HomeMy WebLinkAbout1208PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
I hereby certify that I h. ve read and
laws and • • arices go e ning tics
allowed o pe . • m wok nder
proper licepsei :s re. ed •
Section `,��
Signature
ractor
mined this application and know the same to be true and correct. All provisions of
e of work will be complied with whether specified herein or not. No person shall be
rmit in violation of the labor code of the State of California. I further state that I am
n 7031.5 of the State Business and Professional Code (or claim exemption under
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDRESS:
( 2-0 Thr �CG
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
JOB DESCRIPTION:
Pint Sp
'
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
$22U
$33 Total
$7 Each
`JI
PROPERTY OWNER(S) NAME:
5
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
I
ADDRESS:
a 2-0 T4pal G,(
��� D �y'
$33
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY, STATE, ZIP:
f'f-�
""`""7--r--,9k-o-{
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:
C- `t- ( 910i -S
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: grtoru4 Vrr�
0-1-1 Fog',
ADDRESS: 7ks-
C�{'Ubg'1��
Each Backflow Protective Device i Other//���
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY, STATE, ZIP:
�j,)(1
6�'�/ �-' C. ti-
$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
�;/
PHON • "%"--0b7
7/4 .J`"� (O "-- 0 67 Ci
$62
$87
BUSINESS LICENSE NO:
$134
$186
ICE STAT L /
UC . E N Q7q�/� /
$236
$309
TYPE OF BUILDING:
$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).
DATE ISSUED: 6INA/
ISSUED BY: �__/
�l/-
PERMIT NO: py�40 a
I hereby certify that I h. ve read and
laws and • • arices go e ning tics
allowed o pe . • m wok nder
proper licepsei :s re. ed •
Section `,��
Signature
ractor
mined this application and know the same to be true and correct. All provisions of
e of work will be complied with whether specified herein or not. No person shall be
rmit in violation of the labor code of the State of California. I further state that I am
n 7031.5 of the State Business and Professional Code (or claim exemption under
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13