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HomeMy WebLinkAbout2012 LINE TEST HOODS ALARMS SFG°30HKLER SYSTEM S AST MS`s Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. og-i�000�.7Z- III III I III III IIII 57 1 File Number: � ��4' Address: Bakersfield, CA 933 Date Received: Business Name: Go,4C_Q� X9564. SYSTEM: BUILDING SQUARE FEET: MOPIECTM LOG New Mod. ❑ ❑ Commerc W Hood System Building Sq. Feet: Date ime ❑ ❑ Fire ; arm system Calculation Bldg. Sq. Ft: ❑ ❑ Kure SprinWer System 2. ❑ ❑ 3. ❑ ❑ Aboveground Storage Tank 4. ❑ 3- Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank Sug��t��Q ❑ ❑ Other: Comments: I I�IIIII�IlI�II I IV�I 58 IE I UNDERGROUND STORAGE TANKS a Y$ x s a BAKERSFIELD FIRE DEPT. D _i FAR! � Prevention Services DBNARTMiMT 1600 Truxtun Ave., Ste. 401 APPLICATION V Bakersfield, CA 93301 TO PERFORM ELD/LINE TESTING I % Tel.: (661) 326-3979 /SB989 SECONDARY CONTAINMENT TESTING Fax: (661) 852-2171 /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Page 1 of 1 PERMIT NO. 1 0 —/000O,27 ❑ ENHANCED LEAK DETECTION LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT TESTING ❑ TANK TIGHTNESS TEST ❑ TO PERFORM FUEL MONITORING CERTIFICATION ❑ Cathodic Protection Testing SITE INFORMATION FACILITY Coach America NAME&PHONE NUMBER OF CONTACT PERSON ADDRESS 1800 Golden State Ave. 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 Diesel 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#: 223613761 DATE&TIME TEST TO BE CONDUCTED 10/22/2009 ICC#: SIGNATURE OF APPLICANT DATE October 22,2009 THI§:APPLIGAWN COMES A PERMIT W,HENI APPROVED, APPROVED B DATE FD 2095 (Rev. 09/05) BILLING & PERMIT STATEMENT _ BAKERSFIELD FIRE DEPARTME B E R S F I ".L o prevention Services PERMIT # ARTMr 1501 Truxtun Avenue, 1s' FLR s Bakersfield, CA 93301 LOCATION OF PROJECT r /� �7 � PROPERLY OWNER Off 2 STARTING DATE COMPLETION DATE NAME ,/-'/J PROJECT NAME � ADDRESS �/,�ti--� PH( NE,t ODE PROJECT ADDRESS �j�r �L cm, gA l<-ER,SFI ELD STATE CA ZtP C-5 / CONTFZACTOR INFORMATION CO RN E r � CA LICENSE# OF LICENSE EXPIRATION DATE PHONE 3 �� CONT'RACryIGC�P�A'NY(CnXn NAM Iq, /` /-I L--FAX#,yk� ADDRESS � � ,/I _ CITY � ZIP CODE � All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. 1 ❑ Alarm - New&Modification (minimum charge) $280 ❑ .c Over 10,000 sq ft $0 .028 x sq ft O Sprinkler- New&Modification (minimum charge) $280 ❑ Over 10,000 sq ft $0 .028 x sq ft ❑ Minor Sprinkler Modification (<10 heads) $96 (inspection only) 8' ❑ Commercial Hood (New&Modification) $470 — ❑ Additional hood $58 Cl Spray Booth (New&Modification) $470 9f ❑ lAboveground 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 • Underground 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 Cert/SB989 $96/hr(2 hrs,,m�iniimum)=$192 84 NOTE: $96/hr for each type of test/per site even if – cheduled at the same time TT ❑ Oil well (Installation, Inspection, or re-inspection) X $96/hr 82 ❑ 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+ (5 hrs min standby fee/insp)=$576 84 $96/hr during business hours) PY OTE: After hours Pyrotechnic event inspection is @ $121 1hr 5 hrs min standby fee/ins = 605 ❑ Re-inspection/Follow-up