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Home My WebLink AboutUST-PERMIT COVERSHEET 5/3/2011HOODS ALAAfr°3 41iS SPRINKLER SYSTEMS AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: ay:36 Ce Date Received: -s -3 - // New Mod. Address: ST, Bakersfield, CA 933 - Business Name: C( e tl v-0,1-) SYSTEM: BUILDING SQUARE FEET: Commercial Hood System Fire Alarm System Fire Sprinkler System Aboveground Storage Tank Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank Q' Other. !!E' cl S Comments: Building Sq. Feet: Calculation Bldg. Sq. Ft: 1. Cc- 2. o - . 3. 4. BENSPECT60M L05 Signature UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING/ SB989 SECONDARY CONTAINMENT TESTING/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION PERMIT # H B R S P 4 FIRE AtTN T BAKERSFIELD FIRE DEPARTMENT Prevention Services 1600 Truxtun Ave., Suite 401 Bakersfield, CA 93301 Phone: 661 - 326 -3979 . Fax: 661 - 852 -2171 Page 1 of 1 ENHANCED LEAK DETECTION LINE TESTING MSB -989 SECONDARY CONTAINMENT TANK TIGHTNESS FUEL MONITORING CERTIFICATION FD2095 (Rev 06/07) SITE INFORMATION FACILITY jOW K 1lC 4. NAME & PH2AE-0-Ai CONTACT PERSON Zr4w GLUTADDRESS ./ 17 11 TCf.I I E 1 CT'C3Qv OWNER NAME S nui ev- OPERATOR NAME_ MIT TO OPERATE # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? DSO YES NO TANK # VOLUME CONTENTS TANK TESTING COMPANY TESTING COMPANY NAME & PHONE # DWONTACT PE SO MAILING ADDRESS NAM & PHONE # OF TESTER OR SPECIAL INSPECTOR CERTIFICATION # DATE & TIME TEST TO BE CONDUCTED ICC # a BSI TEST METHOD iU APPLICANT SIGNATURE DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY 0. 4 . zitJ DATE s J —" FD2095 (Rev 06/07) 299 aw« Silil,'Hd 90PIN Wo Gm a+ 212» Cp CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B B R s P i D 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 ARTM T Office Phone: (661) 326 -3979 Application Number . . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . Owner SERVICE STATION HOLDINGS LLC 1508 18TH ST STE 222 BAKERSFIELD CA 93301 11- 10000162 Date 5/10/11 2317 L ST 005- 382- 07 -00 -1 FIRE DEPT 0 Contractor OWNER Permit . . . . . MANDATED LEAK DETECT TEST Additional desc . Phone Access Code 1095652 Permit Fee . . . 96.00 Plan Check Fee 96.00 Issue Date . . . 5/10/11 Valuation 0 Expiration Date . 11/06/11 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 ofextremely 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. regardinghazardousmaterials. _ Owner or Authorized Agen hone No. Date DECLARATIONS: The declarations below are mandated by the State of California 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 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 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 of the 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 himselfor 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 ofsale). 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 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 I Date WORKERS COMPENSATION DECLARATION 1 hereby affirm that under penalty of perjury one of the following declarations: Carrier I have and will maintain a certificate ofconsent 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 ofthe 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 if I 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 I certify that I have read this application and state that the information contained herein is correct. I agree to comply with all city ordinances and state laws relating to building construction and hereby authorize representatives ofthe city to enter the above mentioned - propertyfor inspection purposes. Signature of Applicant or Agent I Date 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: (G.s/r t -'f PERMIT NO. CONTRACTOR: .S)v, 3 Q,.(- PHONE # 3,2Z.— (pip FD 1743