HomeMy WebLinkAbout2701 16TH Street_AST INSTALL 3.17.10K_ST_ RUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT
IIIIIIIIIIIIIII _ _
a -? PREVENTION SERVICES
VIII I B B R s P D 1501 TRUXTUN AVENUE, 1sT FLR75FIREBAKERSFIELD, CA 93313
ARIA/ T Office Phone: (661) 326 -3979
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
SCOTT WESLEY LLC
PO BOX 13428
93399
10- 10000086 Date 3/17/10
2701 16TH ST
004 - 150- 09 -00 -9
FIRE DEPT
0
Contractor
OWNER
Permit . . . . . . ABVGRND STR TANK (1 INSP /INST)
Additional desc .
Phone Access Code 985986
Permit Fee . . . . 90.00 Plan Check Fee 90.00
Issue Date . . . . 3/17/10 Valuation . . . . 0
Expiration Date . . . 9/13/10
Fee summary Charged Paid Credited Due
Permit Fee Total 90.00 90.00 .00 .00
Plan Check Total 90.00 90.00 .00 .00
Grand Total 180.00 180.00 .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:
76
J
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 r"
Yes _ No Will the proposed building or modified facility be within 1000, .
Yes _ No Will the intended use of the building by the applicant or future ion
from the Kern County Air Pollution Control District (KCAPCI.
Yes _ No I have read the Hazardous Material Guide and KCAPCD Perm . • 1
Health and Safety Code Sec. 6.95 and Calif. Govt. Sec. 65850 .u•;r: '• Ting
hazardous materials. Lit of fakersfield
Owner or Authorized A en "a 5 "` '" = X ? • g RECEIPTg -L'ii;"iF.F RECE PT
Uc2i`. iµRSHFORB fpe: IX Draw: !' DECLARATIONS:
The declarations below are mandated by the State of C Ns a: 3117110 @L. Receipt no: T-4299u +:
ription LICENSEDCONTRACTORSDECLARATIONRuann —ty Amount r•
i0 u0 0R6 . IherebyaffirmunderpenaltyofperjurythatIamlicensedunderprovisionso11t,
f the 31lI866
Business
and Professions Code and my license is in full force and effect. • G PERMITS 243
il(461 Lic.
Class Lic. No. Exp. Date Contm fender dot'aiI 0t
l ck ; . Isi . $180. 0 r
OWNER - BUILDER DECLARATION total tedered ,. . 61ti0.CM . I
hereby affirm that under penalty of perjurythat I am exempt from the Contr t+ta) payment #180.00 ss and
Professions Code: Any city or county which requires a permit to construe fray;.; date: 3!17110 'Time: 9 :16:18 issuancealsorequirestheapplicantforsuchpermittofileasignedstatementictors License
Law (Chapter 9 commencing with Section 7000 of Division 3 or the 1 from and
the basis for the alleged exemption. Any violation of Section 7031.5 by i HELP 10NITRul_ THE NET i•WULATITM of not
more than five hundred dollars ($500)): ': L AK 'SPY OR KLITER I,
as owner of the property or my employees with wages as their sole co( • offered
for We (Sec. 7044 Business and Professions Code: The Contrat:'ti,:: uilds or
improves thereon, and who does such work himself or herself through his ui no, vw„ .,,y..,y. ,; Y ........ .. .....• ...._. r_ ..::____._:_e not intended
or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden
of proving that he or she did not build or improve for the purpose of sale). I,
as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code:
The Contractors License Law does not apply to an owner of property who builds or improves thereon and who contracts for such project
with a contractor(s) licensed pursuant to the Contractor License Law). I
am exempt under Sec. B. & P. C. for the reason Owner
Signature ° =k - a . d,.:,.$ :; ' - _ :: °:e : t.. Date WORKERS
COMPENSATION DECLARATION I
hereby affirm that under penalty of perjuryone of thefollowing 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 of thework 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, 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
certifythat I have read this application and state that the information contained herein is correct. I agreeto complywith all city ordinances and state laws
relating to building construction and hereby authorize representatives of the city to enter the above mentioned property for inspection purposes. Signature
of Applicant or Agent I -` >= _•' •' °s =4 ;g_ _ s = $ - b °p;°,. Date