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HomeMy WebLinkAboutN/A (2)76A667A ICE 817B) - 11/76 APPLICATION lPERMIT BUILDING AND FOR APPLICANT TO FILL IN (PRINT OR TYPE( SAFETY DIVISION ADBUILDING 21478 Cold Spring Lane NUMBER FIXTURE OR ITEM @ FEE LOCALITY Diamond Bar California WATER CLOSET BATHTUB NEAREST CROSS ST, Diamond Bar Blvd. SHOWER OWNER Diamond Ridge AJT Venture LAVATORY MAIL ADDRESS 2130 E. 4 th St. -Suit SINK CITY Santa An TEL. NO. DISHWASHER CONTRACTOR (714 ) Industrial Turf Inc. CLOTHES WASHER ADDRESS O. BOX 2247 SWIMMING POOL RECEPTOR . CITY Laguna Hills TEL. NO. LAWN SPRINKLER SYSTEM 3 OO STATE LICENSE NO. 204588 LIC. CLASS C ®2 7 11 A WATER HEATER DISTRICT NO, GROUP ZONE PROCESSED BY GAS SYSTEM OUTLETS OUTLETS OVER S PER SYSTEM INDUSTRIAL WASTE APPROVAL r' INSPECTION RECORD Plan check fee PLUMBING PERMIT ISSUING FEE $ 6 00 TOTAL FEE Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. No. GAS PIPING 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 STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDFA HE ABOVE,AESCRIBED RESIDENTIAL PROPERTY. ,y((� �// SIGNATURE /' /'7 �f�� of PERMITTEE ! �' PLAN CHECK VALIDATION CK, M.O. CASH GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST UTILITY CO. NOTIFIED FINAL PERMIT VALIDATION CK. M.O. CASH ©s