HomeMy WebLinkAbout435 (2)PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
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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 licensed as required by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Section 7044).
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDRESS:
LW -r
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
2m> STi
JOB DESCRIPTION:
)accftVerAVDEL-trsis) `S,j ( -T*2Qes
_
(C `4A-sm`t-ct.
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
$43ottPc.AI
$22
$22
$33 Total
$7 Each
Z
PROPERTY OWNER(S) NAME:
L)D C1 -try
/
Industrial Waste Pretat°ent
1. Interceptor, Inetiiding Trap and Vent
2. Undersi Grease Trap
$55
ADDRESS:
(41'S 2nA Std --r
$33
Each Installation, Alteration or Repair of WaternCITY,
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
STATE, ZIP: 9°2. Li
NfUaoSA -�
Each Repair or Alteration of Drainage or Vent
Piping
$11
PHONE: 310_ �So ( , 3C)
Each Lawn Sprinkler System on any One Meter
(Including Backft6w Protection Devices)
$22
PLUMBING CONTRACTOR:
f,6
EFERR�I, t► LtE 6(CR-S
Atmospheric Type Vacuum-.Breakers
(Not included in Above item)
a. 1-5, TotraL.Fee
b. Over5 (Per Breaker)
$22 Total
$7 Each
EMAIL ADDRESS:
ADDRESS:
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 HeadV,
e. 101-200 Heads
f. 201-300iHeads
g. 307500 Heads
h.'01-1000 Heads
i. 1001 or More Heads
2. Sprinkler Riser Pipe
$22 Plus
$37
PHONE:
$62
$87
BUSINESS LICENSE NO:
$134
$186
STATE LICENSE NO: �,�,�1 44-
$236
$309
TYPE OF BUILDING:
C,OKr>0
$464
$667
NO. OF STORIES:
$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).
friA
DATE ISSUED: rr
l ! l2
J
ISSUED BY:
PERMIT NO: I f ty:,2T3
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 licensed as required by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Section 7044).
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13