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Home My WebLink AboutX2012-1462 - Misc100 3 NevQ M,-f C nhlf br Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTG-IC Projec Name: �, E 4✓ i i �r4ri A /' Date: / /mow,//- j- of � ( 11A, P' Project Address: Location of Sign ❑ Outdoor Signs El 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. Certificate of Compliance Declaration Statement (this maybe a C10, 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. ❑ 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. ni /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''Fri-ijP.i, ,'�e r?9� Signature Company: t/. Phone r Address: number (maybe contractor's tic #) A ALicense r T City/State/Zip: p� q� �=`..'.:'r Date iP " & V1MX 1t ,�(( 1 9p p� ,,4 t>`y !r. y'.". i ') �f1-4!z. 2. Installation Certificate (to be signed by responsible person after installation) Permit number Checked liy/Date _ (Eryfetce.en AgencyUsc) (Enforcement Agency Use Installation Declaration statement ❑ I certify under 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. ❑ 1 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 Name: Responsible Person's Name: Responsible Person's Signature: License number (may be contractor's tic #) Date Signed: Position With Company: 2008 Nonresidential Compliance Forms October 2010 Certificate of Compliance (Sign Lighting) (Page 2 of 4) SLTG-1C Project Name: Date: 3. Mandatory Sin 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 or the entire construction. 3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of 4 on this SLTG-1C shall complete Part 3a. Check Yes or No for all of the following statements: 1 I have responsibility for installing the sign lighting controls Yes, complete parts 3a and 3b of this form ❑ No, complete part 3a of this form 2 here are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑ Yes o 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 kV No There are existing sign lighting controls that do not Coiliply with the applicable provision of § 119 and § 133 and someone else 5 will be responsible to install compliant sign lighting controls ❑ Yes ZNo 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 0£ 4 of this SLTG-IC is responsible for complying with the sign lighting control requirements, that erson shall answer all of the followingquestions: If there are construction documents, indicate where on the building plans the mandatory measures (sign lighting control) note block can be located: 1 §133(a)l. All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA applicable req uirements of § 119. "0 ❑ ❑ §133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus aphoto control, or an outdoor astronomical time switch, that comply with the applicable requirements of § 119. 2 Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during daylight hours. §133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce 4YNA sin power b a minimum of 65 percent duringnighttime hours. Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours. 3 Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during daylight hours. ❑ Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for Y fqA illuminating signs or parts of signs. ❑ lei - §133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than Y N / N/A 15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ ' 4 receiving a demand response signal 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 Com liance (Sign Lighting) (Page 4 of 4 SLTG-IC Project Name: Date: 5. Specific Lithtine 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 Compliance if there are signs using the maximum allowed lighting ower method of compliance) A B C D Er OPTIONAL Specific light source used for Field'. ENERGY Symbol VERIFIED compliance Inspector Inspector Check at or Description label Shall include only lighting Sign; Code (see instructions technologies listed below Complies below) List all that apply ❑ q 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 sin on the building; and the location of sin 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 compliance. Specific Light Source Compliance Method. The signs) identified above use only the following lighting technologies: List all applicable numbers 1 through 10) that apply in column D above for each row. / I High pressure sodium lamps 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 wall lamps, and are served by a ballast with > 80% efficiency 4 Neon or cold cathode lamps with transformer or power sup2ty efficiency ? 75% with rated output cunent < 50 in 5 Neon or cold cathode lamps with transformer or l2ower supply efficiency > 68% with rated output current? 50 mA B 6 Fluorescent lamps with a minimum color rendering index (CRI) of 80 Note: when using electronic ballasts for compliance, lams with a CRI < 80 may be used 7 Light emitting diodes (LEDs) with a power supply with? 80% efficiency Single voltage LED external power supplies designedto 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 coin lying 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 1 D Electronic ballasts with a fundamental output frequency? 20 kHz E This a e doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010