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HomeMy WebLinkAboutN/A (1201)76A667A (GE 817B) — 11/76 i •' APPLICATON FOR PLUMBING PERMIT 1 BUILDING AND SAFETY DIVISION OEM FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS 21446 Cold S ring Lane NUMBER FIXTURE OR ITEM FEE LOCALITY Diamond Bar California WATER CLOSET NEAREST CROSSST. Diamond Bar Blvd. BATHTUB SHOWER OWNER Diamond Ridge AJT Venture LAVATORY MAIL ADDRESS 2130 E . 4th St. e Suite 11 SINK CITY TEL. NO. 5 7- DISHWASHER CONTRACTOR Industrial Turf Inc . (714 CLOTHES WASHER ADDRESS P.O. BOX 2247 SWIMMING POOL RECEPTOR CITY Laguna HMS a TEL NO. LAWN SPRINKLER SYSTEM 3 00 STATE LIC. LICENSE NO. 2045 8 8 CLASS WATER HEATER DISTRICT NO GROUP ZONE PROCESSED BY GAS SYSTEM OUTLETS e OUTLETS OVER S PER SYSTEM F` INDUSTRIAL WASTE APPROVAL INSPECTION RECORD Plan check fee PLUMBING PERMIT ISSUING FEE $ 6 00 TOTAL FEE 9 Q _. Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel. No. GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER HEATER AND STATE LAWS REGULATING PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF, CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF, AND INTEND TO RES)Q IN THE BOVE DE IBED RESIDENTIAL UTILITY CO. NOTIFIED PROPERTY, p 9 SIGNATURE Vt V OF PERMITTEE FINAL PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH ©s