Loading...
HomeMy WebLinkAboutN/A (871)76A667A ICE 8178) - 11/76 ? APPLICATION FOR PLUMBING PERMIT BUILDING AND MENERNM FOR APPLICANT TO FILL IN (PRINT OR TYPE) SAFETY DIVISION BUILDING ADDRESS 21472 Cold S ring Lane NUMBER FIXTURE OR ITEM @ FEE LOCALITY Diamond Bar California WATER CLOSET BATHTUB NEAREST CROSS ST. Diamond Bar B SHOWER OWNER Diamond Ridge AJT Venture - LAVATORY MAIL ADDRESS 2130 E . 4 th S t . ® Suite 11 SINK CITY,Santa Ana, Ca. TEL.NO. 547-3987 DISHWASHER CONTRACTOR Industrial Turf,,Inc714) CLOTHES WASHER ADDRESS P.O. Box 2247 SWIMMING POOL RECEPTOR CITY Laguna Hi1ls,Ca,TEL.No. 837-1231 LAWN SPRINKLER SYSTEM 3 00 STATE LIC. LICENSE NO. 204588 CLASS C®2 7 A WATER HEATER DISTRICT NO. GROUP ZONE PROCESSED BY, GAS SYSTEM OUTLETS OUTLETS OVER 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD Plan check fee PLUMBING PERMIT ISSUING FEE $ 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 IN THE ABOVE DESC ED RESIDENTIAL PROPERTY. /{_. SIGNATURE`;il OF PERMITTEE l 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 I ©s