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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!o
PART 1: To be completed BEFORE PERMIT ISSUANCE
JOBSITE ADDRESS:
_
�- I k COO" L,
N&WOPr &LCrr
CONTRACTOR NAME: `
CONTRACTOR STATE LICEh
22o LW -�(o0
9`6 ;010
PANEL MAKE #:
PANEL MODEL #:';
PART 2: To be completed PRIOR TO INSPECTION REQUES'.
and placed with jobsite inspection card
DECLARATION:
I, C��2- rcrc A Q2-9 declare that the PV module make and r
(PRRVT 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)
aM15 096
�9 Voo Demsu
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
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permittee or homeowner)
Project Address: 4— VIPr Te"7,u.L,
Permit Number: -FyUt q — 4%Sl (a
Property Owner: _ M 1Qj�we (, r(�
Licensed Contractor: 4OL-Aa, �% 0 Lic I
The State of California now requires that smoke and carbon monoxide detectors must be
installed in all residential buildings
California Residential Code (CRC) Section R314.1, CRC R315.2 states in part that
existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors.
CRC Section R314.3, CRC R315.3 defines required locations.
Both boxes below must be checked:
3hbCarbon Monoxide Alarm: On the ceiling or wall outside of each separate
sleeping area in the immediate vicinity of bedrooms or in each hallway outside of
the rooms, and each level of the dwelling. Detectors are also required in
bedrooms with gas fired appliances
ai�Smoke Alarms: Installed in each room used for sleeping purposes, outside
each sleeping area, and on each level of the dwelling unit.
Retrofitted detectors may be battery operated for buildings where no alterations are
performed on the interior. Multiple -purpose alarms (carbon monoxide and smoke alarms)
shall comply with all applicable standards and must be approved by the State Fire
Marshall. The devices must be installed per manufacturer's specifications.
1, the undersigned, hereby certify that I am the permittee or homeowner of the
project 1 further certify that smoke alarms and carbon monmdde alarms are
present and tested til be fu onal in all the following locations:
Signature: Date:
V1 TT
NOTE: This self -certification is only used for projects to the exterior of the structure where access to the
interior of the dwelling by the City of Newport Beach Building Inspector is not achieved during the course of
construction.
FormslSmokeDetectorandCarbonMopoxideSelfCert 08/12/16