HomeMy WebLinkAboutPV2022-0354 - MiscTV ton - 6
CITY OF NEWPORT 13EACCH
S' COMMUNITY DEVELOPMENT DEPART
U rP MENT
BUILDING DIVISION
Beach, CA 92658-8915 '
ow 100 Civic Center Drive I P.O. Box 1768 1 Newport3p00
�tl'o �P www.newportbeachca.gov 1 (949) 644- p�.
SOLAR CONTRACTOR DECLARATION
Keen with Insaection card.
This form is for the Inspector to take at time of final ins ection
B
PART 1: To be completed BEFORE PERMIT ISSUANCE y
JOBSITE ADDRESS: M
A
Z. V3 V(/ 8
CONTRACTOR NAME: CONTRACTOR STATE LICENSE #: S
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PANEL MAKE #: PANEL MODEL #: r
I PART 2: To be completed PRIOR TO INSPECTION REQUEST II
and placed with jobsite inspection card
DECLARATION:
1 ; C>AAJ�/ �)U!" declare that the PV module make and model
(PRM NA W
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.
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(SIGNATURE) (DATE)
i D 6 O 61G. N A N N W O.
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