HomeMy WebLinkAboutN/A76A667A ICE 8178) - 11/76 f,
APPLICATION I I
BUILDING AND
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
SAFETY DIVISION
BUILDING
ADDRESS 21497 Cold Spring Lane
NUMBER
FIXTURE OR ITEM
@
FEE
WATER CLOSET
LOCALITY Diamond Bar California
BATH TUB
NEAREST
CROSSST. DiamondBar
SHOWER
OWNER Diamond Ridge AJT Venture
LAVATORY
MAIL
ADDRESS 2130 E. 4th St. -Suite 110
SINK
CITY Santa Ana Ca. TEL. NO. 5 4 9
DISHWASHER
CONTRACTOR Industrial Turf, In6!14)
CLOTHES WASHER
ADDRESS P.O. Box 2247
SWIMMING POOL RECEPTOR
CITY Laguna Hills Ca:EL"NO 837-1231
LAWN SPRINKLER SYSTEM
3
00
STATE LIC.
LICENSE NO. 204588 CLASS C®2 7 , A
WATER HEATER
DISTRICT NO
GROUP
ZONE
PROCESSED BY
f
GAS SYSTEM OUTLETS
OUTLETS OVER
S PER SYSTEM
INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE $
6
TOTAL FEE
9100
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 OE IN T ABOVE rcRIBED RESIDENTIAL
PROPERTY.
SIGNATURE 'u' /
OFPERMITTEE l� '"h
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAL
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH