HomeMy WebLinkAbout1533PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY (SIDEWALK OR STREET).
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws
and ordinances goveming this type of work will be complied with whether specified herein or not. No person shall be allowed to
perform work under this permit in violation of the labor code of the State of Calif- mia. I further state that I am properly licensed
as required by Section 7031.5 of the State Business and Professional Code (or im exemption under Section 7044).
Signature of Contractor
Signature of Owne
er/Builder)
F:b95/cd/forms-handouts/application/plumbing 9-1-11 Revised 10/3/11
JOB ADDRESS:
6, oc./O8) A-116
Each Plumbing Fixture, Trap or Set of
Fixtures on One Trap (Including Water, Drain
Piping and Backflow Protection)
$ 22
QTY
4
AMOUNT
g9/533
JOB DESCRIPTION:
Move- KITLKr✓ S/N4/ MO'E
,,-Op POT- F/lL ,_,
M0✓F DOwN5 f// S/Nx/
A -DP DOr✓i✓5TI}/r25 Srn/k,
1. Building Sewer
2. Trailer Park Sewer
3. Rainwater System - Per Drain (Inside
Building)
4. Water HeaterNent
5. Gas Piping Outlets (Enter No. of Outlets):
a) 1-5 Outlets, Total Fee
b) Over 5 (Per Outlet)
$ 43,
$ 43
$ 22
$ 22,
PROPERTY OWNERS) NAME:
6P0(2 -Y0
$ 33 Total
ADDRESS.
/� 1533 `� OLPO✓ 4-vE
$ 7 Each
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Tra•
L54
CITY, STATE, ZIP:
110214c/A- .6G`,feli (l'0�5
$ 33 '
Each Installation, Alteration or Repair of
Water System (Piping Equipment or Repipe).
Total Re -pipe = Main + No. of Fixtures '
$ 11
PHONE: ,
ld Zoo (043/
Each Repair or Alteration of Drainage or Vent
Piping
$ 11'
/
PLUMBING CONTRACTOR:
Each Lawn Sprinkler System on any One
Meter (Including Backflow Protection Devices)
$ 22
EMAIL ADDRESS:
Atmospheric -Type Vacuum Breakers (Not
Included in Above Item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)_
$ 22 Total
ADDRESS
$ 7 Each
CITY, STATE, ZIP:
Each Backflow Protective Device (Other Than
Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$ 22 Each
PHONE:
$ 22 Each
1. Fire Sprinkler Piping System
a. 1-10 Heads
b. 11-25 Heads
c. 26-50 Heads
d. 51-100 Heads
e. 101-200 Heads
f. 201- 300 Heads
g. 301-500 Heads
h. 501-1000 Heads
i. 1001 or More Heads
2. Sprinkler Riser Pipe
$ 22 Plus
$ 37
BUSINESS LICENSE NO.:
$ 61•
$ 86
STATE LICENSE NO.:
$133
$184
TYPE OFBUILDING:
5 / t- F*m /.y
$234
$306
NO. OF STORIES:
$459
$660
NO. OF METERS:
$ 11 Each
NO. OF FAMILIES:
1
' L
DATE ISSUED: /,) : r(I
"( 1 �
Miscellaneous
$ 33
Supplemental Permit Fee
$ 17
Issuance Fee
$ 59
ISSUED BY:
TOTAL FEE
PERMIT NO.: fi 13_ 0005
WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY (SIDEWALK OR STREET).
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws
and ordinances goveming this type of work will be complied with whether specified herein or not. No person shall be allowed to
perform work under this permit in violation of the labor code of the State of Calif- mia. I further state that I am properly licensed
as required by Section 7031.5 of the State Business and Professional Code (or im exemption under Section 7044).
Signature of Contractor
Signature of Owne
er/Builder)
F:b95/cd/forms-handouts/application/plumbing 9-1-11 Revised 10/3/11