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HomeMy WebLinkAboutN/A76A667A ICE 817B1 - 11/76 APPLICATION' PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT ORTYPEI BUILDING ADDRESS 21477 Cold Spring Lane LOCALITY Diamond Bar California NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET NEAREST CROSSST. Diamond Bar Blvd. OWNER Diamond Rid BATHTUB SHOWER LAVATORY MAIL ADDRESS 2130 E . 4th St. —Suite 11O SINK CITY Santa Ana Ca. TEL.NO. 547-3987 DISHWASHER CONTRACTOR Industrial Turf Inc�714) CLOTHES WASHER ADDRESS P.O. BOX 2247 SWIMMING POOL RECEPTOR CITY Laguna Hi 1 is , Ca ;EL. No. g 37 ®12 31 LAWN SPRINKLER SYSTEM 3 STATE LIC. 204588 CLASS C-2 7 A WATER HEATER LICENSE NO. DISTRICT NO GROUP ZONE PROCESSED �BY �SL.r INDUSTRIAL ! - WASTE APPROVAL INSPECTION RECORD GAS SYSTEM OUTLETS OUTLETS OVER 5 PER SYSTEM Plan check fee PLUMBING PERMIT ISSUING FEE $ 6 TOTAL FEE q n n Plan check applicant Name Address City Tel. No. 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 COUNT ND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TSJ' R SIDE IN 'HE ABOJU DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE OF PERMITTEE V tt PLAN CHECK VALIDATION CK. M.O. CASH APPROVALS UNDER SLAB WORK ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST UTILITY CO. NOTIFIED FINAL PERMIT VALIDATION DATE INSPECTOR'S SIGNATURE CK. M.O. CASH ©s_