HomeMy WebLinkAbout1249 (2)PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
I hereby certify th. I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinan / -s governing this type of work will be complied with whether specified herein or not. No person shall be
allowed to perf. m work under this permit in violation of the labor code of the State of California. I further state that I am
prope- required by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Section 7044)
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDRESS:
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Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
JOB DESCRIPTION:
)1,,.2.
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1. Building Sewer
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 Total
$7 Each
PROPERTY OWNER(S) NAME:
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
ADDRESS:
$33
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY, STATE, ZIP:
Each Repair or Alteration of Drainage or Vent
Piping
$11
PHONE:
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)
$22
ekUMBING CONTRACT R:
e. SA, )--t )
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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ADDRESS:
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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, STATE, ZIP:
1`!J D q cD.� o a
$22 Each
1. Fire Sprinkler Piping System
b. 1-101-2 HeadsHea$37
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 Plusa
PHONE: 3 7, ` 3 1 / --
d 6
$62
�S
$87
BUSINESS LICENSE NO:
$134
$186
STATE LICENSE NO: fl
~7 LI 5- 8 3
$236
$309
TYPE OF BUILDING:
$464
$667
NO. OF STORIES: 2
$11 Each
Miscellaneous
$33
NO. OF METERS:
Supplemental Permit Fee
$17
Issuance Fee
$60
NO. OF FAMILIES:
I
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: kJ%l�/(ei
/
ISSUED BY: �\ Jam"(
rc
PERMIT NO: 9/17,_ �/ p
I hereby certify th. I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinan / -s governing this type of work will be complied with whether specified herein or not. No person shall be
allowed to perf. m work under this permit in violation of the labor code of the State of California. I further state that I am
prope- required by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Section 7044)
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13