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1 1 <br />Aug 09 11 02:27p Empire Sign & Crane 775467-2105 p.1 <br />10(80-7 31 <br />Certificate of Compliance (Sign Lighting)(Page 1 of 4)SLTG-IC <br />Project Name:V An M,n \.No¥\A Daic:61·44 *14 -: <br />Project Address:Reco g An 4/41 V <br />Location of Sign 'Outdoor Signs 7,1 Indoor Signs <br />Phase of Sign Construction rn Ncw Signs .f O Sign Alterutions <br />Tipc of Lighting Control Jen· Lighting Conlrols O Replaocd Lighting Controls O Not Installing Lighting Controls <br />This Certificute of Compliance includes Lhe following components (check all that apply) <br />O Mandator· Measures (Lighting Controls) ¤Maximum Allowed Lighting Power O Specific Lighting Sources <br />1. Certificate of Compliance Declaration Statement (this may bea C]0, C45 oroll,cr eligible person) <br />• 1 certify undcr penalty of perjwy, under the laws ofthc Stale of California, the informotion provided on this form is true and <br />correct <br />• I am eligible underDivision 3 of the California Business and Professions Code to accept responsibility for the lighting design. <br />• This Certifidalc of Compliance identifies the lighting features and performance specifications required for compliance with <br />Title 24, Pmls 1 and 6 of the Califomia Codc of Regulations. <br />• The design features represented on this Certificate of Compliance are consistent with Lhe inforrnatidn provided to document <br />this design on thc other applicable compliance Forms, worksheets, calculations, plans and specifications submitted to the <br />cnforcemen. agency for approval with Ihis buil £2 pc#it a££1tation. <br />LL,LName: . <br />£-154 AC?if<.Company:Empin:. St.re · (ban e Perot e.es-Address: <br />118\6 Couc (bi CLO fairr.CA,-t <br />City/State'Zipl <br />Ulnuon LAKE-,CA 9268-1 <br />U <br />roone <br />81 8-9307061 <br />License number (may be cantractor's lie #) <br />832>IOG <br />Datc <br />2. Installation Certificate (to be signed by responsible person after installation) <br />Per·mit number Otecke,1 br'Date ' - <br />(Enfocument Aeer.cy Use ) 2 · (Enforcement Agency Use ) <br />Installation Declaration statement <br />• I certify under penalty of pe,jury, wider the laws of the State of California, the informaiion 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 authorized <br />representative ofthc person responsible for construction. <br />• I certify that the installed features, materials, components, 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 thot the requirements detailed on this Curli ficate of Compliance have bcen mel <br />• 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building <br />permiks) issued for the building, and made availablc to Lhe enforcement agency for all applicable inspeclions. I undersland <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: <br />Responsible Person's Name:Responsible Person'g Signature <br />License number (may be conlniclor's lic #)Date Sighed:Position With Company: <br />3008 Nonresidentio! Compliance Forms July 20!0