HomeMy WebLinkAboutFMC 2011HOODS ALARMS SPRINKLER SYSTEMS SP RAV BUS- `lT H AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
DOOC a7s
File Number: . ?/ d 7
Date Received: 7 - i5-- //
New Mod.
Address:
Bakersfield, CA 933
Business Name: -,W* v -` `a> y (< Q,
SYSTEM: BUILDING SQUARE FEET:
Commercial Hood System
Fire Aiarm System
Fire Sprinkler System
sway FWsh System
Aboveground Storage Tank
Underground Storage Tank
minor
modification Underground Storage Tank
removal Underground Storage Tank
21- Other. S43 - Sire
Comments:
Building Sq. Feet:
Calculation Bldg. Sq. Ft: 9
2.
3.
4.
MPECTION LOO
Signature
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD / LINE TESTING
SB989 SECONDARY CONTAINMENT TESTING
TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO.
ENHANCED LEAK DETECTION LINE TESTING
B_ BB9AIR -P
FIRE )
PopAirmsir
BAKERSFIELD FIRE DEPT.
Prevention Services
1501 Truxtun Ave., 1St Floor
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
Page 1 of 1
X SB-9N SECONDARY CONTAINMENT TESTING
TANK TIGHTNESS TEST TO PERFORM FUEL MONITORING CERTIFICATION Cathodic Protection Testing
SITE INFORMATION
FACILITY Jim Burke Ford NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS 2001 Oak St. Bakersfield, Ca.
OWNERS NAME Same
OPERATORS NAME Same PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? YES NO
TANK# VOLUME CONTENTS
1 87 UL
TANK TESTING COMPANY
NAME OF TESTING COMPANY Cal - Valley Equipment Bruce W. Hinsley 661- 327 -9341
MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Bruce W. Hinsley 661- 327 -9341 CERTIFICATION #: 548333761
DATE & TIME TEST TO BE CONDUCTED Icc #: 5270921 -UT
SIGNATURE OF APPLICANT 7114/2011
i UN
APPROVED BY 4 - DATE g .3 .
FD 2095 (Rev. U9IUb)
BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT
Prevention ServicesFIT # site 2101 H StreetwRSr
Bakersfield, CA 93301
Phnnw- 661 -326 -3979 • FATr 661 -R52 -2171
Jim Burke Ford Same
SIANT1NL9 DAIS WMPLETION DATE (NAME
PRO]ECr NAME ADDRESS IPHONE t
2001 Oak St.
CONTRACTOR INFORMATION
CONTRACILIR NAMF I CA LTFNCF S TVW nP 1 TPFNRR FXPIRATTON DATE PWMF !
Cal- Valley Equipment 921733 A 913012011 661 - 327 -9341
1 CONTRACTOR COMPANY NAME I FAX 'I 1
Cal- Valley Equipment 661 - 325 -2529
1 ADDRESS law - ZIPCODE
3500 Gilmore Ave. Bakersfield 93308
All permits must De revitewea, stamped, ana approvea PRIuK Tu tsew mmu wom.
DUE
Alarm - New & Modification (minimum charge) $280
ONLY
ACCT NO
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
I] 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 /sibe 82
Underground Storage Tank (Minor Modification) MTM 167 /site 82
Underground Storage Tank (Removal) TR 573/tank 84
11 Mandated Leak Detection (test) /Fuel Mont Cert/SB989
NOTE: $96 /hr for each type of test/per site even If
scheduled at the same time TT
96/hr (2 hrs minimum) =t!D
sc
82
0 Oil well (Installation, Inspection, or re- inspection) X 96 /hr 82
O 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) Illy
NOTE: After hours Pyrotechnic event Inspection Is Cop 121 /hr
96/hr + (5 hrs min standby fee/insp) =$576
5 hrs min stand fee fns = 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
ry Lf PAerS,field
Type, OL
i I I 'Ai Receipt no. 1510E
guantity Asount
DING I*RMIT6
192, m
6V-58 i
09
t G.M -46
T"!E K POPULATION
j'-AKC "rAY NND NEUTER
BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD
Post this Card at the Job Site and DO NOT Remove for Duration of Work
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
TANK TESTING -
UST REMOVAL
DESCRIPTION DATE SIGNATURE
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)
REMARKS:
BUILDING ADDRESS: -T
JOB DESCRIPTION: OCCUPANCY TYPE:
OWNER: - PERMIT NO. — /6660CONTRACTOR: (. -- PHONE #
FD 1743
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 of the 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 of the City of Bakersfield Fire Dept. regarding
hazardous materials.
Owner or Authorized Agentf Phone No. Date
DECLARATIONS: The declarations below are mandated by the State of California under Section 19825 of the 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 ofthe
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 its
issuance also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 commencing with Section 7000 ofDivision 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 of
not more than five hundred dollars ($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 of property who builds
or improves thereon, and who does such work himself or herself through 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 the
burden of proving that he or she did not build or improve for the purpose of sale).
I, as owner ofthe 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 ofproperty 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 ofthe following declarations:
Carrier
I have and will maintain a certificate of consent to self - insure for workers' compensation, as provided for by Section 3700 ofthe Labor Code,
for the performance of the work for which this permit is issued.
1 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 of the 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 ifI should become subject to the workers' compensation provisions
of Section 3700 of the Labor Code. I shall forthwith comply with those provisions.
Applicant: Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN
EMLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000) IN ADDITION TO
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST AND ATTORNEY'S FEES
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097 Civ. C.)
Lenders Name Lenders Address
1 certify that 1 have read this application and state that the information contained herein is correct. 1 agree to comply with all city ordinances and state
laws relating to building construction and hereby authorize representatives ofthe city to enter the above mentionedpropertyfor inspection purposes.
Signature of Applicant or Agent Date
CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT
PREVENTION SERVICES
E E R s P$ D 1501 TRUXTUN AVENUE 1sT FLR
FIRE
AR M `,' +.r BAKERSFIELD, CA 93313
R Office Phone: (661) 326 -3979
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
BURKE WESTWIND PROP L P
2001 OAK ST
BAKERSFIELD CA 93301
11- 10000275 Date 8/04/11
2001 OAK ST
332 - 222- 20 -00 -6
FIRE DEPT
0
Contractor
OWNER
Permit . . . . . . MANDATED LEAK DETECT TEST
Additional desc . .
Phone Access Code . 1120062
Permit Fee . . . . 96.00 Plan Check Fee 96.00
Issue Date . . . . 8/04/11 Valuation . . . . 0
Expiration Date . . 1/31/12
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 afterl80 days of inactivity.
I have reviewed the above application, and find it to
be correct/complete.
Permittee: Date: