HomeMy WebLinkAboutX2020-2437 - Misc (4)`WPo CITY OF NEWPORT BEACH
O y'
m' COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
N`P 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 926588915
www.newportbeachca.gov 1 (949) 644-3200
CONTRACTOR/PROPERTY OWNER SELF -CERTIFICATION DECLARATION
FOR PLUMBING FIXTURE REPLACEMENT
Project Address: / 7 0 % 20 ,-� [.,�
Date: % � / �� 202.'Z Permit #: X 20 ZO - 7,L4 3:7
The following is to be completed by the California licensed contractor or owner, participating in the City of Newport
Beach Self-Certification/Program. Please or print.
`
Installer's Name: �` �C? License No ('If applicable) Z i 7
Installer's Mailing Address: 26_S Lf 6 4AiC1 Lb Ln Phone # (required): 23 2- jjs 6�
Installer's
FAX
Installer
I certify that the installation is in compliance with applicable code requirements.
I further affirm that I have reviewed and understand the requirements of the applicable 2013 California Green Code and
Newport Beach Municipal Code (NBMC) Section 301.1.1 and that all self -certification reports submitted will be based
on the code requirements contained therein.
I declare that all plumbing fixtures subject to the NBMC 301.1.1 has been replaced meeting the low flow requirements:
Kitchen faucets: 1.5 gal/minute at 60 psi
Shower heads: 1.8 gal/minute at 80 psi
Water closet 128 gal/flush
Faucets: maximum flow rate of 1.5 gaVminute at 60 psi,
and minimum 02 gal/minute at 20 psi
5/ �sr2v Z�
nst.W s Signature t Date
Property Owner (Required)
As the property owner of the project address noted above, I have read, understand and agree to participate in the
Plumbing Fixture Replacement Self -Certification Program. 1 further understand that by participating in this program, the
plumbing system will not be inspected by a City of Newport Beach Building Inspector during construction or after
installation unless requested. The Building Division may request and reserves the right to verify code compliance after
the installation is compAt
" Propert Owners Signature Date
=11
This form must be completed and returned to the City of Newport Beach, Building Division, for a final approval
of the combination permit. Please return this form to the Building Division by mail or fax.
Please mail to: City of Newport Beach Phone: (949) 718-1888
Community Development Department Fax #: (949) 644-3250
Building Division
P. O. Box 1768
Newport Beach, CA 92658
FomslCantra.tor-OwnerSelf-CertDeclaration-Plumbing Fixture Replacement 01/27/20