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PVZ023- o0o3
\a �4 Cow,--+ Avr
CITY OF NEWPORT BEACH
A COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
j4 X 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915
<,N(I og" 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
JOBSITE ADDRESS:
1914 Court St. Newport Beach, CA
CONTRACTOR NAME:
CONTRACTOR STATE LICENSE #:
Richard Vasquez
C-46 #608260
PANEL MAKE #:
PANEL MODEL #:
SOLARIA
POWER X 400
PART 2: To be completed PRIOR TO INSPECTION REQUEST
and placed with jobsite inspection card
DECLARATION:
1 Richard Vasquez declare that the PV module make and model
(PRINT NAME)
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
referenced address within the City of Newport Beach.
Ac"Zlvtc,% &CeV—U—'V ? 09/07/2023
(SIGNATURE) (DATE)