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Home My WebLink AboutUST-PERMIT COVERSHEET 4/12/2011HOODS ALARMSS SpGe3NG'sLER SYSTEMS AST MST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. 33 File Number: 33?7 Address: Date Received: Business Name: L3G6 `5- - Bakersfield, CA 933 C A IAA SYSTEM: BUILDING SQUARE FEET: New Mod. Commercial Hood System Fire Alarm System Fire Sprinkler System Aboveground Storage Tank Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank EY Other: PZ7-&4-1 C. Comments: Building Sq. Feet: Calculation Bldg. Sq. Ft: 1. a. 3. 4. NSPECTM LOG Date Time Signature Signature UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING/ SB989 SECONDARY CONTAINMENT TESTING/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION Please note that these are separate individual tests and will be charged per separate type test accordingly.) PERMIT # FIRS alrer . BAKERSFIELD FIRE DEPARTMENT Prevention Services clot t-t 5 -mev -T Bakerstield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page 1 of 1 ENHANCED LEAK DETECTION SB -989 SECONDARY CONTAINMENT TANK TIGHTNESS FUE=ONTTORING ERTIFICA ON ITE ATION FACILITY h^ NAME & PHONE # OF CONTACT PERSON ADDRESS 3 (DO OWNER NAME OPERATOR NAME PERMIT TO OPERATE # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES NO TANK # VOLUME CONTENTS l JLXI \ S-7 TANK;;TESTING COMPANY TESTING COMPANY l lv tJM>i_ NAME & PHONE # OF CONTACT PERSON t'o_ MAILING ADDRESS 5LOLA3 15<-00%-S CA `3308 NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR 1 OU - sc 9 CERTIFICATION # S09 e5oDATE & TIME TEST tO BE CONDUCTED ICc # aLe 3 - OTa \ TEST METHOD APPLICANT SIGN R DATE y la THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE FD2095 (Rev 03/08) BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT Prevention Servicec PERMIT # ARfO T oZ1o1 S f` Bakersfleld, CA 93301 Phone: 661- 326 -3979 • Fax: 661- 852 -2171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. Alarm - New & Modification (minimum charge) SITE INFORMATION LOCATION OF PROJECT Over 10,000 sq ft PROPERTY OWNER STARTING DATE COMPLETION DATE NAME SY 1 e_ ` O Sprinkler - New & Modification (minimum charge) PROJECT NAME ADDRESS PHONE # PROJECT ADDRESS 31 5 Rose,c le. w CITY g ER,S IELD STATE C.4 ZIP CODE 933og Minor Sprinkler Modification ( <10 heads) CONTRACTOR INFORMATION 84 CONTRACTOR NAME CA LICENSES TYPE OF LICENSE EXPIRATION DATE t PHONE # gaimESzc-vv t o 58 CONTRACTOR COMPANY NAME FAX # 3aco -8a3 ( 470 98 ADDRESS 180 /tank CITYCITY ZIP CODE 3 B All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. Alarm - New & Modification (minimum charge) 280 Over 10,000 sq ft 0.028 x sq ft Sprinkler - New & Modification (minimum charge) 280 Over 10,000 sq ft 0 .028 x sq ft Minor Sprinkler Modification ( <10 heads) 96 (inspection only) 84 Commercial Hood (New & Modification) 470 Additional hood 58 Spray Booth (New & Modification) 470 98 Aboveground Storage Tank (1 inspection per installation) AST 180 /tank 82 Additional Tank ATI 96 /tank 82 Aboveground Storage Tank (Removal, Mod,or Inspect'n) ATR 109 /tank 82 Underground Storage Tank (Installation/Inspection) NI 878 /tank 82 Underground Storage Tank (Modification) MOD 878 /site 82 Underground Storage Tank (Minor Modification) MTM 167 /site 82 Underground Storage Tank (Removal) TR 573 /tank 84 Mandated leak Detection (test) /Fue Mont CS'9139 NOTE: $96 /hr for each type of test/per s en if eduled at the same time TT 96 /hr (2 hrs minimu =$192 82 Oil well (Installation, Inspection, or re- inspection) X 96 /hr 82 Tent # 96 /tent 84 After -hours Inspection fee 121 /hr (2 hrs minimum) =$242 Pyrotechnic (1 permit per event, plus an inspection fee of 96 /hr during business hours) PY OTE: After hours Pyrotechnic event inspection is @ 121 hr 96 /hr + (5 hrs min standby fee /insp)= $576 5 hrs min standby fee ins = 605 84 Re- inspection /Follow -up Inspection 96 /hr 84 Portable LPG (Propane): # of Cages? _ 96 /hr 84 Explosive Storage 266 84 Copying &File Research (File Research fee $50 /hr) 0.25 /page 84 Miscellaneous 84 1 L I.— BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD d at the Job Site and DO NOT Remove for Durc Inspection Request Phone No. (661) 326 -3979 UST NEW INSTALL DESCRIPTION DATE SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF E_ - - TANKTESTING UST REMOVAL DESCRIPTION DATE SIGNATURE REMARKS: AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR AST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE PRIOR TO OPERATION OF ANY SYSTEM; ALL-UST AND /OR AST SYSTEMS SHALL .BE, INSTALL, COMPLETE AND ACCEPTED BY, MISC. ACTIVITY THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL) BUILDING ADDRESS: 1366 s JOB DESCRIPTION: C, OCCUPANCY TYPE: OWNER: C PERMIT NO. CONTRACTOR: O' w< PHONE FD 1743 City ofBakersfield i *t* CWTOKER RECEIPT *4f i lOrn -. TVANF0,55EN Type: GC' Draww-.1 Gate: 4/.9111 01 Receipt no:_ - 99957. 