HomeMy WebLinkAbout989 FOLDER 2011HOODS ALARMS SPRINKLER SYSTEMS S1PRA\ FR)(O i(Ni
Permit No. Permit No. Permit No. Permit No.
File Number. /BV Address:
Date Received:
AST UST
Permit No. Permit No.
1034
Business Name:
SYSTEM: BUILDING SQUARE FEET: p(Z9SPE "TPON LO2
New Mod.
CCommercial Hood System
FFire Alarm System
FFire Sprinkler System
AAboveground Storage Tank
UUnderground Storage Tank
minor
modification UUnderground Storage Tank
removal UUnderground Storage Tank
Building Sq. Feet:
Calculation Bldg. Sq. Ft: 9.
a.
V 3.
4.
Other.
Comments:
Signature
Signature
BILLING & PERMIT STATEMENT ', BAKERSFIELD FIRE DEPARTMENT
s Prevention Servicec
PERMIT # 1 FIRE apt St ET
O' ARpp
p1M
p
r Bakersfield, CA 93301AftgoDhnnoa FaY• AFi1 - RS7 -71 71
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
Alarm -New & Modification (minimum charge)
N
SITE INFORMATION
LOCATION OF PROJECT PROPERTY OWNER
STARTING DATE COMPLETION TE NAME
PROJECT NAME S69 01 ADDRESSC J -/
PHONE
84
PROJECT ADDRESS CI Y gA k_' & ZSFI El D STATE CA ZIP CODE
CONTRACTOR INFORMATION
CONTRACTOR NAME CA LICENSE # ap" 5
TYPE OF LICENSE EXPIRATION DATE
t o l
PHONE #
CONTRACTOR COMPANY NAME FAX #
ADDRESS CI Y ZIP CODE -3
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
Alarm -New & Modification (minimum charge)
N
280
84
Over 10,000 sq ft 0.028 x sq ft
84
Sprinkler - New & Modification (minimum charge) 280
84
Copying & File Research (File Research fee $50 /hr)
Over 10,000 sq ft 0 .028 x sq ft
Miscellaneous
Minor Sprinkler Modification ( <10 heads) 96 (inspection only) 84
Commercial Hood (New & Modification) 470
Additional hood 58
Spray Booth (New & Modification) 470
98
Abov6ground 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
Uhderground 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) /Fuel Mont Ce SB989
NOTE: $96 /hr for each type of test/per site even
Scheduled at the same time TT
96 /hr (2 hrs minimu =$192 82
9= Oil well (Installation, Inspection, or re- inspection) X 96 /hr 82
t 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
NOTE: After hours Pyrotechnic event inspection is @ $121 /hr
96 /hr + (5 hrs min standby fee /insp) =$576
5 hrs min standbv fee /insD) =$605
84
O 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
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TRaipoWt 4192.00
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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
PRIORTO;OPERATION OF ANY - SYSTEM,-
ALL UST AND /OR AST SYSTEMS SHALL BE
INSTALL, COMPLETE AND ACCEPTED BY',,
MISC. ACTIVITY THE'BAKE_RSFIELDCITY FIRE DEPARTMENT.- ,
FIRE DEPARTMENT (FINAL) 4
REMARKS:
BUILDING ADDRESS:
JOB DESCRIPTION: OCCUPANCY TYPE:
OWNER: PERMIT NO. c C
CONTRACTOR: ZL PHONE # 8'
FD 1743
1
UNDERGROUND STORAGE TANKS
APPLICATION'S
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTINGITANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
Please note that these are separate
individual tests and ti Rl be charged per
separate type test zcr_.ordingly.)
PERMIT #
ENHANCED LEAK DETECTION LINE TESTING
TANK TIGHTNESS FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q 10 ( k-E SZREET
Bakerstield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661-852-2171
Page 1 of 1
4::SB-989 SECONDARY CONTAINMENT
SITE INFORMATION.
FACILITY
1
NAM PHONE # OF ONTA P N_
na
ADDRESS,
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE #
OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES NO
TANK # VOLUME CONTENTS
51 g
TANK TESTING; COMPANY
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
51n --13 C do%S GT. - P.P IG RSF 1'Ec. -D C1 °133oF3
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
MA—,QM `16 0 - 8(o q
CERTIFICATION #
S09 eso
DATE & TIME TEST 0 BE CONDUCTED ICC #
5ac k at3 - OT
TEST METHOD
APPLICANT SIGNATUR DATE
U 1(
HIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/08)
CONSTRUCTION PERMIT
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
AHMAD AMIN
12919 W BLUFFCREEK DR
LOS ANGELES CA 90094
BAKERSFIELD FIRE DEPARTMENTPalPREVENTIONSERVICES
R s II B D 1501 TRUXTUN AVENUE, 1 ST FLR
FIRE BAKERSFIELD, CA 93313IRTMrOfficePhone: (661) 326 -3979
11- 10000344 Date 9/14/11
2500 WIBLE RD
023 - 500- 24 -00 -2
FIRE DEPT
0
Contractor
OWNER
Permit . . . . . MANDATED LEAK DETECT TEST
Additional desc .
Phone Access Code 1131903
Permit Fee . . . 96.00 Plan Check Fee 96.00
Issue Date . . . 9/14/11 Valuation 0
Expiration Date . 3/12/12
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 after 180 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 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 —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 ofthe 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 of
not more than five hundred dollars ($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 of sale).
1, 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
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 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
1 certify that 1have 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 of the city to enter the above mentioned - propertyfor inspection purposes.
Signature of Applicant or Agent I Date