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HomeMy WebLinkAboutN/A76A667A ICE 6178) - 11/76 yp APPLICATION FOR PLUMBING BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE( BUILDING ADDRESS 21494 Cold Spring Lane NUMBER FIXTURE OR ITEM Q FEE LOCALITY Diamond Bar, California WATER CLOSET BATHTUB NEAREST CROSS ST. Diamond Bar Boulevard SHOWER OWNER Diamond Ridge AJT Venture LAVATORY MAIL ADDRESS 2130 E . 4 th S t . - Suite 11 O SINK CITY Santa Ana, Ca. TEL.NO.547-3987 DISHWASHER CONTRACTOR Industrial 714 CLOTHES WASHER ADDRESSP.O. BOX 2247 SWIMMING POOL RECEPTOR CITY Laguna Hills,CCA.E;.NO. 837-1231 LAWN SPRINKLER SYSTEM LICENSE NO. 204588 CLASS C-2 7 A WATER HEATER DISTRICT NO. f GROUP ZONE P OCESSED BY GAS SYSTEM OUTLETS OUTLETS OVER S PER SYSTEM INDUSTRIAL_ WASTE APPROVAL INSPECTION RECORD Plan check fee PLUMBING PERMIT ISSUING FEE $ ( 00 TOTAL. FFF 9 OO Plan check applicant Name PPROVALS DATE INSPECTOR'S SIGNATURE LAB WORK Address PLUMBING City Tel. No. ING I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND STATENT THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. I HEREBY CERTIFY THAT I AM OERLY REGISTERED AND/OR LICENSED ASG REQUIRED BY LOS ANGELES COUN/ ND STATE OF CALIFORNIA OR THAT I AM THETLEGAL OWNER OF, AND INTEND TO SIDE IN. HE AB 1 DESCRIBED RESIDENTIALPROPERTY. ,r fJ'� SIGNATURE a j' 4, /fi✓OF PERMITT V1 �V TER HEATER [AN FIXTURES O. NOTIFIED PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH ©s