Loading...
HomeMy WebLinkAboutN/A76A667A ICE 817B) - 11/76 APPLICATION 'PERMIT BUILDING AND FOR APPLICANT TO FILL IN (PRINT OR TYPE) SAFETY DIVISION BUILDING ADDRESS 21491 Cold Spring.. Lane NUMBER FIXTURE OR ITEM @ FEE LOCALITY Diamond Bar California WATER CLOSET BATHTUB NEAREST CROSSST. Diamond Bar Blvd, SHOWER OWNER Diamond Ridge AJT Venture LAVATORY MAIL ADDRESS 2130 E. 4th St. -Suite 110 SINK CITY Santa Ana, Ca. TEL. NO. 547®3987 DISHWASHER CONTRACTOR Industrial Turf, Inc. CLOTHES WASHER ADDRESS P.O. BOX 2247 SWIMMING POOL RECEPTOR CITY Laguna Hills,CaTEL. NO. LAWN SPRINKLER SYSTEM 3 00 STATE LIC. LICENSE NO, 204588 CLASS C®2 % A WATER HEATER DISTRICT NO.r GROUP ZONE PROCESSED BY, ✓ GAS SYSTEM OUTLETS OUTLETS OVER S 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 RES IN THE AB VE DESCRIBED RESIDENTIAL PROPERTY. ry " SIGNATURE OFPERMITTEE "' G " 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