PMT17-00344 City of Menifee Permit No.: PMT17-00344
29714 HAUN RD. Type: Sign-Permanent
�!-�CCEL/!? MENIFEE, CA 92586
MENIFEE Date Issued: 03/10/2017
PERMIT
Site Address: 30384 HAUN RD,Suite#600&601, Parcel Number: 360-690-016
MENIFEE, CA 92584 Construction Cost: $4,020.00
Existing Use: Proposed Use:
Description of INSTALLATION OF 3 SETS OF ILLUMINATED CHANEL LETTERS/LOGO ON BACKER PANEL
Work:
Owner Contractor
DONAHUE SCHRIBER AINOR SIGNS INC
200 E BAKER ST STE 100 5443 STATIONERS WAY
COSTA MESA, CA 92626 SACRAMENTO,CA 95842
Applicant Phone:9163484370
BOBBIE DUDDEY License Number:913842
AINOR SIGNS INC
5443 STATIONERS WAY
SACRAMENTO,CA 95842
Fee Description 01tr Amount fbr
Sign Permit 3 190.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.50
$227.50
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and D I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license Is in full farce and a ect. the following reason:
License Class C. cense-N By my signature below I acknowledge that,except for my personal residence
Expires 1�_J- /7 Signature in which I must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in Its entirety by
D I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Cade,for the performance of work for which �yyyyy,leeinfo.ca.eav/calaw.html.
this permit is issued.
Poll Date
1 have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
numb
O application and the information I have provided is correct.I agree to comply
Cam
Carri r with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy JIc5T Sa—3 L 01) Expires �— `- �, enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($200)or less PROPERTY OWNER OR AUTHORIZED AGENT
D I certify that in the performance of the work for which this permit is issued,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall f caply with those provisions. -7 Will the applicant or future building occupant handle hazardous material or
Applicant ^� Date 7 C) ' mixture containing a hazardous material equal to or greater that the
amounts sp cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes 7o
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC construction
or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines
Qua
CONSTRUCTION LENDING AGENCY D Yes efNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes 9190
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed nextto the applicable item(s)(Section 7031.5 DYes .efNci
Business and Professions Code).Any city or county that requires a permit to
Date ' ( � -
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he orshe is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 70DO)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence o childcare facility to be RRP-certified firms and comply with
than
Applicant fora permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-ROD-424-LEAD(5323).
Cade,The Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that It was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING :SAFETY& SAFETY PERM IT/PLAN CHECK APPLICATION
4
Menifee
DATE 01/30/2017 PERMIT/PLAN CHECK NUMBER
TYPE: ❑✓ COMMERCIAL []RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑✓ SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION [—]ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Install 3 sets of illuminated channel letters/logo on backer panel 29"h x 190 1/2"w
PROJECT ADDRESS 30384 Haun Rd Suite 600 and 610 C[
ASSESSOR'S PARCEL NUMBER 3e,4D, (jCJO-aLj LOT I U TRACT
PROPERTY OWNER'S NAME Donahue Schriber
ADDRESS 200 E Baker St Suite 100 Costa Mesa CA 92626
PHONE (714)545-1400 EMAIL
APPLICANT NAME AKC Services Inc
ADDRESS 18650 Collier Ave Suite B Lake Elsinore CA 92530
PHONE (951)471-8419 EMAIL info@akcservices.net
CONTRACTOR'S NAME AinorSignslnc OWNERBUILDER? ❑YESQNO
BUSINESS NAME Ainor Signs Inc
ADDRESS 5443 Stationers Way Sacramento CA 95842
PHONE (916)348-4370 EMAIL
CONTRACTOR'S STATE LIC NUMBER 913842 LICENSE CLASSIFICATION C45
VALUATION$ $4,020.00 SQ FT 115.08 L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION �el CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGIN&ERING FIRE I GREEN VV SMIP
INVOICE pglD AMOUNT
AMOUNT OCASH OCHECKA 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH '—CHECK# '-CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER C: YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.citycfinenifee.us Inspection Request Line 951-246-6213
d
City of Menifee
DONAHUE Building & Safety Dept.
SCHRIBER FEB 0 6 2017
January 30, 2017 Received
Plans acceptable for
Real Estate Department permit issuance
MATTRESS FIRM, INC.
10201 South Main Street FEB 0 6 2017
Houston, TX 77025
RE., Sign Response for Mattress Firm City of Menifee Planning Department
Countryside Marketplace By:
Menifee, Callfomia
The sign submittal received at our office for the above-referenced project has been
reviewed and approved as noted. Please use the comments noted on the
drawings and the guidelines listed below to make any necessary adjustment to
your documents and the installation of your sign.
