HomeMy WebLinkAbout1831PLUMBING 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 a . • • inances governing t 's type of work will be complied with whether specified herein or not. No person shall be
allow top: orm work un • this permit in violation of the labor code of the State of California. I further state that I am
prop. licen d as re • ' ed by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Secti
Signature of Cori ractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDRESS:
Opym r,on
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1(0
Each Plumbing Fixture, Trap or Set of Fixtures
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 jPer Outlet)
$43
$43cur
$22
$22
$33 Total
$7 Each
PROPERTY OWNER(S) NAME:
L
� Q �� Ar��•
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
ADDRESS:
( 93 keinkt-e/Li
$33
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
(
CITY, STATE, ZIP:
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Each Repair or Alteration of Drainage or Vent
Piping
$11
PHONE: \
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)
$22
PLUIMBIN
17—Lt
CONTRACTOR:
���Atmospheric
,(,( 9�1r(
-Type Vacuum Breakers
(Not included in Above item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
EMAIL ADDRESS: �1,((���
L- - A-(')i-irl� ru'I)ed, C4
ADDRES
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Each Backflow Protective Device ' Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY TATE, ZIP:
--re
( ��d
0/A ,
$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
PHO
.. 10 -- ZR_5 fig
$62
$87
BUSINESS LICENSE NO:
$134
$186
STATE LICENSE N0
C( 4(0 l
$236
$309
TYPE OF BUILDINGS �n
J 14-
`i.
$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: i / 2/ki
ISSUED BY: /J .
PERMIT NO: r i'0019
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws a . • • inances governing t 's type of work will be complied with whether specified herein or not. No person shall be
allow top: orm work un • this permit in violation of the labor code of the State of California. I further state that I am
prop. licen d as re • ' ed by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Secti
Signature of Cori ractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
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