HomeMy WebLinkAbout2055 (2)PLUMBING 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 Sectio7031.5 of the State Business and Professional Code (or claim exemption under
Secon 70 4).
Signature of C
ractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDR S / I\
/, C /v'
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow
$22
I
10Q.pESCF
/��/J 0-
7p-7
grotection)
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 Total
$7 Each
l
'e
PROPS TY OWNER(S) NAME:
��ti�
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
ADDRESS: A ` /
O55 uircie, DrlYe
$33
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY STATE, ZIP:
Pn/ Ove
Each Repair or Alteration of Drainage or Vent
Piping!�
$11
PHO�<j) / \ 1 992_
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)ttidUfh
$22
PLUMBING CONTRCTOR:
/ /(i»s.7j
-6/
Atmospheric-Type Vacuum Breakers
��
(Not included in Above item)
a.1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
Elyl-/�DpRrESSC C0115-fitet
J'C (�I}T el
A
44C.)•DRES T Q I
Each Backflow Protective Device Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY, STATE, ZIP:
r / cyl 7027
\( 4
$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
PH :0) V 73� i3 Q��
((�J 7l ✓O
$62
$87
BU�IIyESSI � /NO:
//e .7
$134
$186
STATE�IC�N� f�0�
44 f,�
$236
$309 \
TY ��BIyiDING/�
vJ �,Q�yl
$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
IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY (SIDEWALK OR STREET).
DATE ISSUED: s/L1(/( el
ISSUED BY: llik.,WORK
PERMIT NO: (Jr j/_ NV/ /
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 Sectio7031.5 of the State Business and Professional Code (or claim exemption under
Secon 70 4).
Signature of C
ractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13