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1 4 --7 A <br />1 :I <br />Certificate of Compliance (Sign Lighting)(Page 4 of 4)SLTG-IC <br />Project Name: .Date: <br />5. Specific Lightine Source Method of Compliance <br />Certificate of Compliance and Field Inspection Energy ChecklistComplete this part ifthere are signs using the Specific lighting source method of compliance. (Complete part 4 ofthisCertificate of Compliance ifthere are signs using the maximum allowed lighting power method of compliance) <br />A B C D E <br />OPTIONAL FieldUL - Specific light source used for Inspector <br />Symbol or other compliance <br />or Description label Shall include only lighting <br />Check that <br />Code <br />(see Signtechnologies listed belowinstructions Complies <br />dow)List all that apply ,be <br />4 <br />El <br />f 0 <br />0 <br />0 <br />0 0 <br />J 0 <br />07\ ft. r) FirK-jfv,1£7 fliA 0.< <br />A Symbol or code used on the plans (when plans are required) ang other documents.B A narrative description of the sign, or location ofsign on the building; and the location of sign on construction documentsC OPTIONAL - Check this box only ifthis sign has a permanent, pre-printed, factory-installed label, listed with Underwriters Laboratory(UL) or other testing laboratory accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) or InternationalStandards Organization (ISO) 17025 in accordance with ISO/IEC 1701 I with the products produced under an ongoing inspection programcarried out by a Type A inspection body in accordance with ISO/IEC 17020, confirming that this sign complies with the Section 148 of theCalifornia 2008 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. For signs with such a label, column'D' is not required to be filled out. Note: Using a label is an optional method to validate compliance. A label is not needed for compliance. <br />Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies:List all applicable numbers (1 through 10) that apply in column D above foieach row. <br />1 ..High pressure.sodium lamps.„.... ..........._...._._ ...._....... _-.... . .... <br />2 -Pulse start.or.ceramicmetal halide lamps served by a ballast with 288% efficiency3 . Pulse start metal halide lamps that are 5 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast <br />with 2 80% efficiency4 Neon or cold cathode lamps with transformer or power supply efficiency 2 75% with rated output current < 50 mA5 Neon or cold cathode lamps with transformer or power supply efficiency 2 68% with rated output current 2 50 mAD 6 Fluorescent lamps with a minimum color rendering index (CRI) of 80(Note: when using electronic ballasts for compliance, lamps with a CRI < 80 may be used) <br />7 Light emitting diodes (LEDs) with a power supply with k 80% efficiency<-7 Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC( 8 j output, having a nameplate output power less than 6r equal to 250 watts, and certified to the Energy Commission as -- complying with the applicable requirements ofthe Appliance Efficiency Regulations (Title 20) <br />9 Compact fluorescent lamps that do not contain a medium screw base sockets *24826) <br />10 Electronic ballasts with a fundamental output frequency 2 20 kHz <br />E This page doubles as a field inspection checklist. <br />' Field Inspector Notes: <br />2008 Nonresidential Compliance Forms July 2010