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This form is for the Inspector to take at time of final inspection PART 1 To be completed BEFORE PERMIT ISSUANCE JOBSITE ADDRESS: � ���yYtorJi�l CONTRACTOR NAME: r CONTRACTOR STATE LICENSE #:' t4 100A783 PANEL MAKE #: PANEL MODEL #: L- LG 3�5Q X495 I, a—tom' a�aF declare that the PV module make and model (P T 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. 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