HomeMy WebLinkAboutN/A76A667A ICE 617B) - 11/76
Az
APPLICATION
BUILDING AND
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
SAFETY DIVISION
BUILDING
ADDRESS 2
NUMBER
FIXTURE OR ITEM
@
FEE
LOCALITY Diamond Bar California
WATER CLOSET
BATHTUB
NEAREST
CROSSST. Diamond Bar Blvd.
SHOWER
OWNER Diamond Ridge LIT Venture
LAVATORY
MAIL
ADDRESS 2130 E . 4th St. -Suite 110
SINK
CITY Santa Ana Ca. TEL.NO. 547-3987
DISHWASHER
CONTRACTOR Industrial Turf Inc. (71
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL. NO. 8 3 7 -12 3 1
LAWN SPRINKLER SYSTEM
3
00
STATE LIC
LICENSE NO. 204588 CLASS C -2 7, A
DISTRICT NO GROUP ZONE PROCESSED BY
WATER HEATER
GAS SYSTEM OUTLETS
OUTLETS OVER
S PER SYSTEM
INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE $
6
00
TOTAL FEE
9
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address
ROUGH PLUMBING
City Tel. No.
GAS PIPING
I 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 ANQ"S ATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF, AND INTEND TO RE ODE N THE A O VE DES ]BED RESIDENTIAL
PROPERTY. /
SIGNATURE
OF PERMITTEE "
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAL
PLAN CHECK VALIDATION CK, M.0. CASH PERMIT VALIDATION CK. M.O. CASH