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Certificate of Compliance (Sign Lighting) <br />Project Name: <br />Project Addre,sWAH n OUL-\An UOcd ajde A <br />(Page 1 of4) , SLTG-1CDate: 3/ 1 O |114 <br />Location 6f Sign ,-8-0*jr Signs O Indoor Signs <br />Phase ofSign Construction .-0-New Signs ¤Sign Alterations <br />Type of Lighting Control ¤New Lighting Controls ¤Replaced Lighting Controls O Not Installing Lighting Controls <br />This Certificate of Compliance includes the following components (check all thatapply) <br />¤ Mandatory Measures (Lighting Controls)O Maximum Allowed Lighting Power ¤Specific Lighting Sources <br />.1.11 <br />1. Certificate of Compliance Declaration Statement (this may be a (10, C45 or other eligible person) <br />• I certify under penalty ofperjury, under the laws ofthe State of California, the information provided on this form is true and <br />correct. <br />• I am eligible under Division 3 ofthe California Business and Professions Code to accept responsibility for the lighting design. <br />• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with <br />Title 24, Parts 1 and 6 ofthe California Code ofRegulations. <br />• The design features represented on this Certificate of Compliance are consistent with the information provided to document <br />this design on lile other applicable compliance forms, worksheets <br />enforcement agency for approval with this building permit applic <br />Signature ZName: i\ <br />Company <br />Addressl <br />City/State/Zip:661 Elf. 1 Ck 11-Sei Date w' · <br />1 <br />2. Installation Certificate (to be signed by responsible person after installation) <br />Permit number :Di:,itr- 6,1.:, thectiddliyeate; 2 0 · .,··. :. <br />·i 't · .,.._ ..43 '; .- ghrcemEntAgency Use )(Enforcement Agency Use ) <br />Installation Declaration statement <br />• I certify under penalty of perjury, under the laws ofthe State of California, the information provided on this form is true and <br />correct. <br />• I am eligible.under Division 3 ofthe Business and Professions Code to accept responsibility for construction, or an authorized <br />representative ofthe person.responsible for construction. <br />| • I certif> 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 certilj, that the requirements detailed on this Certificate of Compliance have been met. <br />I • I will ensure that a completed, 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 ofthis Installation Certificate is required to be included with the documentation the builder provides to the <br />building owner at occupancy. <br />Company Name: ,f\54 Fl 1; 11 , <br /> Responsible Pe** ) bUd(fd <br />:5(T-13ontTrA Diatt*b q Vith Conillanv: <br />kwou\4.*00 Y <br />Respo 1 <br />Post on N <br />2008 Nonresidential Compliance Forms July 2010 <br />h <br />0 <br />, yalculations, plans and specifications submitted to the <br />IOn. <br />0 01, Al) . <br />Phone 7/9 2,3-7 1(20 <br />License *mber (may be contractor)J559.0 5,0 -0/47