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Home My WebLink AboutX2012-1450 - Misc)(1012- i1-1r) Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTGIC� Project Name: Date: Project Address: Location of Sign �O'Outdoor Signs ❑ Indoor Signs Phase of Sign Construction -EMew 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. Certificate of Compliance Declaration Statement (this may be a CIO, C45 or other eligible person) I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. r I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24, Parts 1 and 6 of the California Code of Regulations. The design features represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name I Signature Company: Address: License number (may be contractor's lic #) City/State/lip: Date 2. Installation Certificate (to be signed by responsible person after installation Permit number Checked by/natc (Enforcement Agency Use (EnfnrccMcrdA envy Use Installation Declaration statement I certify wider penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction. I certify that the installed features, materials, components, or manufactured devices identified on this certificate conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. I certify that the requirements detailed on this Certificate of Compliance have been met. ❑ I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Namc: Responsi le son's Natnc: r �l Responsi son' ignature: h rye.lsY--- License number (may be connx tor's lic 11) Dat Signe Paiii ion With Co any: 'Z.c, ram. 2008 Nonresidential Compliance Forms October2010 Certificate of Compliance (Sign Lighting) (Page 2 of 4) SLTG-IC Project Name: .� Date: 3. Mandatory Sign Lighting Controls NOTES: 1. The same responsible person may install bath the sign lighting power and the sign lighting controls, or a dfrrent 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 reguired,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 Statementfor the entire construction. 3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of 4 on this SLTG-IC shall complete Part 3a. Check Yes or No for all of the following statements: I I have responsibility for installing the sign lighting contr is ❑ Yes, complete arts 3a and 3b of this form No, complete part 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑ Yes ❑ No 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls Yes ❑ No There are existing sign lighting controls that do not comply with the applicable provision of §119 and § 133 and I will be 4 installing compliant sign lighting controls ❑ Yes ❑ No There are existing sign lighting controls that do not comply with the applicable provision of §119 and §133 and someone else 5 will be responsible to install compliant sign lighting controls ❑ Yes ❑ No 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-IC is responsible for complying with the sin 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; I §133(a)1. All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA applicable requirements of §119. gr ❑ ❑ §133(a)I and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA 2 control or an outdoor astronomical time switch, that comply with the applicable requirements of § 119. jzI ❑ ❑ Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ ❑ §133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA sign ower by a minimum of 65 percent during nighttime hours. ❑ ❑ ❑ Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours. Y NA 3 ❑ Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. ❑ ❑ Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for Y NA illuminatina signs or parts of signs. C7 ❑ §133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than 15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when Y N 4 receivinga demand response Strad al that is sent out by. the local utility. ❑ ❑ X Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including Y NA but not limited to exit signs and traffic signs. ❑ Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 Certificate of Compliance (Sign Lighting) (Page 3 of 4) SLTG-IC Project Name: Date: 4. Maximum Allowed Lighting Power Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 5 of this Certificate of Compliance if there are signs using the S ecific li htin sources method of compliance A B C D E F G 13 I J q Allowed Watts Design Complies? Watts Y/N ° o wY C7 vi V p " °� N A U h Field Inspector CIO w w Check that c 2 v Sign 0 F Complies Description ✓ ❑ Q ❑ ❑ ❑ ❑ ❑ A Symbol or code used on the plans when plans are required) and other documents. B A narrative description of the sin or location of sign on the building; and the location of si n 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 148 of the California 2008 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized C, by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISOQEC 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 com fiance. An ENERGY VERIFIED label is not needed for compliance. D The sin area ins uare feet. E List "I" if the sign is internal!illuminated. List "E" if the sign is externally illuminated. F Allowed watts Eer square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2.3 if si2 is listed as "F" in column E. G Multiply the square footage in column D times the allowed Lighting Power Density PD =watts) in column F. H Show the total installed watts in the sin as determined according to the a licable provisions of § 130 d ore . 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 com 1 . J This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 Certificate of Com fiance (Sign Lighting) (Page 4 of 4) SLTG-IC Project Name: Date: t 5. Specific Lighting Source Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this Certificate of Com fiance if there are signs using the maximum allowed lighting ower method of com liance) A B C D E OPTIONAL Specific light source used for Field ENERGY Symbol VERIFIED compliance Inspector or Description label Shall include only lighting Check that Code (see instructions technologies listed below Sign below) List all that apply Complies ❑ ❑ 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 buildin • and the location of sign on construction documents C OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed ENERGY VERIFIED label., confirming that this sign complies with the Section 148 of the California 2008 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label, column `D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance. An ENERGY VERIFIED label is not needed for com liance. Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies: Listall a licable numbers I thrnu h 10 that apply in column D above for each row. I Hi presssodium lam s 2 Pulse start or ceramic metal halide lamps served by a ballast with > 88% efficiency 3 Pulse start metal halide lamps that are < 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast with > 80% efficiency 4 Neon or cold cathode lam s with transformer or power supply efficient ? 75% with rated output current < 50 mA D 5 Neon or cold cathode lamps with transformer or power supplysupp!y efficiency> 68% with rated output current > 50 mA 6 Fluorescent lamps with a minimum color rendering index (CRI) of 80 Note: when using electronic ballasts for com liance, lamps with a CRI < 80 may be used 7 Light emitting diodes (LEDs) with a power su ly with? 80% efficiency Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC 8 output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as complying with the a plicable requirements of the Appliance Efficiency Regulations Title 20) 9 Compact fluorescent lams that do not contain a medium screw base sockets E24/E26 10 Electronic ballasts with a fundamental output frequency >_ 20 kHz E This pMe doubles as afield inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010