1. All signs shall be reviewed for conformance with the sign criteria and overall
design quality and is not a plan check for dimensional errors, code
violations or any other restrictions to the property. Approval or disapproval
of sign submittals based on aesthetics of design shall remain the sole right
of the Landlord/Manager.
2. Prior to the installation and manufacture of any sign, the Tenant shall
provide Landlord with a copy of the sign permit from the governmental
agency having jurisdiction.
3. Each tenant shall be responsible to repair any damage to any surface
caused by the signage or its' installation.
4. Landlord reserves the right to periodically hire an independent electrical
engineer, at Tenant's sole expense, to inspect the installation of all Tenants'
signs. Tenants shall be required to have any discrepancies and/or code
violations corrected at Tenant's expense. Any code violations, requests for +
sign removals, or discrepancies not corrected within fifteen (15) days of
notice, may be corrected by the Landlord at Tenant's expense.
5. Upon vacancy, Tenant shall remove sign and restore fascia to original
condition at Tenant's sole cost and expense within fifteen (15) days of Y
expiration of term or earlier termination of Tenant's lease.
200 E.Baker Street
Suite 100
Costa Mesa, CA 92626
(714) 545-1400
FAX:(714)545-4222
donahueschriber.com
tic.01875932
January 30, 2017
Mattress Firm
Countryside Marketplace
Page 2
6. Exposed junction boxes, transformers, lamps, tubing, conduit, or raceways
of any type are NOT PERMITTED.
7. Sign manufacturer's names, stamps, or decals may not be visible from the
street or normal viewing angles.
8. Tenant's sign contractor shall install and connect sign display and primary
wiring at sign location approved by Landlord. Signs are to be connected to
the J-box provided by the Landlord, which is connected to the Landlord's
house panel, and shall be wired to Landlord's control at Landlord's timer for
uniform control of hours of illumination unless otherwise directed by
Landlord.
9. Prior to sign installation, we require the following:
a. A copy of your sign contractor's insurance certificate naming Donahue
Schriber Realty Group. L.P. and all related affiliates as additional
insured (with additional insured endorsement page attached).
b. A copy of the permit and the contractor's license.
c. At least 48 hour notice of date of install and requesting access to
electrical room, if required.
Should any other contractor provide installations or other work on the site,
please call me to coordinate insurance requirements.
In the event that the above information contradicts the lease signage criteria, the
lease signage criteria are to supersede. Should you have any questions, please
call me at 714.966.6475.
Sincerely,
DONAHUE SCHRIBER
--MCALc�
Michael Osborne
Project Manager
cc: Jackie Check, DSRG
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STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC.LTS-01-E Revised 08/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 1 of 5)
"'°" N...: Mattress Firm °"`rRwaa: 01/30/2017
A.General Information
Project Address:
30384 Haun Rd Ste 600 &610
Location of Sign ®Outdoor Signs ❑Indoor Signs
Phase of Sign Construction ❑New 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 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
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 (e.g. a C-10 contractor may complete parts la and lb on one compliance document and a C-45
contractor may complete parts 2a and 2b on a separate compliance document—the Responsible Designer shall submit the two
compliance documents together for the some complete installation).
I have responsibility for installing the sign lighting controls:
I]Yes,I have responsibility for the sign lighting controls,and will ❑No,I do not have responsibility for installing the sign lighting controls.
complete parts la and lb of this compliance document Someone else will complete parts la and lb of this compliance document.
la.Check Yes or No for all of the following statements:
1 There are existing sign lighting controls that comply with the applicable provisions of§110.9 and§130.3
®Yes ❑ No
There are no existing sign lighting controls and I will be installing sign lighting controls that comply with the applicable
2 provisions of§110.9 and §130.3
❑Yes ❑ No
There are existing sign lighting controls that do not comply with the applicable provisions of§110.9 and§130.3 and I will be
3 installing sign lighting controls that comply with the applicable provisions of §110.9 and§130.3
❑Yes ❑ No
City of Menitee
Building & Safety Dept.
