50 lbs maximum.
Use minimum 4 bolts or 4 self drilling screws per letter.
Client:
Donco & Sons Inc.
Job No. Date QUO
WA -002 16/17/2015
W
d
4
FESS
OD
No. C27429
EXP. 6-30- I
Or
T CIVI
SOF CX
HEIGH-
VARY
4 BOLTS
PER LETTER
SINGLE FACE
SIGN CABINET
BY OTHERS
HEI(
VAI
n
SINGLE FACE WALL SIGN ELEVATION
SHEET METAL
OR ACME
FOR WOOD STUD WALL
1/4" DIAM. LAG BOLT
BY 3" LONG HEIGHT
(PRE DRILL HOLES VARY
3/8" DIAM. PER LAGS)
WOOD STUD WALL
SINGLE FAC
SIGN CABINI
BY OTHERS
CONC. WALL
SINGLE FACE -
SIGN CABINET
BY OTHERS
SINGLE FACE
SIGN CABINET
BY OTHERS
EXISTING STEEL
FASCIA FRAME
4-#12X1'/2"L.
TEK SCREWS
SHEET METAL FASCIA
ACM
FOR CONC. WALL: 1/4" DIAM.
HILT[ KWIK BOLT II
EXPANSION ANCHORS
2" MIN. EMB.
2"
SINGLE FACE
SIGN CABINET
BY OTHERS
SIGN SECTION
WALL SIGN
ATTACHMENT DETAILS
I -
HEIGHT
VARY
GENERALNOTES
1. CONTRACTOR SHALL VERIFY ALL DIMENSIONS AND CONDITIONS.
2. STRUCTURAL PIPE SHALL CONFORM TO ASTM A501, ASTM A53 GRADE
"B" TYPE E OR S FY = 35 KSI. MIN.
3. STRUCTUAL TUBE SHALL CONFORM TO ASTM A500, GRADE "B" FY =
46KSI.
4. STRUCTUAL STEEL SHALL CONFORM TO ASTM A36.
5. ALL BOLTS SHALL CONFORM TO ASTM A307 W/WASHER U.N.O.
6. FABRICATION, ERECTION AND PAINTING OF STRUCTURAL STEEL SHALL
CONFORM TO ICC
7. ALL STEEL LESS THAN'/." THICK SHALL BE GALVANIZED OR USE DOUBLE
COAT OF PRIMER.
8. ALL HOLLOW STEEL SECTIONS MUST BE CAPPEDAND WELDEDALL
AROUND TO PREVENT WATER FROM ENTERING THE SECTION.
9. FLAMMABILITY OF ALL MATERIALS IN SIGN SHALL COMPLY WITH ICC
10. IDENTIFYING NUMBER REQUIRED ON SIGN AND WEIGHT OF SIGN
CLEARLY LABELED.
11. ALL HOLES DRILLED OR PUNCHED.
12. ALL WORKS SHALL CONFORM TO CURRENT ICC
13. SIGNS TO BE 6 FT HORIZ. R 12 FT. VERT. FROM HIGH VOLTAGE WIRES.
14. SIGNS TO BE U.L. LABELED AND COMPLY WITH ART. 600, NFC.
15. SIGNS TO BE ON SPEARATE CIRCUIT WITH UNDERGROUND FEEDER.
16. PROVIDE PEDESTRIAN PROTECTION DURING SIGN ERECTION PER ICC
17. STRUCTURAL ALUM., 6061-T6, Fb=19000.PS1.
18. RED HEAD TRU BOLT WEDGEANCHORS PER ICBO #ER -1372, INSTALL
PER MANUF. SPECIFICATION.
19. HILTI HY 150 EPDXY ADHESIVE PER ICBG 5193 INSTALL PER MANUF.
SPEC.
20, DESIGN WIND LOAD 85 MPH EXP. "C" (3 SECOND GUSTS)
1/4" DIAM.
TOGGLE BOLTS
PLYWOOD
SHEATHING
STUD WALL W/
PLYWOOD SHEATHING
HEIGHT
VARY j
I
I
I
I
L —
0
q�x
Q
oo�
CMU WALL
FOR CMU WALL: 1/4" DIAM.
HILTI KWIK BOLT II
EXPANSION ANCHORS
2" MIN. EMB. CITY OF DIAMOND BAR
THESE PL iNS AND DETAI,.✓a'
�Pih,,..
211
DESIGN CRITE (IAO 7 2015
EACH SIGN LEITER/'IS ABOUT,10�SQ..�,FTRE
�. r•ryplCroiiFrl Tr ^c � �
SIGN LETTERV,,E�I,GH,TS;50LBS �MAXIMiJM.
USE MINIMUM FOUR- BOLT$LPER, LETTER.
��RALL R1=Uucs�c:; ;;vP€GTlONS
2
0
W
uj co
Q � co
V 0) N
ZVq
uj
� W= ><
!IX
co co
coQa
ry I--
W
W=
00
Q
Q
QZ
7Q
Fri
U) v J
O N
z CD
m Q
O 3:
d
c o
0
oLo
N UN
a
W
cnO�
otj Z 00
W
Z N
cn�
vW�
C W=
Oooa
Oma
Uzw_
J
DATE: 1-03-08
REVISION
SCALE:
NTS
SHEET NUMBER
1 OF 1
Q�pFESS/QN _
Quo Op KIM �Fy
( No. C27429
\d Exp. 6-30.
WV
�
J I H It: Ur UALit-VKNIH
SIGN LIGHTING
Fal.
CEC-NNCC-LTS-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION
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
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
G 1, 1 •5,
❑
❑
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 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 June 2014
J IH I t Ur' WALIt-UMNIH
SIGN LIGHTING
CEC-NIeCC-LTS-01-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 5 of 5)
Project Name: Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Nam .
Documentation Au Ign ure:
1`1% C V
Company: ,
Signature D
Address:
CEA/ HERS Certification Identification (if applicable):
e L
City/St to/Zip:
Phone:
�p
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 thatq 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 Nam
Responsible Desig S' re:
l 4a 1 aiAfi�
Com any :
Date Signed:
Address:
`s
License:
City/State/Zip:
Phone:
L/S— 9 280`1
— S — 39
CA Building Energy Efficiency Standards - 2013. Nonresidential Compliance June 2014