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HomeMy WebLinkAboutN/A (904)76A667A ICE 617B) - 1 1/76 ' APPLICATION 8 BUILDING AND FOR APPLICANT TO FILL IN (PRINT OR TYPE) SAFETY DIVISION BUILDING ADDRESS 2 4 cold Spring I, NUMBER FIXTURE OR ITEM @ FEE LOCALITY Diamond Bar California WATER CLOSET BATHTUB NEAREST CROSS ST. Diamond Bar Blvd. SHOWER OWNER Diamond LAVATORY MAIL ADDRESS 2 130 E. 4 th St. -Suite 110 SINK CITY Santa Ana Ca. TEL.NO. 547- 98 DISHWASHER CONTRACTOR Industrial Turf Inc ( 714 ) CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY Laguna TTi 1 1 S TEL, NO. 8 LAWN SPRINKLER SYSTEM 3 00 STATE LIC. LICENSE NO. 204588 CLASS WATER HEATER DISTRICT NO. GROUP ZONE PROCESSED BY f GAS SYSTEM OUTLETS OUTLETS OVER 5 PER SYSTEM INDUSTRIAL /. WASTE APPROVAL INSPECTION RECORD Plan check fee PLUMBING PERMIT ISSUING FEE $ ( 0 TOTAL FEE 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 M 19D STATE OF ALIFORNIA R THAT I AM THE LEGAL OWNER OF, AND INTEND TO RS//�E IN THE OVE DES BED RESIDENTIAL 1 PROPERTY. /... SIGNATURE OFIRERMITTEE . J 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