HomeMy WebLinkAbout1160 (2)PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department 11%Jim/ ,5
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' s governing this type of work will be complied with whether specified herein or not. No person shall be
allowed to pe . -m work under this permit in violation of the labor code of the State of California. I further state that I am
properly lice , as required by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Section 7044
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/14.xlsx rev 8/26/14
QTY
Amount
JOB ADDRESS: `
r
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CI 5S bt/4
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)
$44
$44
few rii\L!� S-
$22
$22
$34 Total
$7 Each
PROPERTY OWNER(S) NAME:
j�,/�„ �� ` V �(
iqD (rt '2
Industrial Waste Pretreatment
1. Interceptor, Including Trap and Vent
2. Undersink Grease Trap
$56
�
ADDRESS: �"
p 'l4ji,_/) �-
���1/ h n _ / Q buo �Y`
$34
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY, STATE, ZIP:
i (, clD X15 /
(� (jJ
Each Repair or Alteration of Drainage or Vent
Piping
$11
PHONE:
Each Lawn Sprinkler System on any One Meter
(Including Backflow Protection Devices){�.
$22
P UMBING CONTRACTOR:
ce '4- { -s-Agyy,C;
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 S: J(�
Mc.oke lcSo,CtS S "-MS _ ga;
ADDRESS:
1
r. a A.
. A Vk
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
$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
$38
PHONE
S --nd 'a63
$63
$88
BUSINESS LICENSE NO:
$136
S"l
$189
STATE LICENSE NO:
/ S
$240
$314
TYPE OF BUILDING: r
- T:
$472
$678
NO. OF STORIES:
$11 Each
Miscellaneous
$34
lk
NO. OF METERS:
Supplemental Permit Fee
$17
Issuance Fee
$61
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: 11)/).1 ii
ISSUED BY: "
PERMIT NO: !Lf- t)
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' s governing this type of work will be complied with whether specified herein or not. No person shall be
allowed to pe . -m work under this permit in violation of the labor code of the State of California. I further state that I am
properly lice , as required by Section 7031.5 of the State Business and Professional Code (or claim exemption under
Section 7044
Signature of Owner (If Owner/Builder)
f... \application\plumbing 9/1/14.xlsx rev 8/26/14