HomeMy WebLinkAbout1533 (2)PLUMBING PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
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 licensed as required by Section 7031.5 of the State Business and Professional Code (•l claim exemption under
Section 7044). '
Signature of Contractor
Sig ature of06wn .
(If Owner/Builder)
f... \application\pl bing 9/1/14.xlsx rev 8/26/14
QTY
Amount
JOB ADDRESS:
1533 GOt;QQV AVE
Each Plumbing Fixture, Trap or Set of Fixtures
on One Trap (including Water, Drain Piping and
Backflow Protection)
$22
�l'"
JOB DESCRIPTION:
/40V/ 7 'M4i41. 4A/p
IOWA/4 SKPPu6S rex
it enite4DtiOtir o OATH1146
10/774 5K owe?.
1. Building Sewer
2. Trailer Park Sewer
3. Rainwater System - Per Drain (Inside Building)
4. Water Heater/Vent
5. Gas Piing Outlets (Enter No. of Outlets):
a. )_,6 Outlets, Total Fee
b/Over 5 (Per Outlet)
$44
$44
$22
$22
$34 Total
$7 Each
PROPERTY OWNER(S) NAME:
d(ao4y &q'SO
Industrial WasePretreatment
1. InterceRt6r, Including Trap and Vent
2. Uncle/Kink Grease Trap
$56
ADDRESS:
(5'33 if014 lit/ /41/6
$34
Each Installation, Alteration or Repair of Water
System (Piping Equipment or Repipe).
Total Repipe = Main + No. of Fixtures
$11
CITY, STATE, ZIP:
HOMOOAte -i toxo
I•if R
Each Repair or Alteration of Drainage or Vent
Piping
$11,..K
-i›<.
PHONE:3t0 zoo 4¢3?
Each Lawn Spr pkler System on any One Meter
(Including B,ac/ckflow Protection Devices)
$22
PLUMBING CONTRACTOR:
Atmospheric -Type Vacuum Breakers
(Not includedjtAbove item)
a. 1-5, Tot9l'Fee
b. Over 5"Per Breaker)
$22 Total
$7 Each
EMAIL ADDRESS:
ADDRESS:
Each Backflow Protective Device 'Other
Than Atmosp eric-Type Vacuum Breakers):
a. 2 Inche and Smaller
b. Over Inches
$22 Each
CITY, STATE, ZIP:
$22 Each
1. Fire Sprinkler Piping System
a. 1-10 Heads
b. 11-25 Heads
c. 26-50 Heads
d. 51-100 Heads
e. 101-209 Heads
f. 201-300 Heads
g. 30 -500 Heads
h. 1-1000 Heads
i. 1001 or More Heads
2. Sprinkler Riser Pipe
$22 Plus
$38
PHONE:
$63
$88
BUSINESS LICENSE NO:
$136
$189
STATE LICENSE NO:
$240
$314
TYPE OF BUILDING:
$472
$678
NO. OF STORIES:
$11 Each
Miscellaneous
$34
►
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: / /ti
ISSUED BY:
PERMIT NO: 10/tHO WO
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 licensed as required by Section 7031.5 of the State Business and Professional Code (•l claim exemption under
Section 7044). '
Signature of Contractor
Sig ature of06wn .
(If Owner/Builder)
f... \application\pl bing 9/1/14.xlsx rev 8/26/14