HomeMy WebLinkAboutN/A76A667A ICE 817B) - 11/76 fr
APPLICATION IPERMIT
BUILDING AND
SAFETY DIVISION
BUILDING
ADDRESS 21502 Cold S ring
Lane
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
NUMBER
FIXTURE OR ITEM
@
FEE
LOCALITY Diamnd Bar, Calif.
WATER CLOSET
BATH TUB
NEAREST
CROSS ST.
SHOWER
OWNER Diamond Ridge AJT
Ve
LAVATORY
MAIL
ADDRESS 2130 E . 4 th 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 Ca;EL.NO,
837-123
LAWN SPRINKLER SYSTEM
3
00
STATE LIC.
LICENSE NO. 204588 CLASS
WATER HEATER
DISTRICT NO.
GROUP
ZONE
PROCESSED BY
�•
GAS SYSTEM OUTLETS
OUTLETS OVER
S PER SYSTEM
INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE $
6
O O
TOTAL FEE
9
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
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'?STATE STATE F CNIA OR THAT I AM THE
LEGAL OWNER OF, AND INTEND TO IN T ABOVEALIFO E CRIBED RESIDENTIAL
PROPERTY. JJ_%
SIGNATURE
OF PERM ITT EE "v "'
PLAN CHECK VALIDATION V CK. M.O. CASH
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIHED
FINAL
PERMIT VALIDATION CK.
M.O. CASH
Os