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CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT 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 inspect!a
II 350 Sue luta COy00 C4, cot -ova dd gar, oft 9W7-5
V13 4P 330!54-1k
II PART 2: To be completed PRIOR TO INSPECTION REQUES
and placed with jobsiteinspection card
DECLARATION:
I, 0�9 N4declare that the PV module make and r
(PRINT NAME)
number, quantity, and location are installed as per the approved plans. M
manufacturer, make, model and number, fire classifications of modules
brackets match the approved plans for the project located at the
referenced address within the City of Newport Beach.
(SIGNATURE) (DATE)