HomeMy WebLinkAbout1309PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
if/F7- of?. -a -xe
I hereby certify th
laws and or
allowed to
properly li
Section 7
ve read and examined this application and know the same to be true and correct. All provisions of
ing this type of work will be complied with whether specified herein or not. No person shall be
er this permit in viola 'on of the labor code of the State of California. I further state that I am
by Section 70 . o 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: 1
e`9 /`Q�j, A
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
/
7
JOB
ct'(1
DESCRIPTIO J:1
Us(. 4Y-(kel
P61/1A-6(i2.----
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 TotalIF,�
$7 Each
P=1 PERTY OWN S) NAME:
�C 6� 6
' r��
Industrial Waste Pretreatment
1. Interceptor, Including p rap and Vent
2. Undersink Grease Trap
$55
ADDRESS:
C3o� eprts5
$33
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY, STATE, ZIP:
} CQ C (L (�O�i-T�
A. -( '� '1(
Each Repair or Alteration of Drainage or Vent
Piping
$11
PHONE:
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)
$22
PLUM'.
G CO TRACT
R:
Atmospheric -Type Vacuum Breakers
(Not included in Above item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
EMAILADPRESS:
ADDRESS:
Each Backflow Protective Device 'Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY, STATE, ZIP:
$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
PHONE:
$62
$87
BUSINESS LICENSE NO:
STATE LICENSE NO:9g r^ I
` l� l
$134
$186
$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: C� /'_ /� pg
(.
ISSUED BY:
PERMIT NO: p/`'-'00 /9E
I hereby certify th
laws and or
allowed to
properly li
Section 7
ve read and examined this application and know the same to be true and correct. All provisions of
ing this type of work will be complied with whether specified herein or not. No person shall be
er this permit in viola 'on of the labor code of the State of California. I further state that I am
by Section 70 . o 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