HomeMy WebLinkAboutPV2022-0211 - MiscSEW PART
o."'.Llo
D
U . ' is
v
"1<7F�FN"T
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
SOLAR CONTRACTOR DECLARATION
Keep with Inspection card
PART 1: To be completed BEFORE PERMIT ISSUANCE
JOBSITE ADDRESS:
/323
CONTRACTOR NAME:
PANELMAK -
CONTRACTOR STATE LICENSE #:
LEPAkNEL MODEL #:
PART 2: To be completed PRIOR TO INSPECTION REQUEST
and placed with jobsite inspection card
DECLARATION:
I, 4we AME)
declare that the PV module make and model
IPRMT N
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.
(SIGNATURE)
(DATE)
3-7-1