HomeMy WebLinkAbout760PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
NEW DEVELOPMENT/ADDITION/REMODEL
JOB ADDRESS:
160 m 0 v..♦ e re,. 6i vol.
PLUMBING FIXTURE, TRAP OR SET OF
FIXTURE ON ONE TRAP (INCLUDING WATER
AND DRAIN PIPING AND BACKFLOW
PROTECTION)
$ 17
QTY
I
AMOUNT
PROPERTY OWNER(SAME:
/
Lee. + Lev,` e.- iZet,.'derc d
1. BUILDING SEWER
2. TRAILER PARK SEWER
3. RAINWATER SYSTEM - PER DRAIN (INSIDE
BUILDING.)
4. WATER HEATERNENT
5. GAS PIPING: a) 1-5 OUTLETS, Total Fee
b) OVER 5 (per outlet)
$ 51
51
ADDRESS:
766 ry'a ,,.♦:r Q j��
$ 17
$ 21
CITY, STATE, ZIP:
�In
11t / w..a S a` e P1/4,.c-L, C 11 aj oz
$ 21 total
$ 3 each
PHONE:
INDUSTRIAL WASTE PRETREATMENT
INTERCEPTOR, (INCLUDING TRAP AND VENT,
AND KITCHEN -TYPE GREASE INTERCEPTORS)
$ 40
PLUMBING CONTRACTOR:
T 1, / ell ,.,....1: r„3
EXISTING DEVELOPMENT
EACH INSTALLATION, ALTERATION OR REPAIR
OF WATER SYSTEM (PIPING EQUIPMENT OR
REPIPE)
$ 9
ADD ESS:
f /I j
! i 4 L w..�#e, '7
EACH REPAIR OR ALTERATION OF DRAINAGE
OR VENT PIPING
$ 9
CITY, STATE, ZIP:
/
SP `"� drI/ Cp �j 02.y5
EACH LAWN SPRINKLER SYS. ON ANY ONE
METER, (INCLUDING BACKFLOW PROTECTION
DEVICES)
$ 28
H
PHONE:
3)o -322-25'0k
BUSINESS LICENSE NO.:
66 9.6.-a4 0
ATMOSPHERIC -TYPE VACUUM BREAKERS
(NOT INCLUDED IN ABOVE ITEM)
A. 1-5, Total Fee
B. OVER 5 (per breaker)
$ 21 total
STATE LICENE NO.:
p
C36 414 id,
$ 3 each
EACH BACKFLOW PROTECTIVE DEVICE
OTHER
BREAKERS: THAN ATMOSPHERIC TYPE VACUUM
1.2 INCHES AND SMALLER
2. OVER 2 INCHES
$ 21
1
TYPE OF BUILDING:
V^5 I e A.�: I Ret.'�0..� e_ e
NO. OF STORIES: 2
$ 51
NO. OF METERS:
i
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
$ 21 plus
$ 36
NO. OF FAMILIES:
i
$ 60
$ 84
NEW DEVELOPMENT:
$ 130
$ 180
EXISTING DEVELOPMENT:
$ 229
$ 299
DATE ISSUED: ;,, - i !,
r� l
$ 448
$ 645
ISSUED BY: \I -4A_
MISCELLANEOUS
SUPPLEMENTAL PERMIT FEE
$ 14
PERMIT NO.:
p 13- DD 21 4TOTAL
ISSUANCE FEE
$ 51
FEE
y
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).
NATURE OF CONTRACTOR
SIGNATURE OF OWNER (IF OWNER BUILDER)
F:b95/cd/application/plumbing - 9/1/2007