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Home My WebLink About1125 COFFEE ROAD (5)HOODS ALARMS SPRINKLER SYSTEMS J U' 00- " i Permit No. Permit No. Permit No. Permit No. File Number: 2 Z 35 Date Received: /O —e4 — / AST UST Permit No. Permit No. 11- 16n663'q Address: / /ate `}'rL- Bakersfield, CA 933 Business Name: CA r`d SYSTEM: BUILDING SQUARE FEET: ONSPECTION LOG New Mod. Date Time Commercial Hood System Building Sq. Feet: Fire alarm System Calculation Bldg. Sq. Ft: l El Fire Sprinkler System 2' 3. tip.;; C `u Aboveground Storage Tank 4. Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank Other. C Comments: 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 # ENHANCED LEAK DETECTION TANK TIGHTNESS b 8 R S P 1 n FIRE ARTM BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 . Fax: 661-852-2171 Page 1 of 1 LINE TESTING SB -989 SECONDARY CONTAINMENT FUEL MONITORING CERTIFICATION SITE INFORMATION FAC I Y ^ ^ Q'[J 11J ME & PHONE # OF CONTACT P ON ADDRESS S Coffee, OWN AME e1v OPERAT R NAME eV yov% PERMIT TO OPERATE k OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES X— NO TANK # VOLUME CONTENTS I I a IL e- me- a- 3 a iL 1?e u,l TANK TESTING COMPANY TESTTING CqMPANY M l) 1c, NAME & PHONE # OF CONTACT PER ON 1/0w) w) MAILING 411ADD SS QUS e 1 eQ 1 _Q,M 0. G cX 1 LA 11 a 5 0 UIE & PHON #OFT STER 0 SPECI L INSPECTOR neda Da -,a 7a., CERTIF CATION # 9 DATE )& TIM TEST TO BE CONDUCTED Q J) ICC # _ ooao TEST METHOD APPLICANT SIGNATURE DATE lo r T S APPLICATION BECOMES A PERMIT WHEN APPROVED APPVED BY . DATE FD2095 (Rev 03/08) 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) tEMARKS: BUILDING ADDRESS: A2 JOB DESCRIPTION: ?iyt C_ OCCUPANCY TYPE: OWNER: PERMIT NO. CONTRACTOR: —7-• ,j p PHONE ru 1 /4,5 CONSTRUCTION PERMIT Application Number . . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . Owner CHEVRON USA INC P 0 BOX 1392 BAKERSFIELD CA 93302 11- 10000382 Date 10/21/11 1125 COFFEE RD 501- 010- 06 -01 -2 FIRE DEPT 0 Contractor OWNER Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code . 1141977 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date . . . . 10/21/11 Valuation . . . . 0 Expiration Date . . 4/18/12 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: BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B x s P c 'a n 1501 TRUXTUN AVENUE, 1 ST FLR FIRE BAKERSFIELD, CA 93313ARTM _ T ti Office Phone: (661) 326 -3979 11- 10000382 Date 10/21/11 1125 COFFEE RD 501- 010- 06 -01 -2 FIRE DEPT 0 Contractor OWNER Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code . 1141977 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date . . . . 10/21/11 Valuation . . . . 0 Expiration Date . . 4/18/12 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: 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 ofa 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. 1 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 Ageny 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)): 1, 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 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 ofsale). 1, 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: 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: Carrier Policy No. I certify that in the performance of the work for which this permit is issued, 1 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 - property for inspection purposes. Signature of Applicant or Agent I Date