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ITT OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 I Newport Beach, Ca 92658-8915
www.newportbeachca.gov I (949) 644-3200
SOLAR CONTRACTOR DECLARATION
Keep with Inspection card.
This form is for the Inspector to take at time of final laapection
PART Z: To be completed PRIOR TO INSPECTION:REQUEST
and placed with jobsite inspection card
DECLARATION:
I, P c.- 6GQV2 declare that the CSV module make and model
(PKINTNAME) _
number, quantity, and location are installed as per the approved plans. Ulod_ile
manufacturer, make, model and number, "fire classit)cations of modules, and
brackets match the approved plans for the project located at the abode
referenced address within the City of Neluvport Beach.
3I tato
(SIGNATU E (DATE)