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Home My WebLink About1483A76A667A CE 817 (REV. 6/781 ©s APPLICATION 1PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NUMBER FIXTURE OR ITEM @ WATER CLOSET BATH TUB SHOWER LAVATORY SINK DISHWASHER CLOTHES WASHER SWIMMING POOL RECEPTOR X LAWN SPRINKLER SYSTEM WATER HEATER GAS SYSTEM OUTLETS OUTLETS OVER 5 PER SYSTEM Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE ws i BUILDING ADDRESS Lot 16 Tract FEE LOCALITY NEAREST CROSS ST. OWNER a ry G. Miller MAIL ADDRESS CITY Diamond Bar T CONTRACTOR Gary G . Mill ADDRESS CITY T 3.00 CENSENO. 295177 C rVAVALS DATE UNWORK ROBING GAGAHOHEATERPLUIXTURESGAUTINOTIFIED mxi Plan check applicant Name Gary G. Miller Address 2505 Indian Creek Road City Diamond Bar Tel. No. 594-4117 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. I jffj �y SIGNATURE OF PERMITTEE DISTRICT NO. PROCESSED BY INDUSTRIAL WASTE APPROVAL PLAN CHECK VALIDATION PERMIT VALIDATION EL. NO. 5 9 4 - 4117 EL. NO. C. LASS INSPECTOR'S SIGNATURE