Who completes the water heater self-certification declaration?

The participating licensed plumbing contractor completes the contractor and installer sections, and the property owner completes the owner section.

How do I submit the water heater self-certification declaration?

Return it to the Building Division by mail at P.O. Box 1768, Newport Beach, CA 92658, or by fax at (949) 644-3250.

When is this declaration used?

The form is for a water heater installed in the same location and with the same size and type through the city’s Self-Certification Program. It is returned for final plumbing permit approval.

Newport Beach, CA · Orange County

No notary required

Contractor/Property Owner Self-Certification Declaration for Residential Properties (Water Heater)

Licensed plumbing contractors and property owners complete this declaration to participate in Newport Beach’s water heater self-certification program and obtain final plumbing permit approval.

What this form is

This declaration is for a water heater installed in the same location and with the same size and type, as part of Newport Beach’s voluntary Self-Certification Program. The licensed plumbing contractor provides project and license details and certifies the installation; the property owner confirms participation. The form states that it must be returned to the Building Division for final plumbing permit approval.

Who needs it

A participating licensed plumbing contractor and the property owner complete the declaration for an eligible residential water heater installation.

How to submit it

Return the completed form by mail or fax to the Building Division, Community Development Department. Mail it to P.O. Box 1768, Newport Beach, CA 92658, or fax it to (949) 644-3250.

About notarization

This form is signed and dated without a notary; the installer makes an affirmation under penalty of perjury, and the property owner signs and dates.

How to submit this form

1
Download The Declaration
Download the water heater self-certification declaration for the Newport Beach project.
2
Complete The Form
Enter the project and contractor details, complete the installer certification, and have the property owner complete the owner section.
3
Sign And Date
The installer and property owner sign and date their respective sections.
4
Return It To The Building Division
Mail the completed form to P.O. Box 1768, Newport Beach, CA 92658, or fax it to (949) 644-3250.

Frequently asked questions

Do I need a notary for this water heater self-certification declaration?: No. The form has no notary block; the installer makes an affirmation under penalty of perjury, and the installer and property owner sign and date it.
Who completes the water heater self-certification declaration?: The participating licensed plumbing contractor completes the contractor and installer sections, and the property owner completes the owner section.
How do I submit the water heater self-certification declaration?: Return it to the Building Division by mail at P.O. Box 1768, Newport Beach, CA 92658, or by fax at (949) 644-3250.
When is this declaration used?: The form is for a water heater installed in the same location and with the same size and type through the city’s Self-Certification Program. It is returned for final plumbing permit approval.

Need something notarized?

This Contractor/Property Owner Self-Certification Declaration for Residential Properties (Water Heater) doesn’t need a notary — but if you have another Newport Beach form that does, a commissioned online notary can help.