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2188 E LINCOLN AVE (6)City of Anaheim BUILDING DIVISION INSPECTION RECORD SIGN PERMIT ADDRESS: 2188 E LINCOLN AVE OWNER: NMC ANAHEIM LLC PERMIT #: SGN2021-00061 DATE ISSUED: 6/9/2021 DESCRIPTION: Installation of (1) illuminated wall sign for "Simple Boba & Tea". POST THIS .CARD WITH THE APPROVED PLANS IN A CONSPICUOUS PLACE ON THE JOB SITE Inspection Code Date Inspector SET BACK, FORMS, TRENCHES 602 UNDERGROUND CONDUIT 604 MASONRY: REINFORCEMENT, BOND BEAM, 606 PRE -GROUT FINAL 699 MISCELLANEOUS INSPECTIONS Inspectors can normally be reached between 7:30 - 8:00 A.M. and 3:30 - 4:30 P.M. (714) 765-5153 + 0 signeW INSPECTION REQUIREMENTS Contractor shall verify with the City Inspector prior to final inspection if a representative is required to be on the site to expose any concealed wiring for final inspection. INSPECTION REQUESTS Inspection requests made before 5:00 pm will be scheduled on the following workday. To schedule your building inspection online, please go to httr)://www.anaheim-nettinspectionRequest. You may also request your inspection by calling (714) 765-4626 and continue with the following steps: • Press 1 for inspection function. • Press 1 to schedule inspection. • Press 6 for Sign inspection. • Enter your permit # 202100061. • Enter the Code number for the inspection requested (indicated in blue.) • Press 1 for next business day, or enter date preferred. • Select time preference (Request is subject to inspector's schedule.) • At the end of your request you will receive a confirmation number. To access your inspection timeframe, please go to www.anaheim.net/buildina after 7:30 am on the day of your inspection. Under Online Services, click on the "Inspection Timeframes" link or call (714) 765-5153 + 0. SIGN PERMIT NO. SGN2021-00061 TYPE OF PERMIT � New Attached to Structure Sign C I 1 Y DATE: 6/9/2021 JOB ADDRESS: LEGAL DESCRIPTION: 2188 E LINCOLN AVE PERMIT APPLICANT: CHANH TIEN OWNER INFORMATION: NMC ANAHEIM LLC SANFORD D SIGAL TARZANA, CA 91356-3362 CONTRACTOR INFORMATION: 88 SIGN CORP 1906 DOREEN AVE SOUTH EL MONTE, 91733 0000 CA JOB DESCRIPTION: Installation of (1) illuminated wall sign for "Simple Bobs & Tea". BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 E I M INSP CTI65 O 626 QUEST LINE: QUARTER SECTION: 113 ARCHITECT/ENGINEER INFORMATION: VALUATION: 2,200.00 PROCESSED BY: AEG OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold with one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale). ❑ I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law). ❑ 1 am exempt under Sec. B & P.C. for this reason: Date: Owner: WORKER'S COMPENSATION DECLARATION LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I I hereby affirm under penalty of pedury that I am licensed ❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, or the performance of the work for which this permit is issued. My workers Compensation insurance carrier and policy are: Carrier. EXEMPT Policy Number. EXEMPT This section need not be completed If t he permit Is for one hundred dollars ($100) or less. ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person it any manner so as to become subject to the workers compensation laws of California, and agree that if I should become subject to the workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 6/9/2021 Applicant: WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATIoN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. I CONSTRUCTION LENDING AGENCY 1 I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec.3097.Civ.C): Lenders Information: 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representives of this city to enter upon the above mentioned property for inspection purposes. Date: 6/9/2021 Signature of Applicant or Agent The permit shall expire by limitation and become null and void if the building or work has not passed final inspectoin 365 days from the date of permit issunace. A new permit is required to commence or continue work. under provisions of chapter 9 (commencing with Section 7000) of Divsion 3 of the Business and Professions Code. Date: 6/9/2021 NUMBER: BUS1998-022477 TYPE: C10 TYPE: BUS Contractor: EXPIRATION DATE: 8/28/2023 Fees paid forPermit: Total: 583.75 STATE OF CALIFORNIA Sign Lighting NRCGLTS-E (Created 03/20211 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE _ NRCC-LTS-E This document is used to demonstrate compliance with requirements In 4110.9. -4110.2 4130.0. 6130.3• 6140.8• and 4141.0tb)2M for sign lighting scopes using the prescriptive path. Exit signs and traffic signs are not required to comply with prescriptive requirements per exceptions to 1140.8 and do not need to complete this compliance document. Project Name: SIMPLE BOBA & TEA lReport Page: Page 1 of 4 Project Address: 2188 E. LINCOLN AVE. jDate Prepared: 5-28-2021 A. GENERAL INFORMATION 01 Project Location (city) ANAHEIM 02 Climate Zone 8 03 ❑ Building is a healthcare facility B. PROJECT SCOPE Table Instructions: Include any illuminated signs that are within the scope of the permit application and are demonstrating compliance using the prescriptive path outlined in 140 or -4141.0(b)2M for alterations. Exit•signs and traffic signs are not required to comply with prescriptive requirements per exceptions to §14Q8 and do not need to complete this compliance document. WARNING: Changing the Compliance Method in this table will result In the deletion of data previously input. If you need to change the compliance method, please open a new form or use "Save As". 