HomeMy WebLinkAbout1001 (2) PLUMBING PERMIT APPLICATIONkP/7 7
City of Hermosa Beach -Community Development Department
QTY Amount JOB ADDRESS , r
Each Plumbing Fixture,Trap or Set of Fixtures pd,/.-- Jt-
on One Trap (including Water, Drain Piping and $22
Backflow Protection) JOB DESCRIPTION: /'
1. Building Sewer $43 �Q O I�L -6 „*.pt-t�S (3)
2. Trailer Park Sewer $43 c+
3. Rainwater System - Per Drain (Inside Building) $22 K. C- A,�
4. Water Heater/Vent $22
5. Gas Piping Outlets (Enter No. of Outlets): PROPERTY OWNER(S) NAME:
a. 1-5 Outlets,Total Fee $33 Total
b. Over 5 (Per Outlet) $7 Each �S �
Industrial Waste Pretreatment ADDRESS:
1. Interceptor, Including Trap and Vent $55i/
/6767/ 4/744 �t,�.
2. Undersink Grease Trap $33 '1`
Each Installation, Alteration or Repair of Water CITY,STATE, ZIP:
System (Piping Equipment or Repipe). $11
,�/ G� ep7 ''(4-
?OZ6i 4r
Total Repipe = Main + No. of Fixtures "
Each Repair or Alteration of Drainage or Vent $11Z PHONE:
Piping
Each Lawn Sprinkler System on any One Meter $22 PLUMBING CONTRACTOR: ,��
(Including Backflow Protection Devices) CE' C�/_ _ 54 J L PLA,A-"-
Atmospheric-Type Vacuum Breakers »'l I
(Not included in Above item) EMAIL ADDRESS:
a. 1-5, Total Fee $22 Total
b. Over 5 (Per Breaker) $7 Each ADDRESS:
Each Backflow Protective Device ,Other
Than Atmospheric-Type Vacuum Breakers):
a. 2 Inches and Smaller $22 Each CITY, STATE, ZIP:
b. Over 2 Inches $22 Each
1. Fire Sprinkler Piping System $22 Plus
a. 1-10 Heads $37 PHONE:
b. 11-25 Heads $62
c. 26-50 Heads $87 BUSINESS LICENSE NO:
d. 51-100 Heads $134
e. 101-200 Heads $186 STATE pJbSFrN�
f. 201-300 Heads $236 . LOj
g. 301-500 Heads $309 TYPE OF BUILDING:
h. 501-1000 Heads $464
i. 1001 or More Heads $667 NO. OF STORIES: 2-
2. Sprinkler Riser Pipe $11 Each
Miscellaneous $33 NO. OF METERS:
Supplemental Permit Fee $17
Issuance Fee $60 NO. OF FAMILIES:
TOTAL FEE
DATE ISSUED: O !�c l 7 eirs3
*PLEASE CONTACT THE PUBLIC WORKS DEPARTMENT AT(310)318-0214 IF ISSUED BY: b
WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY(SIDEWALK OR STREET).
PERMIT N0:n!5 06 q
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 governing 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 California. I further state that I am
properly lic-nsed as requir•d by Section 7031.5 of the State Business and Professional Code (or claim exemption under
S c on 704,A1 ' ' ,
Signat re of Contractor Signature of Owner(If Owner/Builder)
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