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HomeMy WebLinkAboutN/A76A667A (CE 6178) - 1 1/76 APPLICATION IPERMIT � 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 0 WATER HEATER GAS SYSTEM OUTLETS OUTLETS OVER 5 PER SYSTEM Plan check fee PLUMBING PERMIT ISSUING FEE $ 6 00 TOTAL FEE 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 I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND SygTE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESID I THE ABOV DESCRI)RESIDENTIAL PROPERTY. ,/ SIGNATURE /I ��// �' OF PERMITTEE 4s v PLAN CHECK VALIDATION CK. M.O. CASH I BUILDING ADDRESS 21470 Cold Spring Lane LOCALITY Diamond Bare California NEAREST CROSSST. Diamond Bar Blvd. OWNER Diamond Ridge AJT Venture MAIL ADDRESS 2130 E . 4th St. -Suite 110 CITY Santa Ana, Ca. TEL.NO. 547-3987 CONTRACTORIndustrial Turf, In. 714) ADDRESS P.O. BOX 2247 CITY Laguna Hills,Ca TEL. NO. 837-1231 STATELICENSE NO. 204588 CLASS C-2 7 A DISTRICT NO GROUP ZONE PROCESSED BY 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 ©s