01 02 03 04 05 Name or Complete Sign Description Sign Status' Sign Type Compliance.Method2 Item Tag Compliant Light Sources ENERGY VERIFIED Label Compliance Results (See Table B) j FRONT SIGN WALL CHANNEL LETTER New Outdoor Max Allowed Lighting Power FRONT SIGN WALL CHANNEL LETTER 'FOOTNOTE. Sign alterations that increase the connected lighting load, replace and rewire more than 50% of the ballasts, or relocate the sign to a different location must comply with 140.8. See 4141.Otb)2M for more details. 'The ENERGY VERIFIED Label compliance method is only applicable if the sign has a permanent, factory -installed, ENERGY VERIFIED label certified by UL or comparable, confirming the sign complies with 140.8. Note that using an ENERGY VERIFIED label is an optional compliance path, not a mandatary requirement. See the tool tips for this table for more details. C. COMPLIANCE RESULTS Table Instructions: If any cell on this table says "DOES NOT COMPLY" or "COMPLIES with Exceptional Conditions" refer to Table D. for guidance. 01 02 03 Z 04 OR 05 OR 06 07 Name orotal Item Tag Complete Sign Description Allowed (Watts) Total Designed (Watts) Compliant Light Sources ENERGY VERIFIED Label Compliance Results (See Table B) j (See Table B) .(See Table F) (See Table F) (See Table G) (See Table -H) FRONT SIGN WALL CHANNEL LETTER 180 1 z 1 120 JORI JORICOMPLIES Controls Compliance (See Table F/G/H for Details) COMPLIES CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: htto://www.enerev.ca.itov/title24/2019standards March 2021 STATE OF CALIFORNIA Sign lighting NRCC-LTS-E (Created 03/2021) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-E Project Name: SIMPLE BOBA & TEA lReport Page: Page 2 of 4 D. EXCEPTIONAL CONDITIONS This table is auto filled with uneditable comments because of selections made or data entered in tables throughout the form. No exceptional conditions apply to this project. E. ADDITIONAL REMARKS This table includes remarks made by the permit applicant to the Authority Having Jurisdiction. F. MAXIMUM ALLOWED LIGHTING POWER AND CONTROLS 10 Table Instructions: Complete this table for illuminated signs using the Maximum Allowed Lighting Power compliance method per §140.8(a) as indicated on Table B of this compliance document. Also demonstrate compliance with mandatory controls requirements from 130.3 by indicating control types for each sign. 01' 02 03 04 05 06 07 08 09 Name or Complete Sign Illumination Sign Area Allowed Density Allowance Design Mandatory Controls Field Inspector Tag Item Ta Description P Method ( ft2) (W/ft2) (Watts) ( Watts Shut -Off Dimming Demand Response pass Fail FRONT WALL CHANNEL Internally 15 12 180 120 Auto Timer+ Photocontrol Pwr. reduced 65%+ NA SIGN LETTER *NOTE: Controls with a * require a note in the space below explaining how compliance is achieved. EX: Sign within tunnel illuminated day & night; EXCEPTION to -4130.3(a)2A. FOOTNOTES: Demand response controls are only required for an Electronic Message Center having a new connected lighting power load greater than 15 kW per §110.12(d). G. LIGHT SOURCES AND CONTROLS This Section Does Not Apply H. ENERGY VERIFIED LABELED SIGNS AND CONTROLS This Section Does Not Apply CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: htto://www.energy.ca.gov/title24/2019standards March 2021 STATE OF CALIFORNIA Sign lighting CALIFORNIA ENERGY COMMISSION ILS CERTIFICATE OF COMPLIANCE NRCC-LTS-E Project Name: SIMPLE BOBA & TEA lReport Page: Page 3 of 4 Project Address: 2188 E. LINCOLN AVE. Date Prepared: 5-28-2021 I. DECLARATION OF REQUIRED CERTIFICATES OF INSTALLATION Table Instructions: Selections have been made based on information provided in previous tables of this document. If any selection needs to be changed, please explain why in Table E. Additional Remarks. These documents must be provided to the building inspector during construction and can be found online at httns://www.energy.ca.gov/ tit1e24 2019stondards 2019 compliance documents Nonresidential Documents NRCI YES NO Form/Title Field Inspector Pass Fail C0 r NRCI-LTS-01-E - Must be submitted for all buildings. ❑ ❑ 1. DECLARATION OF REQUIRED CERTIFICATES OF ACCEPTANCE There are no Certificates of Acceptance applicable to sign lighting requirements. CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: httu://www.enerev.ca.eov/title24/2019standards March 2021 STATE OF CALIFORNIA Sign Lighting NRCC-LTS-E (Created 03/2021) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-E Project Name: SIMPLE BOBA & TEA Report Page: Page 4 of 4 (Project Address: 2188 E. LINCOLN AVE. IDate Prepared: 5-28-20211 CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: http://www.enerav.ca.nov/title24/2019standards March 2021 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Compliance documentation is accurate and complete on 06 Documentation Author Name: CHANH TIEN Documentation Author Signature: Company: 88 SIGN CORP Signature Date: 5-28-2021 Address: 1906 DOREEN AVE. CEA/ HERS Certification Identification (if applicable): City/State/Zip: S. EL MONTE CA 91733 Phone: 626-823-7916 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer) 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5: 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: DAN HAN LUONG Responsible Designer Signature: Company: 88 SIGN CORP. Date -Signed: -2021 Address: 1906 DOREEN AVE. License: #702474 City/State/Zip: S. ELMONTE, CA 91733 Phone: 626-442-8033 CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: http://www.enerav.ca.nov/title24/2019standards March 2021