1 Descri tion @1 antity Annum cg11 1BQI` 133 i E+V BUILDTH6 PERMITS . 1.8+0 $152: TindEr detail H CHEC11 320 f 152A IDW tendered 1192:& TJtal payo.eiit $192e8 T,-;vs. date: 4119111 Time: 11:1a:40 KLP CwWROL THE PET POPULATION PRASE. SPAY AND NEUTER i CONSTRUCTION PERMIT Aamkl pol BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B E R S P 1 D 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313ARTMTOfficePhone: (661) 326 -3979 Application Number . . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . Owner CC PROP LLC 15039 CHAMPIONSHIP WY BAKERSFIELD CA 93314 11- 10000133 Date 4/19/11 3605 ROSEDALE HWY 332- 470- 05 -00 -2 FIRE DEPT 0 Contractor OWNER Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code . 1089234 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date . . . . 4/19/11 Valuation . . . . 0 Expiration Date . . 10/16/11 Fee summary Charged Paid Credited Due Permit Fee Total 96.00 96.00 .00 .00 Plan Check Total 96.00 96.00 .00 .00 Grand Total 192.00 192.00 .00 .00 CALL FOR INSPECTION 661) 326 -3979 Please state the Permit Number, the Job address, and the Type of Inspection. Requests for inspections should be made at least 48 hours in advance. DECLARATIONS Permit is issued in accordance with all applicable Federal, State and Local Ordinances. The permittee has properly signed and dated the reverse side of this form. This Permit expires after180 days of inactivity. I have reviewed the above application, and find it to be correct/complete. Permittee: Date: HAZARDOUS MATERIALS STATEMENT Yes—No Will the applicant or future occupant handle hazardous material or a mixture containing a hazardous material equal to or greater than the amounts specified on the list of extremely hazardous substances? See checklist for guidelines. Yes — No Will the proposed building or modified facility be within 1000 feet of the outer boundary of a school? Yes—No Will the intended use ofthe building by the applicant or future building occupant require a permit for construction or modification from the Kern County Air Pollution Control District (KCAPCD) or from the Bakersfield Fire Dept? See checklist for guidelines. Yes—No I have read the Hazardous Material Guide and KCAPCD Permitting Checklist. I understand my requirements under the Calif. Health and Safety Code Sec. 6.95 and Calif. Govt. Sec. 65850 and the requirements ofthe City of Bakersfield Fire Dept. regardinghazardousmaterials. Owner or Authorized Agent- gen hone No. Date DECLARATIONS: The declarations below are mandated by the State ofCalifornia under Section 19825 ofthe Health and Safety Code. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of the Division 3 of the Business and Professions Code and my license is in full force and effect. Lic. Class Lic. No. Exp. Date Contractors Signature Date OWNER- BUILDER DECLARATION I hereby affirm that under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to itsissuancealsorequirestheapplicantforsuchpermittofileasignedstatementthatheorsheislicensedpursuanttotheprovisionsoftheContractors License Law (Chapter 9 commencing with Section 7000 of Division 3 or the Business and Professions Code) or that he or she is exempt there from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofnotmorethanfivehundreddollars ($500)): I, as owner ofthe property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors License Law does not apply to an owner ofproperty who builds or improves thereon, and who does such work himself or herselfthrough his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have theburdenofprovingthatheorshedidnotbuildorimproveforthepurposeofsale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon and who contracts for such project with a contractor(s) licensed pursuant to the Contractor License Law). I am exempt under Sec. B. & P. C. for the reason Owner Signature I Date WORKERS COMPENSATION DECLARATION I hereby affirm that under penalty of perjury one of the following declarations: Carrier I have and will maintain a certificate of consent to self- insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Policy No. I certify that in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisionsofSection3700oftheLaborCode. I shall forthwith comply with those provisions. Applicant: Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT ANEMLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSANDDOLLARS ($100,000) IN ADDITION TOCOSTOFCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097 Civ. C.) Lenders Name Lenders Address 1 certify that 1 have read this application and state that the information contained herein is correct. 1 agree to comply with all city ordinances and statelawsrelatingtobuildingconstructionandherebyauthorizerepresentativesofthecitytoentertheabovementioned - propertyfor inspection purposes. Signature of Applicant or Agent I Date