HomeMy WebLinkAboutN/A (973)76A667A (CE B17E0 - 11/76
APPLICATION, 1 �W
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT
OR TYPE(
BUILDINGADDRESS 21425 Cold S ring Lane
NUMBER
FIXTURE OR ITEM
O
FEE
LOCALITY Diamond Bar California
WATER CLOSET
BATHTUB
NEAREST
CROSSST. Diamond Bar Blvd.
SHOWER
OWNER Diamond Ridge AJT Venture
LAVATORY
MAIL
ADDRESS 2130 E. 4th St. -Suite 110
SINK
CITY Santa Ana Ca . TEL. NO. 547-3987
DISHWASHER
CONTRACTOR Industrial Turf Inc. ( 7 14
CLOTHES WASHER
ADDRESS P.O. Box 2247
SWIMMING POOL RECEPTOR
CITY Laguna Hills Ca TEL. No. 83 - 2
LAWN SPRINKLER SYSTEM
3
00
STATE LIC.
LICENSE NO. 204588 CLASS C-2 % A
DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER
GAS SYSTEM OUTLETS
OUTLETS OVER
5 PER SYSTEM
INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
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
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND TE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF, AND INTEND TO RESID I THE ABOV DESCRIBED SIDENTIAL
PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE� FINAL
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH