HomeMy WebLinkAbout1516, 1518 (2)PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
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 pe orm work under this permit in violation of the labor code of the State of California. I further state that I am
properly lice d as re • uired by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Section '44
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDRESS:
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Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
JOB DESCRIPTION:
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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
$22
$33 Total
$7 Each
PROPERTY OWNER(S) NAME:
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
ADDRESS:
$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:
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)
$22
PLUMBING CONTRACTOR:
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Atmospheric -Type Vacuum Breakers
(Not included in Above item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
EMAIL ADDRs:
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ADDRESS: 1
1312 (,t z��, 611/4j 3
Each Backflow Protective Device , Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY, STATE, ZIP:LL - J q/�
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$22 Each
1. Fire Sprinkler Piping System
a. 1-10 Heads
b. 11-25 Heads
c. 26-50 Heads
$22 Plus
$37
PHONE.
0 - -3
$62
$87
WON
BUSINESS LICENSE NO:
d. 51-100 Hea •
$134
`7 d
i 1-200 Heads
f. 201-300 Heads
g. 301-500 Heads
h. 501-1000 Heads
i. 1001 or More Heads
2. Sprinkler Riser Pipe
$186
STATE LICproN ,, 3
$236
$309
TYPE OF BUILDING:
$464
$667
NO. OF STORIES:
$11 Each
Miscellaneous
$33
NO. OF METERS:
Supplemental Permit Fee
$17
Issuance Fee
$60
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NO. OF FAMILIES: 7 'i.
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TOTAL FEE
*PLEASE CONTACT THE PUBLIC WORKS DEPARTMENT AT
WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY
(310) 318-0214 IF
(SIDEWALK OR STREET).
DATE ISSUED: /
11 ILfi I 5
ISSUED BY:
PERMIT NO: 73 ^ n-0.3 8
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 pe orm work under this permit in violation of the labor code of the State of California. I further state that I am
properly lice d as re • uired by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Section '44
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13