HomeMy WebLinkAboutX2021-2383 - Misc (3)Wp CITY OF NEWPORT BEACH
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 926580916
www,newportbeachca.gov1(949)044-3200
CONTRACTORIPROPERTY OWNER SELF -CERTIFICATION DECLARATION
FOR PLUMBING FIXTURE REPLACEMENT
Project Address: _1 '� 2-a W ei.J Or
Date: L01A Permit #: X 101 _ 3
The following Is to be completed by the California licensed contractor -or owner, participating In the City of Newport
Beach Self -Certification Program. Please type or print.
Installer's Name: l(i•PrL, PLicense No (if applicable)_ 103`I t
Installer's Malling Address:lc;(o0 4. A.. a Ia L� A Q IyrQ C(, j7� Phone # (requlred):b`-t, 9fa�i — bf3 f2.
Installer's EmalC I-Pa-✓r FAX
Installer
I certify that the Installation Is In compliance with applicable code requirements.
I further affirm that I have reviewed and understand the requirements of the 2019 California Green Building Standards
Code (CGBSC) Section 301A.1 and that all seif•certiflcation reports submitted will be based on the code requirements
contained therein,
I declare that all plumbing fixtures subject to the CGBSC 301.1A has been replaced meeting the low flow
requirements:
Kitchen faucets; 1,8 gal/minute at 60 pal Shower heads: 1.8 gal/minute at 80 psi
Water closet: 1.28 gal/flush Faucets: maximum flow rate of 1.2 gal/minute at 60 psi,
and minimum 0.8 gallminute at 20 psi
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Property Owner (Required)
As the property owner of the project address noted above, I have read, understand and agree to participate in the
Plumbing Fixture Replacement Self-Certlflcatlon Program. I further understand that by participating in this program, the
plumbing system will not be Inspected by a City of Newport Beech Building Inspector during construction or after
installation unless requested. The Building Division may request and reserves the right to verify code compliance after
the installation Is complete.
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Print Name Email
This form must be completed and returned to the City of Newport Beach, Building Division, for a final approval
of the combination permit. Please return this form to the Building Division by mail or fax.
Please mall to: City of Newport Beach Phone: (249) 718-1888
Community Development Department Fax A (049) 044-3250
Building Division
P. 0. Box 1768
Newport Beach, CA 92668
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