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CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
SOLAR CONTRACTOR DECLARATION
Keep with Inspection card
This form is for the Inspector to take at time of final inspection
PART 1: To be completed BEFORE PERMIT ISSUANCE
JOBSITE ADDRESS:'
CONTRACTOR NAME:
SgIIPP S014r peS��n
CONTRACTOR STATE LICENSE
C_q6, 992 G33
PANEL MAKE #:
Quo (grr'q
PANEL MODEL #:
�0 werxT, q0 0
PART 2: To be completed PRIOR TO INSPECTION RE UEST
and placed with lobsite inspection card
DECLARATION:
I, XQV(P(' CDn'+(Prg declare that the PV module make and model
WF 4I NAB)
number, quantity, and location are installed as per the approved plans. Module
manufacturer, make, model and number, fire classifications of modules, and
brackets match the approved plans for the project located at the above
referenced address within the City of Newport Beach.
(SIGNMU ) 0 1 22
(DATE)
Forms\Soia ontractorneclmtton 3-7-16