HomeMy WebLinkAbout1250 (2)PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
I hereby certify tha`�•rhave read an xamined this application and know the same to be true and correct. All provisions of
laws and ordin1n s governin is type of work will be complied with whether specified herein or not. No person shall be
allowed to,.perfp m work ur der this permit in violation of the labor code of the State of California. I further state that I am
properlv4'icens'ed as req fred by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Sectiof 704 . --
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13
QTY
Amount
JOB ADDRESS: 1 Z. 5v (cw,,i...)>. s
���anoSA �W
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
JOB DESCRIPTION:
•vJ .--c, L. J S-4\
/
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
'P
$33 Total
$7 Each
'2-
f.
to
PROPERTY OWNER(S) NAME:
'" 1 IS Ailt ' 5
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$55
ADDRESS: 7 cmc.) n) r,,q. CIT;
$33
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY, STATE, ZIP: OEewicc A s>✓ er
9 U H
Each Repair or Alteration of Drainage or Vent
Piping
$11
PHON31Y ZO
U) 2 6
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices)
$22
PLUMBING CONTRACTOR:
'^v 3vc-51 Cct.J S1-2uC; ko;
D
Atmospheric-Type Vacuum Breakers
(Not included in Above item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
EMAIL AD ESS:
NI t N rt1 1). it ^43cic51 T=c 1L S ec
ADDRESS:
5 rJ ,T€- F
Each Backflow Protective Device Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY, STATE, ZIP:
_J' R�G-TZ U C.k 't'77)
$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
1) 9'3 $_ a l t
$62
$87
BUSINESS LICENSE NO:
$134
$186
STATE LICENSE NO: q
Ias---0.
$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: 4zif/t1
ISSUED BY: Q J ''t "
PERMIT NO: p/L/.—
1)62,0(p
I hereby certify tha`�•rhave read an xamined this application and know the same to be true and correct. All provisions of
laws and ordin1n s governin is type of work will be complied with whether specified herein or not. No person shall be
allowed to,.perfp m work ur der this permit in violation of the labor code of the State of California. I further state that I am
properlv4'icens'ed as req fred by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Sectiof 704 . --
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13