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aEWPoRT CITY OF NEWPORT BEACH
oil i' e COMMUNITY DEVELOPMENT DEPARTMENT
n BUILDING DIVISION
1 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
�P
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:
1405 Keel Dr, Corona Del Mar, CA 92625
CONTRACTOR NAME:
CONTRACTOR STATE LICENSE #:
SunSolar US, INC
975072
PANEL MAKE #:
PANEL MODEL #:
Solaria
Solaria PowerX-400R
PART 2: To be completed PRIOR TO INSPECTION REQUEST
and placed with jobsite inspection card
DECLARATION:
Ronald L Rhodes declare that the PV module make and model
(PRINT NAME)
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.
2 ." z �- lU -z
(SIGNATURE) (DATE)