FEB 0 6 2017
Received
r
CA Building Energy Efficiency Standards-2016 Nonresidential Compliance August 201
STATE OF CALIFORNIA
.SIGN LIGHTING
CEC-NRCC-LTS-01-E Revised 06116 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 2 of 5)
wekdNam`: Mattress Firm u.termwr<d:
01/30/2017
1b.Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E is responsible for complying with
the sign lighting control requirements,that person shall answer all of the following questions:
If there are construction documents,indicate where on the building plans the
mandatory measures(sign lighting control)note block can be located:
1 §130.3(a)1.All indoor sign lighting is controlled with an automatic time-switch control or astronomical time- Y N NA
switch control. O O Oc
§330.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N NA
2 switch control,or an astronomical time-switch control. ® O O
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. O
§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%during nighttime hours.Signs that Y N NA
3 are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both day and O O Q
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. O (�
§130.3(a)3. Demand Responsive Electronic Message Center Control.An Electronic Message Center(EMC) Y NLNAhaving a new connected lighting power load greater than 15 kW has a control installed that is capable of4 reducing the lighting power by a minimum of 30%when receiving a demand response signal. OEXCEPTION to Section 130.3(a)3:Lighting for EMCs that is not permitted by a health or life safety statute, Y
ordinance,or regulation to be reduced by 30%. O
Field Inspector Notes:
CA Building Energy Efficiency Standards-2016 Nonresidential Compliance August 2016
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E(Revised 08116) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 3 of 5)
N.J1dNi"" Mattress Firm DalePfepied: 1/30/2017
2. Mandatory Sign Lighting Measures
I have responsibility for installing the sign lighting
®Yes,I have responsibility for the sign lighting,and will complete ❑No,I do not have responsibility for installing the sign lighting.Someone
parts 2a and 2b of this compliance document else will complete parts 2a and 2b of this compliance document.
2a.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 2b 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 i
OPTIONAL—
Symbol or
Energy Verified Field Code Description of the Sign Label(see Allotted Watts Design Complies InspectorWatts Y/N Check that
instructions
below) Sign Complies
t�
w =m c a 3 3 x .0
< 'c E E
n
fn cw ¢ cw < F 3 0
V
❑ 0 ❑
❑ 0 ❑
❑ 0 ❑
❑ 0 ❑
❑ 0 ❑
❑ 0 ❑
❑ 0 ❑
❑ 0 ❑
❑ 0 ❑
❑ 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 construction documents.
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 2016 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
C authorized by Underwriters Laboratories(LIQ or other Product Certification Body accredited to ISO/IEC Guide 65 by the American
National Standards Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body shall be an
ongoing annual Inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020.For signs with such
an ENERGY VERIFIED label,columns'D'through'I'are not required to be filled out.Note:Using an ENERGY VERIFIED label is an
optional method to validate compliance.An ENERGY VERIFIED label is not needed for compliance.
D The sign area in square feet.
E List"I"if the sign is internally illuminated. List"E"if the sign is externally illuminated.
F Allowed watts per square foot. Enter 12 if the sign is listed as"I"in column E.Enter 2.3 if sign is listed as"E"in column E.
G Multiply the square footage in column D times the allowed Lighting Power Density(LPD=watts)in column F.
H Show the total installed watts in the sign,as determined according to the applicable provisions of§130(c).
I Enter Y if the number in column H is less than or equal to the number in column G. Otherwise,the sign does not comply.
1 This page doubles as a field inspection checklist.
Field Inspector Notes:
CA Building Energy Efficiency Standards-2016 Nonresidential Compliance August 2016
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC.LTS-01-E(Revised 08/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 4 of 5)
"'°i"`n""` Mattress Firm °i" paed 01/30/2017
2b.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
ENERGY Specific light source used for
Symbol VERIFIED compliance Field Inspector
or Description label Shall include only lighting Check that Sign
Code (see technologies listed below Complies
instructions (List all that apply)
below)
A Channel letters/logo on backer panel ❑ 7 ❑
B Channel letters/logo on backer panel ❑ 7 ❑
C Channel letters/logo on backer panel ❑ 7 ❑
❑ ❑
❑ ❑
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
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 2016 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
C (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%or greater.
2 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
3 served by a ballast that has a minimum efficiency of 80%.
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%when
D 4 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%tubing load.
Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68%when
5 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%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%or greater.
Single voltage external power supplies that are designed to convert 120 volt AC input into lower voltage DC or AC output,and have a
8 nameplate output power less than or equal to 250 watts,shall comply with the applicable requirements of the Appliance Efficiency
Regulations(Title 20).
9 Compact fluorescent lamps that do not contain a medium screw base sockets(E24/E26).
E This page doubles as a field inspection checklist.
Field Inspector Notes:
CA Building Energy Efficiency Standards-2016 Nonresidential Compliance August 2016
STATE OF CALIFORNIA
-SIGN LIGHTING
CEC-NRCC-LTS-01-E Revised 06116 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 5 of 5)
P'"j�Na1e Mattress Firm
Dar`Prepfed: 01/30/2017
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Company: Signature Date:
Ainor Si ns Inc
Address: 5443 Stationers Way CEA Certification Identification(If applicable):
CDp/State/Zlp. Sacramento CA 95842 phone. 916-348-4370
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 the building owner at occupancy.
Responsble Designer Name: Responsible Designer Signature:
Company: Date signed:
Ainor Signs Inc
Address: 5443 Stationers Way tkeme. 913842
city/stateMp:Sacramento CA 95842 phone` 916-348-4370
CA Building Energy Efficiency Standards-2016 Nonresidential Compliance August 2016