HomeMy WebLinkAbout1601 (7)cW 10 -
PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development DepartmentSs
SWev2 /666X r.
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 ordinan : -ruing this type of work will be complied with whether specified herein or not. No person shall be
allowed to pe ► • rm work under4his permit in violation of the labor code of the State of California. I further state that I am
properly lice sed as r; . • red by ection 7031.5 of the State Business and Professional Code (or claim exemption under
Section .4 ). Tql
filVAJI
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 bn l 6 00-C-41
-1?'AC,\\c_- k i "- .
5. ?-.BO k\f374kferz.ifc Zi6Ptc0.
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
JOB DESCRIPTION:
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
t -_Q--- s k
k7.5'''
$43
- ,e_..44S , \ b \ ...(-
$22
$22
$33 Total
$7 Each
PROPERTY OWNER(S) NAME:
X O1 2-tc _s.? - -t1,Pa
`- t 3-4
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
ewMBIN C �oT�RACTOR:
-e _CP
"` \`?2
001,) .I NQ,
Atmospheric -Type Vacuum Breakers
(Not included in Above item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
EMAIL ADDRESS:
.V (63 � ti -FIL %x
ADDRESS: ��
(a5 k ted N
VP,13 V3U -eS, , 914 DC,
Each Backflow Protective Device Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY, STATE, ZIP:
VP -i3 UOQ Si &
$22 Each
1. Fire Sprinkler Piping System
a. 1-10$37
ds
b. 11-251-25 Heads
c. 26-50 Heads
d. 51-100 Heads
e. 101-200 Head,
$22 Pluslust
�)
PHONE: �i� ct8 b 12�
$62
$87
BUSINESS LICENSE NO:
SZ v 14,
$134
$186
STATE LICENSE NO:
63 a 1 U,
f: 201-300 Heads
g. 301-500 Heads
h. 501-1000 Heads
i. 1001 or iviore Heads
2. Sprinkler Riser Pipe
$236
0-)
$309
TYPE OF BUILDING:
Z,
$464
$667
NO. OF STORS:
$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).
'Sal
DATE ISSUED: I 'ala/
ISSUED BY: `�1 /
�1 G�/
PERMIT NO:
ph --a° i' D
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 ordinan : -ruing this type of work will be complied with whether specified herein or not. No person shall be
allowed to pe ► • rm work under4his permit in violation of the labor code of the State of California. I further state that I am
properly lice sed as r; . • red by ection 7031.5 of the State Business and Professional Code (or claim exemption under
Section .4 ). Tql
filVAJI
Signature of Contractor
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/13.xlsx rev 8/31/13