HomeMy WebLinkAbout150 (2)PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
LJ 1st
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 thi -of work will be complied with whether specified herein or not. No person shall be
allowed to perform work • - his permit in violation of the labor code of the State of California. I further state that I am
pro • r li ensed a • uired by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Se
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDRESS:
56 f-
` 1
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
on
Backflow Protection)
$22
JOB DESCRIPTION:
t1,2C-,WA'
` ll
1. Building Sewer
2. Trailer Park Sewer
3. Rainwater System - Per Drain (Inside Building)
4. Water Heater/Vent
5. Gas Piping Outlets (Enter No. of Outlets):
a. 1-5 Outlets, Total Fee
b. Over 5 (Per Outlet)
$43
$43
$22,4(
$22
2--
$33 Total
$7 Each
PROPERTY OWNER(S) NAME:
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\C1.144
PArt Mid \ `e•)
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
ADDRESS:
SGS_
$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
Piping
$11
PHONE `')
3io v • • 0
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)
$22
PLUMBING CONTRACTOR:
tf
'/‘e» �{ e` r� L_,
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:
lrXc X %-Q S IS t_ , t+•
ADDRESS: /
I V) 8(, ( 3.-,-
Doi.- 9t —
Each Backflow Protective Device Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY, STATE, ZIP:
$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
P 0 :
� cA,iaQUo2.Ut
$62
$87
BUSINESS LICENSE NO:
$134
$186
STATE LICEN O ((��
$236.�p
$309
TYPE OF BUILD N
$464
$667
NO. OF STORI
$11 Each
Miscellaneous
$33
NO. OF METERS:
Supplemental Permit Fee
$17
Issuance Fee
$60
NO. OF FAMILIES:
TOTAL FEE
*PLEASE CONTACT THE PUBLIC WORKS DEPARTMENT AT (310) 318-0214 IF
WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY (SIDEWALK OR STREET).
DATE ISSUED:
ISSUED BY:
PERMIT NO: ? 1?-. O o2�1
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 thi -of work will be complied with whether specified herein or not. No person shall be
allowed to perform work • - his permit in violation of the labor code of the State of California. I further state that I am
pro • r li ensed a • uired by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Se
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13