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HomeMy WebLinkAbout1002 (2) PLUMBING PERMIT APPLICATION City of Hermosa Beach -Community Development Department QTY Amount JOB ADDRESS: Each Plumbing Fixture, Trap or Set of Fixtures ©© 107'1'1- T— on One Trap (including Water, Drain Piping and $22 Backflow Protection) JOB=I: � �, 1. Building Sewer $44 I 2. Trailer Park Sewer $44t' C `�` 3. Rainwater System - Per Drain (Inside Building) $22 �� 4. Water Heater/Vent $22 P•• i&` "00`` / /-- 5. Gas Piping Outlets (Enter No. of Outlets): PROPERTY OWNER(S) NAME: a. 1-5 Outlets,Total Fee $34 Total b. Over 5 (Per Outlet) $7 Each , 4,112-- LL1J ®r_ICIAA 2,*3 Industrial Waste Pretreatment ADDRESS: . 1. Interceptor, Including Trap and Vent $56 /& Z /D -Si 2. Undersink Grease Trap $34 ---= ‘._�,::. ._-- Each Installation, Alteration or Repair of Water CITY, STATE, ZI': System (Piping Equipment or Repipe). $11 /� Total Repipe = Main + No. of Fixtures t 1 0 g OiF Each Repair or Alteration of Drainage or Vent $11 tt PH E: Piping 1 si ) 7elJ4 f' Each Lawn Sprinkler System on any One Meter $22 PL ING CONTRACTOR: (Including Backflow Protection Devices) �1(- . t-_ S .89l Atmospheric-Type Vacuum Breakers /'! , (Not included in Above item) EMAIL ADDRESS: a. 1-5,Total Fee $22 Total b. Over 5 (Per Breaker' $7 Each ADDRESS: Each Backflow Protective Device 'Other Than Atmospheric-Type Vacuum Breakers): a. 2 Inches and Smaller $22 Each CITY, STATE, ZIP: b. Over 2 Inches $22 Each 1. Fire Sprinkler Piping System $22 Plus a. 1-10 Heads $38 PHONE: b. 11-25 Heads $63 c. 26-50 Heads $88 BUSINESS LICENSE NO: d. 51-100 Heads $136 e. 101-200 Heads $189 STATE LICENSE NO: 1. 201-300 Heads $240 g. 301-500 Heads ' . $314 TYPE OF BUILDING: h. 501-1000 Heads $472 i. 1001 or More Heads $678 NO. OF STORIES: 2. Sprinkler Riser Pipe $11 Each Miscellaneous $34 1, NO. OF METERS: Supplemental Permit Fee $17 Issuance Fee $61 NO. OF FAMILIES: TOTAL FEE DATE ISSUED: i totici'� / *PLEASE CONTACT THE PUBLIC WORKS DEPARTMENT AT(310)318-0214 IF ISSUED BY: Fe, " '-( WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY(SIDEWALK OR STREET). � PERMIT NO: • *PH—60�'J;�� ] 1 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 li ensed as required by Section 7031.5 e.\the State Business and Professional Code (or claim exemption under Section 7 44). A . Sig ature of Contractor Signature of Owner(If Owner/Builder) f...\application\plumbing 9/1/14.xlsx rev 8/26/14