HomeMy WebLinkAboutN/A (1031)76A667A ICE 817B) - 11/76 Jls.
APPLICATION IPERMIT
BUILDING AND SAFETY
MEMEMEM
FOR APPLICANT TO FILL IN (PRINT OR TYPE(
DIVISION
BUILDING
ADDRESS 21462 Cold Spring Lane
NUMBER
FIXTURE OR ITEM
@
FEE
LOCALITY Diamond Bar California
WATER CLOSET
NEAREST
CROSS ST. Diamond Bar Blvd,
BATHTUB
SHOWER.
OWNER Diamond Ridge AJT Venture
LAVATORY
MAIL
ADDRESS2130 D . 4th St. -Suite
SINK
CITY Santa Ana TEL. NO.
DISHWASHER
CONTRACTORInduStrial Turf, Inc. (714)
CLOTHES WASHER
ADDRESS P.O. BOX 2247
SWIMMING POOL RECEPTOR
CITY Laguna Hills TEL No. 837-1231
LAWN SPRINKLER SYSTEM
3
00
STATE LIC.
LICENSE NO. 204588 CLASS C- 2 7 A
DISTRICT NO le 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 $
6
00
TOTAL FEE
9
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 COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF, AND INTEND TO RES19 THE ABOVE DESC ED RESIDENTIAL
PROPERTY.
SIGNATURE �✓' -�
OF PERMITTEE
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAL
'..
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH