HomeMy WebLinkAboutN/A76A667A ICE 817B) - 1 1/76 -
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPEI BUILDING
ADDRESS 21443 Cold Spring Lane
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY Diamond Bar, California
NEAREST
BATH TUB CROSS ST. i Mond Bar Blvd.
SHOWER
OWNER
LAVATORY
MAIL
ADDRESS 2 130 E . 4 th St. -Suite 110
SINK
CITY S an ta An a CaTEL. NO.
DISHWASHER
f
CONTRACTOR Industrial Turf Inc (714 )
CLOTHES WASHER
ADDRESS P.O. Box 2247
SWIMMING POOL RECEPTOR
CITY Laguna Halls, CdE: NO 837-1231
LAWN SPRINKLER SYSTEM
3
00
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 $
(
00
TOTAL FEE
9
1 00
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 COUNT D STATE OF CALIFORNIA OR THAT I Am THE
LEGAL OWNER OF, AND INTEND T4' SIDE IN TF�E ABO�DESCRIBED RESIDENTIALPROPERTY. J11(/
SIGNATURE � �'' _
OFPERMITTEE �b LL
PLAN CHECK VALIDATION CK. M.D. CASH
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAL
PERMIT VALIDATION CK. M.O. CASH