HomeMy WebLinkAbout540 (6)PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
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ertify that I have read and examined this application and know the same to be true and correct. All provisions of
ordinances governing this type of work will be complied with whether specified herein or not. No person shall be
orm work under this permit in violation of the labor code of the State of California. I further state that I am
d as ruired by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \ application \plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDRESS: t -7
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/on
% y T
Each Plumbing Fixture, Trap or Set of Fixtures
One Trap (including Water, Drain Piping and
Backflow Protection)_
$22
2
JOB
DESCRIPTION:
Aori.-i '/('/
1.Building Sewer
2. Trailer Park Sewer
Rainwater System - Per Drain (Inside Building)
4. Water Heater/Vent
5. Gas Piping Outlets (Enter No. of Outlets):
a. 1-5 Outlets, Total Fee
Over 5 (Per Outlet)
$43
$43Q��Ln�±3.
$22�j
$22
$33 Total
$7 Each
PROPS TY OWNER(S) AME:
F(C(4- �.rktr I/TT � /L66b.
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
ADDRE S:
A Z
vi bA/F
$33
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY, STATE, ZIP:
Each Repair or Alteration of Drainage or Vent
$11
PH � G) �(f (-- le(711'3Piping
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)
$22
P BING CONTRACTOR:
� a�A� � ��� .
�x `'"�
Atmospheric -Type Vacuum Breakers
(Not included in Above item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
EMAIL ADDRESS:
ADDRESS:
2 Cgs L45 )%L S Da.
NC) RI(i
Each Backflow Protective Device l Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY STATE, ZIP: �V
(?\j - -7 41
-V • ' ' �6Z `
$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
PC NE• 2�— --
� 7� (� — 3L 5
$62
$87
I L��L"0:
G
$134
$186
STAT LICENSE NO:
$236
$309
TYPE OF BUILDING:
C6ti D d _
$464
$667
NO. OF STORIES: 2_.-
$11 Each
Miscellaneous
$33
NO. OF METERS:
Supplemental Permit Fee
$17
Issuance Fee
$60
NO. OF FAMILIES:
TOTAL FEE
CONTACT THE PUBLIC WORKS DEPARTMENTAT (310)318-0214 IF
WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY (SIDEWALK OR STREET).
DATE ISSUED: ! J
0 Er71r3?*PLEASE
ISSUED BY:
PERMIT NO: p 3 00251,
I he
la s
alto
pro
Sect
an
e to p
rly lic=
n 704
ertify that I have read and examined this application and know the same to be true and correct. All provisions of
ordinances governing this type of work will be complied with whether specified herein or not. No person shall be
orm work under this permit in violation of the labor code of the State of California. I further state that I am
d as ruired by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \ application \plumbing 9/1/13.xlsx rev 8/31/13