HomeMy WebLinkAbout2035PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
I hereby certify that I have r d and examined this application and know the same to be true and correct. All provisions of
laws and ordinances govern g this type of work will be complied with whether specified herein or not. No person shall be
allowed to perform work u der this permit in violation of the labor code of the State of California. I further state that I am
properly licensed as requi d 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:
raiD 15 �"j--1 A,
bs9e U'
Each Plumbing Fixture, Trap or Set of Fixturesn
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
JOB DESCRIPTION:
,Cc �llLIel S
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
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
PLUMBING CONTRACTOR:
n
a S 4 ,j 'S4R-As
Atmospheric -Type Vacuum Breakers
(Not included in Above item)
a. 1-5, Total Fee
b. Over 5 (Per Breaker)
$22 Total
$7 Each
EMAIL ADDR JJ p
CAC() uT'`E,sA le, 5 mY Cor•
ADDRESS:
J �)Z !2 �1 S /10'L i Vv -
Each Backflow Protective Device i Other
Than Atmospheric -Type Vacuum Breakers):
a. 2 Inches and Smaller
b. Over 2 Inches
$22 Each
CITY, STATE, ZIP:
/�`j
.6-
$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
PHONEj55 -c �3
�7Sz
$62
$87
2Cf
BUSINESS LICENSE NO.
--
$134
$186
STATE LICENSE NO:
7 VIS-- 3033
$236
$309
TYPE OF BUILDING:-
J T
$464
$667
NO. OF STORIES:
$11 Each
Miscellaneous
$33
NO. OF METERS:
Supplemental Permit Fee
$17
Issuance Fee
$60
NO. OF FAMILIES: r
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: Gr7206/
ISSUED BY: L
\%
VV
PERMIT NO:>j)1 it., 0020
I hereby certify that I have r d and examined this application and know the same to be true and correct. All provisions of
laws and ordinances govern g this type of work will be complied with whether specified herein or not. No person shall be
allowed to perform work u der this permit in violation of the labor code of the State of California. I further state that I am
properly licensed as requi d 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