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APPLICATION FOR PI I
BUILDING AND SAFETY
FOR APPLICANT TO FILL IN (PRINT OR TYPE(
DIVISION
BUILDING
ADDRESS 21504 Cold Spring
NUMBER
FIXTURE OR ITEM
@
FEE
LOCALITY Diamond Bar
California
WATER CLOSET
BATHTUB
NEAREST
CROSSST. Diamond Ridge
Boulevard'._,
SHOWER
OWNER Diamond Ridge
Venture
AJTMAIL
LAVATORY
ADDRESS 2130 E. 4th
St. - Suite 110
SINK
CITY Santa Ana
TEL.NO. (714) 5 4 7 - y`
DISHWASHER
CONTRACTOR
Industrial
Turf, Inc.
CLOTHES WASHER
ADDRESS P.O. $OX 2247
SWIMMING POOL RECEPTOR
clrY Laguna T-iills,CaTEL.No• 837-1231
LAWN SPRINKLER SYSTEM
3
00
LIC NSENo. 204588
DISTRICT NO. GROUP
c ASS C-27,A
ZONE PROCESSED BY
`y,r.
WATER HEATER
GAS SYSTEM OUTLETS
OUTLETS OVER
S PER SYSTEM
INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE $
6
00
TOTAL FEE
a
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
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 STATE OF ALIFORNIA OR THAT I AM THE
LEGAL OWNER OF, AND INTEND TO ESI E IN TH OVE DES BED RESIDENTIAL
PROPERTY. g
SIGNATURE /r Jl /, ✓��¢7,� r
OFPERMITTEE v V �/V` W/
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