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PMT17-01478 City of Menifee Permit No.: PMT17-01478 29714 HAUN RD. �ACCELA— MENIFEE, CA 92586 Type: Sign-Permanent MENIFEE Date Issued: 06/14/2017 PERMIT Site Address: 29121 NEWPORT RD, MENIFEE, CA Parcel Number: 364-190-020 92584 Construction Cost: $22,000.00 Existing Use: Proposed Use: Description of INSTALLATION OF 6 ILLUMINATED WALL SIGNS, 1 DRIVE-THRU CLEARANCE,2 ILLUMINATED Work: DIRECTIONAL SIGNS, 3 ILLUMINATED MENU SIGNS FOR DRIVE-THRU&2 TENANT PANELS ON EXISTING PYLON SIGN Owner Contractor USS SLATON, LLC YESCO SIGNS LLC 1949 ARROYO DR 2401 FOOTHILL DRIVE RIVERSIDE, CA 92506 SALT LAKE CITY, UT 84109 Applicant phone: 8014644600 SCOTT HAMPTON License Number: 980698 YESCO SIGNS LLC 2401 FOOTHILL DRIVE SALT LAKE CITY, CA 84109 Fee Description Ott, Amount($1 Sign Permit 14 454.00 Building Permit Issuance 1 27.00 Additional Plan Review Electrical 165 165.00 GREEN FEE 1 1.00 SMIP COMMERCIAL 1 7.00 General Plan Maintenance Fee-Building 1 22.70 $676.70 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 perjurythat I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State License Law for Professions Code and my license is in full force and effecct.y p / the following reason: License Class G` C-11"S License No. / O Q 6 ! cr By my signature below I acknowledge that,except for my personal residence Expires ��J —! `l Signature in which I must have resided for at least one year prior to 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 ❑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 workers 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 Code,for the performance of work for which www.IeRinfo.ca.gov/calaw.htmI.permit is issued. Policy# Date trYKave and will maintain workers 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 workers compensation Insurance carrier and policy owner or authorized to act on the property owners behalf.1 have read this number are: application and the information I have provided is correct.I agree to comply Carrier L r A�c'�7y �^-L—e' t.rL with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# Z6gf Y$jy7k46Expires 7—(—/ 7 enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED,A�GEN1T_ ❑I certify that in the performance of the work for which this permit is issued, O a 1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 0:? 1 workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provision)s#Section 3700 of the Labor Code,1 shall forthwit omply with t ose prov' ns. Will the applicant or future building occupant handle hazardous material or a Applicant Date /t( / mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes erlfo 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($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC construction or See permtion ingfrom checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines Qua CONSTRUCTION LENDING AGENCY ❑Yes ergo I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) o Yes ergo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item hazardous mat vial reporting.$)(Section 7031.5 oyes cIqTR—Q 6 Business and Professions Code).Any city or county that requires a permit to Date /r t- construct,alter,improve,demolish or repair any structure,prior to Its PRO ER OWNER OR AUTH IZED AGENT 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI License Law(Chapter 9(commencing with Section 7000)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 Iicensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a 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 ❑1,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.epa.epv/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code,The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project propertywho,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. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑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. �pV�Ep G G b �810 Bureau Veritas City of Menifee 1665 Scenic Avenue, Suite 200 29714 Haun Rd. Costa Mesa, CA 92626 Menifee, CA.92586 BV Project: 40017-420179.00 Jurisdiction No.: PMT17-01478 Reviewer: Ed Chock Description: 6 Illuminated Wall Signs, 1 Drive Direct:714-431-4191 Thru Clearance Bar, 2 Illuminated Directional Signs, 3 Illuminated General: 714-431-4123 Menu Signs for Drive Thru edwin.chock@bureauveritas.com Project Address: 29121 Newport Road Owner(s): USS Slaton LLC Occupancy Group(s): U Construction Type: V-B PC 1 APPROVED May 24, 2017 This plan has been reviewed and approved for conformance to the minimum requirements of the 2016 California Building Standards Code, as amended and adopted by the City of Menifee,California. 