HomeMy WebLinkAboutN/A (1030)76A667A ICE 8176t - 1 1/76 r_
APPLICATION I
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET
BATH TUB
SHOWER
LAVATORY
SINK
DISHWASHER
CLOTHES WASHER
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM 3 00
WATER HEATER
GAS SYSTEM OUTLETS
OUTLETS OVER
S PER SYSTEM
Plan check fee
PLUMBING PERMIT ISSUING FEE $ ( 00
TOTAL FEE 9 00
Plan check applicant
Name
Address
City Tel. No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF, AND INTEND TO RE E IN TH ABOVE DE IBED RESIDENTIAL
PROPERTY.
SIGNATURE v�
OF PERMITTEE
MMMM
PLAN CHECK VALIDATION CK. M.O. CASH
BUILDING
ADDRESS 21459 Cold Spring Lane
LOCALITY Diamond Bar, California
N EA REST
CROSSST. Diamond Bar Blvd.
OWNER Diamond Ridge AJT Venture
MAIL
ADDRESS 2130 E. 4th St. -Suite 110
CITY Sjjja to Ana, TEL. 54i-3987
CONTRACTOR Industrial Turf, Inc. (714
ADDRESS P.O. Box 2247
CITY Laguna Hllls,Ca;EL.NO, 837-1231
LICENSE NO, 204588 CLASS C-27 A
DISTRICT NO GROUP ZONE PROCESSED BY
s1
INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
ROUGH PLUMBING
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAL
PERMIT VALIDATION CK. M.O. CASH
