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Certificate of Compliance (Sign Lighting)(Page 4 of 4)SLTG-IC <br />Project Name:Date: , 1morshaU s 7/1/13 <br />5. Specific Lighting Source Method of Compliance <br />Certificate of Compliance and Field Inspection Energy Checklist <br />Complete this part if there are signs using the Specific lighting source method of compliance, (Complete part 4 of this <br />Certificate of Compliance if there are signs using the maximum allowed lighting power method of compliance) <br />A B C D E <br />OPTIONAL Field·. <br />ENERGY Specific light source used for <br />Symbol VERIFIED compliance Inspector. * <br />Check that.or Description label Shall include only lighting <br />Code Dee instructions technologies listed below Signi· <br />below)List all that apply .,Complied. <br />4 <br />(Wall sibe--4, 50, A,2,*c, ,De .0:A Channe-\ l-,W.ert <br />0 . 0 -7 <br />0 0 3 <br />r. <br />0 ' 01 <br />J, <br />A Sym x,1 or code used on the plans (whon plans arc required) and other documents, <br />B A narrative description ofthc sign, or tocation of sign on tho building; and tho location o bign on construction documents <br />C OPTIONAL- Check this box only ifthis sign has a permancnt, prc·printed, factory-installed ENERGY VERLFIED label, confirming that <br />this sign complies with the Section !48 of tho Call fomia 2008 Titlc 24, Part 6 Standards, using-tho Specific Lighting Source Method ofCompliance. Thc only labcis thai will bc rccognizcd for this purpose arc ENERGY VERIFIED Certification Marks authorized by <br />Underwriters Laboratories (UL) or other Product Certification Body accredited to ISOREC Guidc 65 by the American National Standards <br />Institutc in accordancc with 1SO/1 EC 1701 1, Surveillance by the Accredited Cortification Body shull bc an ongoing annual inspection <br />program carried out by a Type A Inspection body in accordanoc with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label, <br />column 'D' 19 not required to be filled out. Notc: Using an ENEROY VERIFIED label is on optional method to validate compliance. An <br />ENERGY VERIFIED label is not needed for compliance, <br />Spocific Light Source Compliance Method. The sign(s) identificd above use only tho following lighting technologies: <br />Listallapplicable numbers (1 through 10) tholapply incolumn D above for each row. <br />1 High pressure sodium lamps <br />2 Pulse start or ceramic metal halide la[nps served by a ballast with 288% efficiency <br />3 Pulse start metal hallde lamps that are 1 320 watts, are not 250 watt or 175 waM lamps, and are served by a ballastwith.2 80% efficiency <br />4 Neon or cold cathode lamps with transfonner or power supply efficiency 2 75% with rated output current < 50 mA <br />5 Neon or cold cathode lamps with trans former or power supply efficiency 2 68% with rated output current 2 50 mA <br />d Fluorescent lamps with a minimum color rendering index (CRI) of 80 <br />(Note: when using electronic ballasts for compliance, lamps with a CRI < 80.may be used) <br />7 Light emitting diodes (LEDs) with a powet supply with 2 80% efficiency <br />Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC <br />8 output, having a nameptate output powerless than or equal to 250 watts, and ©crtifi©d to the Energy Commission as <br />complying with the applicable requitements of the Appliance Efficiency Regulations (Title 20) <br />9 Compact fluorescent lamps that do riot contain a medium screw base sockets (E24/£26) <br />10 Electronic ballasts with a fundamental output frequency Z 20 kI-tz <br />£ This page doubles as a flcld inspcction checklist. <br />Field [nspcctor Notes: <br />2008 Nonresidential Compliance Forms Ociober 2010 <br />4. <br />1