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CITY OF NE`VPORT BEACH
COMMUNITN' DEVELOPD9ENT 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:
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CONTRACTOR NAME:
CONTRACTOR LICENSE #:
STATE
PANEL MAKE #:
PAN/EL MODEL #:
PART 2: To be completed PRIOR TO INSPECTION REQUEST
and placed with jobsite inspection card
DECLARATION:
I, K (.,FNk(ggclare that the PV module make and model
,PRINT \ UII
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
refer n d address within the City of Newport Beach.
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