Inspection $96/hr 84 ❑ Portable LPG(Propane): #of Cages? _ $96/hr 84 ❑ 1 Explosive Storage $266 84 ❑ Copying&File Research (File Research fee$50/hr) $0.25/page 84 ❑ Miscellaneous 84 BAKERSFIELD FIRE DEPT. JOBCARD Prevention Services s s n s a n 1501 Truxtun Ave.,Is'Floor Pigs Bakersfield,CA 93301 POST CARD AT JOB SITE �RrM T Tel.: (661) 326-3979 INSPECTION RECORD-USTs . Fax: (661) 852-2171 Page 1 of 1 FACILITY NAME OWNER 'S An45 L,�T tAIC, - ADDRESS �3r� ��' ADDRESS 70 Z 8 �,�26 �� sL�J CITY STATE ZIP CITY STATE ZIP I3 ?2--716 PHONE NO. \ r PERMIT NO. Z 2- O INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY WHEN EACH GROUP OF INSPECTIONS WITH THE SAME NUMBER ARE READY. THEY W ILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER 1. DO NOT COVER WORK FOR ANY NUMBERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION DATE INSPECTOR TANKS AND BACKFILL 02G BACKFILL OF TANK(S) MANUFACTURES METHOD/BRINE FILLED PIPING SYSTEM PRIMARY PIPING OR ELD Pif'ESS✓fib Z' Soz�" % 23 SECONDARY PIPING s ,Pb f SO2 i?Si 0 D \ GArF SECONDARY CONTAINMENT TANK(S) ki10R-ttTd€D ANNULAR SPACE,VACUUM ANNULAR SPACE,BRINE FILLED Of SECONDARY CONTAINMENT SUMP(S) L DISPENSER PANS/D.W.DISPENSER PANS FILL SUMPS/D.W.FILL SUMPS o/ ttRY-FiCt'�tvtPS LEAK DETECTION EQUIPMENT ANNULAR SENSOR(S) b� UDC SENSORS SUMP SENSORS 2,0 11 IS SYSTEM SET UP WITH POSITIVE SHUT-DOWN f W HEALY SYSTEM INSTALLED IS HEALY SYSTEM SET UP FOR I.S.D. o FINAL p L TYPE&MODEL OF MONITOR DEVICE C 11.12-0 109 FILL BOX LOCKS L AUTHORIZATION FOR FUEL DROP �+//G , � DROP 1 f � ELECTRICAL SEAL-OFF 9 !Z CONTRACTOR �'�O� o 1 ' ��L� LICENSE NO. 6g23� CONTACT /�1 I � �Gc 11 PHONE NO. 76r_>404 —63 St FD 2097(Rev.11/07) SAM'S CLUB NO.4819 DATE: 09-10-08 PROJECT: BAKERSFIELD, CALIFORNIA REV 1 PROJECT NO. 07-08-03001 TO: REVISON 1 This Revision forms a part of the Contract Documents and modifies the original Permitting Documents, dated 06-28-08, as noted below. SUMMARY: Adjustments/corrections made on drawings per City Plan Check Correction List dated 08-06-08. Adjustments/corrections made on drawings per City Fire Department Plan Review dated 08-19-08. Request from Shaw Engineering for an Architectural Site Plan of the Fueling Station. This Revision consists of Narrative pages 1 thru 3, and Drawing Sheets FSCO, FSAS1, FSA1, FSA2, FSS1, FST1. FSP1, FSE1, Metal Canopy drawings FS1, FS2, FS3, FS4, Modular Building drawings FKCS, FKA1 thru FKA6, FKE1, FKF1, FKM1, FKP1 AND FKSP1 all dated 09-10-08. FUELING STATION ARCHITECTURAL SHEET FSCO—COVER SHEET • Added to DRAWING INDEX: ARCHITECTURAL drawing FSAS1 PARTIAL FACILITY PLOT PLAN • Added to DRAWING INDEX: METAL CANOPY drawings (previously deferred submittals) • Added to DRAWING INDEX: MODULAR BUILDING drawings (previously deferred submittals) • Omitted from CONSTRUCTION DATA&CODE INFORMATION: DEFERRED SUBMITTALS (Note—these drawings were incorporated into the DRAWING INDEX. SHEET FSAS1 —PARTIAL FACILITY PLOT PLAN • New sheet added to the set of drawings. SHEET FSA1 —CANOPY DETAIL 1 —OVERALL PLAN • Changed 4" diameter"hoop" bollards to (2)6" diameter straight bollards. DETAIL 2—FRONT AND BACK ELEVATION • Changed 