HomeMy WebLinkAboutN/A (15)76A667A ICE 817B1-11/76
APPLICATION
IPERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
DRESS 2 9 2 4- South Diamond Ridge
NUMBER FIXTURE OR ITEM @ FEE
ADILDING
WATER CLOSET
LOCALITY
NEAREST
BATH TUB
CROSS ST.
SHOWER
OWNER
LAVATORY
ADDRESS 2130 E . 4th St.
— Suite 1lO
SINK
CITY Santa Ana Ca. TEL.NO- 547-398�
DISHWASHER
CONTRACTOR Industrial Turf Inc � 714)
CLOTHES WASHER
ADDRESS P.O. $OX 2247
SWIMMING POOL RECEPTOR
TEL. NO.
CITY Hi_11
8 3 % — 12 31
LAWN SPRINKLER SYSTEM
3
00
STATE UC.
LICENSE NO. 204588 CLASS C-2 % A
WATER HEATER
DISTRICT NO GROUP c ZONE
PfiOCESSED Y
GAS SYSTEM OUTLETS
f
OUTLETS OVER
5 PER SYSTEM
INDUSTRIAL"
WASTE APPROVAL
INSPECTION RECORD
qj
0
6
c�
z
Plan check fee
PLUMBING PERMIT ISSUING FEE $
6 00
TOTAL FEE
9 0
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
GAS VENT
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
HOT WATER HEATER
AND STATE LAWS REGULATING PLUMBING.
PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
GAS TEST
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF, AND INTEND T'l�i/OSIDE IN T E ABOVE D 'RIBED RESIDENTIAL
UTILITY CO. NOTIFIED
PROPERTY. f /"
SIGNATURE �s L
//'
OP PERMIT
FINAL
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.o. CASH