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DEPUTY 1 INSPECTION
Project Address:
Permit Number:
Inspection Type
Inspection Date
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658
www newportbeachca gov 1 (949) 644-3200
SPECIAL INSPECTION REPORT
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Describe Inspection, Inclupling Location(s):
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Total Inspection Time Each Day:
Hours:
Ust All Items Requiring Correction (include Previously Usted Uncorrected Items):
. . . .... . . ..... . .. . ......... . . . . . ..... . .......
Comments:
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To the best of my knowl e . sped �Inac ance with the Building Division approved design drawings,
specifications and orkmanshi visions of the U.B. except as noted above.
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Skeclal InspectoNftfiore: I/ Date:
Print Full Name: i Newport Beach Registration No.:
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Community Development Department I Building Division
— n 100 Civic Center Dr.1 P.O. Box 1768 1 Newport Beach, CA 92658
www.newportbeachca.gov 1 (949) 644-3200
CALGREEN DOCUMENTATION COMPLIANCE CERTIFICATION
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ADDRESS: 4 PERMIT NO.:/ \
THIS FORM SHALL BE COMPLETED AND SIGNED PRIOR TO REQUEST FOR FINAL BUILDING
INSPECTION. ONE COPY OF THIS FORM SHALL BE SUBMITTED TO THE BUILDING INSPECTOR AT
FINAL INSPECTION AND ONE SHALL BE PROVIDED TO THE BUILDING OWNER AS PART OF THE CAL
GREEN CERTIFICATION PACKAGE.
The following section shall be completed by a person with overall responsibility for the planning and
design portion of the project.
REQUIRED DOCUMENTATIONS PROVIDED TO THE PROPERTY OWNER(S)
❑ Franchise Hauler for Construction/Demolition Waste (65% min. reuse of nonhazardous waste)
❑ VOC Contents Limitation
❑ Formaldehyde Emissions Limitation
❑ T-24 Energy Certificate of Installations (Env., QII, Lighting, Photovoltaic, Mech., Plumb.)
❑ T-24 Energy Certificate of Verifications or Acceptance ( Env., QII, Lighting, Photovoltaic, Mech.,
Plumb., HERS)
❑ Operations and Maintenance Manual
MOISTURE CONTENT OF BUILDING MATERIAL (RESIDENTIAL CONSTRUCTION ONLY)
❑ 1 certify that the moisture content of the wall and floor framing is less than 19 percent as
determined in accordance with Section 4.505.3 of CAL Green prior to being enclosed.
DECLARATION STATEMENT
• 1 certify under penalty of perjury, under the laws of the State of California, the information
provided is true and correct.
I certify that the installed measures, materials, components, or manufactured devices identified
on this certificate conform to all applicable codes and regulations, and the installation is
consistent with the plans and specifications approved by the enforcing agency.
Responsible Person's Name:
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Responsible Person's Signature:
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Date Signed:
Position/Title:
Notes:
Forms\CALGreen Documentation Compliance Cert Form 1-2017