1665 Scenic Avenue ♦ Suite 200 *Costa Mesa, CA 92626 Phone: (714)431-4100 ♦ Fax: (714)825-0685 ♦ www.us.bureauveritas.com An Equal Opportunity Employer Page 1 of 1 �Pu vF9 r j � D m m r8y8 CITY OF MENIFEE TRANSMITTAL Building Division Date: 5/24/17 Project Location: 29121 Newport Rd Plan Check No.: PMT17-01478 BV Project#: 40017-039131.00 Project Description: olr ►' 14AClf-� Reviewer Date Hour Hourly Rate Total 1't Plan Check E Chock 5/24/17 1.5 $110.00 $165.00 2nd Plan Check 3rd Plan Check 4th Plan Check Final Approval: E Chock 5/24/17 1.5 $110.00 $165.00 Bureau Verilas North America,Inc. 1665 Scenie Avenue,Suite 200 osla Mesa,CA 02626 1.1 714.431.4100 F: 714.825.0685 - BUILDING & SAFETY PERMIT/PLAN CHECK • / ;Menifee DATE 03/28/2017 PERMIT/PLAN CHECK NUMBER ( 1 / —614 TYPE: ❑COMMERCIAL [—]RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑✓ SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK 6 illuminated wall signs; 1 drive thru clearance bar,2 illuminated directional signs 3 Illuminated menu signs for drive thru 4 2. +tn•.4 Qa nJi e n eyo t PROJECTADDRESS wewportRd. ASSESSOR'S PARCEL NUMBER 3LPL4 - 110 -0X0 LOT TRACT PROPERTY OWNER'S NAME USS Slaton, LLC ADDRESS 1949 Arroyo Drive,Riverside CA 92506 PHONE (951)760-0760 EMAIL Ijcent@aol.00m APPLICANT NAME Scott Hampton ADDRESS 10235 Bellegrave Ave.,Jurupa Valley CA 91752 PHONE (909)915-0527 EMAIL shampton@yesco.com CONTRACTOR'S NAME Paul Young OWNER BUILDER? ❑YES❑✓NO BUSINESS NAME YESCO Signs LLC ADDRESS 10235 Bellegrave Ave.,Jurupa Valley CA 91752 PHONE (909)923-7668 EMAIL CONTRACTOR'S STATE LIC NUMBER 980698 LICENSE CLASSIFICATION C-45 VALUATION$ $22,000.00 SQ FT L SO FT APPLICANT'S SIGNATURE DATE 2 7 /7 DEPARTMENT DISTRIBUTION !iQ CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 03tv9 tc 0 INVOICE ' t] PAIDAMOUNT AMOUNT 51 I• 7 O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Hour;Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 YESCo. Custom Electric Signs Landlord Approval — Signage Installation/Renovation City of Menifee Building & Safety Dept. Project Name: Starbucks#25942 Newport& Menifee Menifee, CA MAY 10 20V Customer Name:Starbucks Coffee Company eceived Job Site Address:29216 Newport Rd. Menifee, CA Date:7/19/2016 SB Project#: 65642-001 Design#: 607252 R4 By signing this letter you are giving approval for YESCO Signs LLC to INSTALL, RENOVATE, REPAIR and/or REPLACE signage, based on the DESIGN#above, at your location for the tenant who appears in the section titled CUSTOMER NAME. This letter is forthe purpose of submitting the associated design to the City for obtaining all ' applicable permits which are required to perform said work. Signature: Date: 3/2317 Printed Name: Lawrence J. Canale Title: USS Slaton, LLC, memeber Landlord Information: NAME: ' USS Slaton, LLC ADDRESS 1: 1949 Arroyo Drive ADDRESS 2: Riverside, CA 92506 PHONE: 951-760-0760 (Larry Cel) EMAIL: Ijcent@aol.com STATE OF CALIFORNIA SIGN LIGHTING City of Menitee ' CEC-NRCC-LTS-01-E evisetl 05/15 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of5) PraleR Name: G 1 Ae&�C r oa .y, pate Prepared: ,l 1, J IL.riid. [..1 - .w 3-A. General Information Rioceived Project Address: 2`1.2L to iJovuPOfir RLb , MIff0i ct! Location of Sign KMutdoor Signs ❑Indoor Signs Phase of Sign Construction i5'fJew Signs ❑Sign Alterations Type of Lighting Control DYfSew 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 U-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 ore 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 la.Check Yes or No for all of the following statements: 1 1 have responsibility for installing the sign lighting controls ❑Yes,complete parts la and lb of this form Lrho,complete part la of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑Yes [1!o 3 Th7ee a are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls HYes ❑ No There are existing sign lighting controls that do not comply with the applicable provision of§110.9 and§130.3 and I will be 4 installing compliant sign lighting controls ❑Yes I"No There are existing sign lighting controls that do not comply with the applicable provision of§110.9 and§130.3 and someone 5 else will be responsible to install compliant sign lighting controls ❑Yes C�Na These plans and doeumenle no'm been reviewetl Far corepliante with the appbcable code teoe rcmenls p' 'Fe iunsdR..... The 111M 1 of tppdc plans stall rn pe hnld to pumw dr be Ilmraval of any vrolation p- ap 1Lnhle 11,1d and nindarda nor mhevr the owns,', devyn prolussnrwl of record or eodbazbr of compliance wdh nnVlicble cocas and slandxds.Plan review al documents tines not aU1110r1ie consltuthpn to voccea In vie.tion of day ledl'JI. Suit nW ipCdpp rep!o.n I'1k� G tl Z; 11 Nureau Venli North America, Ina. CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-1_TS-01-E Revised 05115 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) ProieR Name: /;�µr_V[ / n F oah Prepared: 7 J l-V 3- Zs-0 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. ❑ ❑ §130.3(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. ❑ ❑ EXCEPTION to Section 130.3(a)2A:Outdoorsigns 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. ❑ R/ §130.3(a)26. