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HomeMy WebLinkAboutXR2023-1420 - MiscAT-76? 3 -142o 1�e'4 SeA_ I Sl a o,r CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 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 I t Project Addr ss: t1 Sea I � j Ile Date: Ti ad Permit#: XRao,3 - jyao The following is to be completed by the California licensed contractor or owner, participating in the City of Newport Beach Self -Certification Program. Please type or print. Installer's Name: Tr-4 "Oo L` License No (if applicable) Installer's Mailing Address: '1`{0`I� ZrnCon MiSSNaYit►•T tqT Phone#(required):!/4 60J 1713 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 2019 California Green Building Standards Code (CGBSC) 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 CGBSC 301.1.1 has been replaced meeting the low flow requirements: Kitchen faucets: 1.8 gal/minute at 60 psi Shower heads: 1.8 gal/minute at 80 psi Water closet: 1.28 gal/flush Faucets: maximum flow rate of 1.2 gal/minute at 60 psi, and minimum 0.8 gal/minute at 20 psi �- III Y123 Installer's Signature �� Date Propeffy Ovbner (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. I 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 complete. Property Owner's Signature Date Print Name Email 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 Forms\Con(rector-OwnerSelf-CertDe lamtion-Plumbing Fixture Replacement 03/04/22