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=r CITY OF NEWPORT BEACH
"I COiNINfUiNTTY DEVELOPYIEiNT DEPARTNIENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 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 inspection
PART 1: To be completed BEFORE PERMIT ISSUANCE
JOSSITE ADDRESS:
CONTRACTOR NAME: CONTRACTOR STATE LICENSE #:
PANEL MAKE M PANEL MODEL #:
()A" Soo )C. G1q(AY 370
_ J
PART 2: To be completed PRIOR TO INSPECTION REQUEST 11
and placed with jobsite Inspection card
DECLARATION:
iAg> -{-n r R ntcnY to declare that the Pot module make and model
(PRINT NAME)
number, quantity, and locat¢on are installed as per the approved plans. Module
manufacturer, make, model and number, fire classifications of modules, and
brackets match the approved pla.is for the project located at the above
address within the City of i lq+,export Beach.
: - 6 —Zzl-