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A.-1 1 I <br />t <br />Certificate of Compliance (Sign Lighting)(Page 1 of 4)SLTG-le <br />Project Name:9,4 0%Date: |I. 25·13 <br />Project Address.36% \ 9. SY- iffil SE Sarhn Ancx 'CA (A 273 4 <br />Location ofSign (putdoor Signs O Indoor Signs <br />Phase of Sign Construction ew Signs ¤Sign Alterations <br />Type o'fLighting Control ew Lighting Controls O Replaced Lighting Controls O Not Installing Lighting Controls_ <br />This Certificate of Compliance includes the following components (check all that apply)O MandatoryMeasures (Lighting Controls) O Maximum Allowed Lighting Power *pecific Lighting Sources <br />1. Certificate of Compliance Declaration Statement (this may be a Clo, 045 or other eligible person) <br />• I certilj, under penalty of perjury, under the laws ofthe State of California, the information provided on; this form is true and <br />' correct. <br />e I am eligible under Division 3 of the California Business and Professions Code to accept responsjbility for the lighting design. <br />• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with <br />T,itle 24, Parts 1 and 6 of the California Code of Regulations. <br />• - The design features represented on this Certificate of Compliance are consistent with, the information provided to document <br />this; design on the other applicable compliance forms, worksheets, calcuiations, plans and specifications submitted to the <br />enforcement agency for approval with this building permit application. <br />Name:-Tka Howard Signature <br />Company:914 263· 470 2- <br />Phone <br />Address:.(900 W. Freedorn Ave.971740 00 -45)License number (may b; contractor' s lic #) <br />City/State/zip:Date 11·15·13OrM\+ CA. 97%65 <br />2. Installation Certificate (to be signed by responsible person after installation) <br />Permit number 5..:1,3....I:,f ....; 1 Checf¢d.1;y/Date, ·'·: .. ,· :,· ·....·, <br />(Enforcement AgEn@ Use ) t, ·'·,·'·.tf:...1-:.1...1 - - :I(Eddiceniebt ABEAbli;Us ) .. <br />Installation Declaration statement <br />• I certily under penalty of perjury, under the laws of the State of California, the information provided on this form is true and <br />correct. <br />• I am eligible.under Division 3 of the.Business and Professions Code to accept responsibility for construction, or an autborized <br />representative ofthe person.responsible for construction. <br />e I certify that the installed features, materials, compohents, or manufactured devices identified on this certificate conforms to all <br />applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the <br />enforcement agency. <br />• I certify that the requirements detailed on this Certificate of Compliance have been met. <br />e I will ensurethat acompleted, signed copy ofthis Installation Certificate shall be posted, or made available with the building <br />permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand <br />that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the <br />building owner at occupancy. <br />' Company Name:irsiedickResponsible Person's NameT.Ed Hovord <br />License number (may be cpntractor's lic #)90 2790 (c-45) <br />Responsible Person's Signature: <br />Date Signed:Position With Company: <br />lt·2543 i (-oorAN,Akr <br />2008 Nonresidential Compliance Forms July 2010 <br />A