HomeMy WebLinkAbout334PLUMBING 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 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
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Signature of Contractor
Signature of Owner (If Owner/Builder)
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QTY
Amount
JOB ADDRESS:
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
)
3,3 Pi ow, -0 \irt
JOB DESCRIPTION:
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
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$43
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$22G
� 's nL� ,)
$22
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$33 Total
$7 Each
PROPERTY OWNER(S) NAME:
.w tr30
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Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
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ADDRESS:
3. Ore Yd1
-1-1
$33
--3,4-
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Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY, STATE, ZIP:
(`-e L V' iit
Each Repair or Alteration of Drainage or Vent
Piping
$11
XI
PHONE: nQ
3l b s-t,u 243 1,
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)
$22
PLUMBING CONTRACTOR:[CT
Atmospheric -Type Vacuum Breakers
(Not included in Above item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
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EMAIL ADDRESS; � �/
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ADDRESS:
26622-S4 tA/C0Y)
Each Backflow Protective Device Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
,
CITY, STATE, ZIP:
14 2�f7
$22 Each
0
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
$22 Plus
Ar
$37
PHON :
2/0 56`.9--‘ / 2-4 .
$62
$87
BUSINESS LICENSE NO:
$134
$186
STATE LICENSE N :
8662 Z4
f. 201-300 Heads
$236
g. 301-500 Heads
$309
TYPEBUILDING:
kZCS101:733C-ki\ty
h. 501-1000 Heads
$464
i. 1001 or More Heads
$667
NO. OF STORK
2. Sprinkler Riser Pipe•
$11 Each
Miscellaneous
$33
NO. OF METER_:,
1 -
Supplemental Permit Fee
$17
Issuance Fee
$60
NO. OF FAMILIES:
'�
TOTAL FEE
DATE ISSUED:t//7
*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).
ISSUED BY:
PERMIT NO:
/9/ g -Mole/.
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
I I
�
i
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
f