HomeMy WebLinkAboutPV2023-0044 - MiscNmZ IS — 0o 1-I 9
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92858-8915
6vnv.newportbeachca.gov1(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 BLFORE_PERMIT ISSUANCL
_ JOBSITE ADDRESS:
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CONTRACTOR NAME —CONTRACTOR STATE LICENSE #:
M Ilk 51Jler 992,5 33
PANEL MAKE #: I PANEL MODEL M
SE SOur em0 - H✓
PART 2: To be completed PRIOR TO fNSPEIO C N REQUEST
and placed with jobair 'r;spection card
DECLARATION:
I, ,x4 LI tf C-IAiff declare that the PV module make and model
ira�n, r+nea:,
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.
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