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides the ability to automatically reduce sign lighting power by a minimum of 65 percent during nighttime hours. Y N NA 3 Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ ❑ day and night. EXCEPTION to Section 130.3(a)2B:Outdoor signs in tunnels and large covered areas that are intended to be Y NA illuminated both day and night. ❑ 1 9' §330.3(a)3. Demand Responsive Electronic Message Center Control.An Electronic Message Center"MC) y N N/A having a new connected lighting power load greater than 15 kW has a control installed that is capable Of ❑ ❑ B� 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. ❑ Field Inspector Notes: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 05115 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) P.J.d Name: Date Prepared: 2. Maxim Allowed Lighting Power Method of Compliance Certificate of Co fiance and Field Inspection Energy Checklist Complete is part if there are signs using the maximum allowed lighting power method of compliance.(Complete part 3 of this Certifica of Compliance if there are signs using the Specific lighting sources method of compliance) A B C D E F G H I 1 Filed Symbol OPTIONAL—Energy Design Complies Inspector or Description of the Si Verified Label(see Allotted Watts Code instructions below) Watts Y/N Check that sign complies O V� 06n$ d m VI w W T at C W Q c v E ro m 0 l u O Q ✓ V ✓ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ A Symbol or code used on the plans(when plans are required)and other documents. B I A description of the sign,or location of sign on the building,and the location of sign 0 construction documents. OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-install ,ENERGY VERIFIED label,confirming that the sign complies with the Section 140.8 of the California 2013 Title 24,Part 6 Standards,usin the Maximum Allowed Lighting Power method of compliance. The only labels that will be recognized for this purpose are ENERGY ERIFIED Certification Marks authorized by C Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Gui\@n e American National Standards Institute 1n accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body ongoing annual inspection program carried out by a Type A Inspection body in accordance with I50/IEC 17020.For signsan ENERGY VERIFIED label, columns'D'through Tare not required to be filled out.Note:Using an ENERGY VERIFIED labional method to validate compliance.An ENERGY VERIFIED label is not needed for compliance. D The sign area in square feet. E I 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" 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 4130(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 c ply. 1 This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SIGN LIGHTING �! CEC-NRCC-LTS-01-E Revised 05115 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting C_ L c (Page 4 of 5) Pm1ed Name: ♦ 2-e �C�S lro• 1. Natt PnR.d: l� 3. Specific Lighting Source Method of Compliance ZJ 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 ENERGYVERIFIED. 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 A-$-C WALL Su6,nfS Cl 6—f4 ❑ ❑ ❑ ❑ ❑ 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,usingthe 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 Cl 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 greaterthan 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 greaterthan 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 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 May 2015 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 05/15 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting T (Page 5 of 5) Prolect Name: S-r A n 2u GV-J Q rT E& Date PreWred: '7 — ry Tf'K/ DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: S c o-t-,- arx�ItoiL Company: Signature Date: F6co S t ns LLG Address: i0235 I,Tc/ �I_f_cbff-Aur—a JEF . CEA Certification Identification(if applicable): City/State/Zip: Phone: VAu.c GA C'tL-fSZ 90 r - 523-74 6 f� 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 an 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 oft Certificate of Compliance is required to be included with the documentation the builder provides to Ve buildin wner pt occupan Responsible Designer Name: Responsible Designer Signature: Company: Date Signed: -28 - / Address: License: Q G06 CAY/State/2ip: Phone: CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015