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CITY OF NEWPORT BEACH 25-32
COMMUNITY DEVELOPMENT DEPARTMENT GCQf-M PSV
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200 Dr
SOLAR CONTRACTOR DECLARATION
PART 1: To be completed BEFORE PnSSUANCCE
JOBSITE ADDRESS
�u3� '��fV�e►v fir.
CONTRACTOR NAME:
CONTRPANEL
MA #:
gan6 hiq
• �S
PART 2: To be completed PRIOR TO INSPECTION REQUEST
and placed with jobsite inspectioncard
I, .Y/n l ul declare that the PV module make and model
(PRINT
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
the City of Newport Beach.
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