4" diameter"hoop" bollards to (2)6" diameter straight bollards. DETAIL 3—SIDE ELEVATION • Changed 4" diameter"hoop" bollards to (2)6" diameter straight bollards. DETAIL 4—DISPENSER PLAN • Changed 4" diameter"hoop" bollards to (2)6"diameter straight bollards. • Dimensioned bollards. • Added the 15" diameter bollard footing hown to be at to of Canopy slab. 9 P pY • Added Box Note regarding bollard connection to Canopy Column footing. • Added note/leader to bollard footing to read: "CONC FOOTING AT BOLLARD NOT TO INTERFER WITH PVC DOWNSPOUT PIPING OR CLEANOUT CONNECTIONS". DETAIL 5—PIPE GUARD • Changed 4" diameter"hoop" bollards to (2)6"diameter straight bollards. • Omitted Equip Sched ID Mark 34 and replaced it with: "6" DIA STEEL PIPE BOLLARD— FILL WITH CONC AND PARGE TOP SMOOTH TYP" (note—the paint designation remains as P5.) • Added Box Note: "REF STRUCTURAL DRAWINGS FOR BOLLARD CONNECTION AT CANOPY COLUMN FOOTINGS". EQUIPMENT SCHEDULE • Omitted ID Mark 34 (note-changed 4" diameter"hoop" bollards to (2) 6" diameter straight bollards). 1 �, �f q:�' �� ������ � ,r� SAM'S CLUB NO.4819 DATE: 09-10-08 PROJECT: BAKERSFIELD, CALIFORNIA REV 1 PROJECT NO. 07-08-03001 SHEET FSA2—SERVICE BUILDING DETAIL 2— ELEVATION • Added Key Box per Bakersfield Fire Department comments dated August 19, 2008. • Added Address Letters per Bakersfield Fire Department comments dated August 19, 2008. DETAIL 4— ELEVATION • Added Address Letters per Bakersfield Fire Department comments dated August 19, 2008. FUELING STATION STRUCTURAL SHEET FSS1 —FUEL STATION PLAN, SECTIONS,AND DETAILS DETAIL 2—CANOPY FOUNDATION PLAN • Added bollards that are structurally attached to the canopy column footings. DETAIL 3—CANOPY COLUMN FOOTING • Added bollards in generic locations to show structural attachment to the canopy column footings. • Added Box Note: "NOTE: CONCRETE FOOTING AT BOLLARD NOT TO INTERFER WITH PVC DOWN SPOUT PIPING OR CLEANOUT CONNECTIONS". FUELING STATION UNDERGROUND STORAGE TANKS SHEET FST1 —PIPING PLAN AND DETAILS DETAIL 1 — PIPING PLAN • Changed 4"diameter"hoop" bollards to (2)6" diameter straight bollards. • Added Canopy column footings to show relationship to dispenser sumps and piping., FUELING STATION PLUMBING SHEET FSP1 —SERVICE BUILDING PLUMBING PLAN AND DETAILS DETAIL 1 — PLUMBING FLOOR PLAN • Added note to waterline from meter that reads: "APPROX. 30' FROM METER TO FURTHEST PLUMBING FIXTURE" per City Plumbing Plan Check Item 4. DETAIL 6— DOWNSPOUT DRAIN LAYOUT • Changed 4" diameter"hoop" bollards to (2)6" diameter straight bollards. FUELING STATION ELECTRICAL SHEET FSE1 —SITE ELECTRICAL PLANS DETAIL 1 — DISPENSER POWER PLAN • Changed 4" diameter"hoop" bollards to (2)6"diameter straight bollards. DETAIL 2—CANOPY LIGHTING PLAN • Changed 4" diameter"hoop" bollards to (2) 6"diameter straight bollards. METAL CANOPY SHEET FS1 —COVER SHEET AND NOTES • Added to set(previously deferred submittal). SHEET FS2— FOUNDATION LAYOUT, ROOF PLAN AND DETAILS • Added to set(previously deferred submittal). 2 J SAM'S CLUB NO.4819 DATE: 09-10-08 PROJECT: BAKERSFIELD, CALIFORNIA REV 1 PROJECT NO. 07-08-03001 SHEET FS3—LIGHTING PLAN AND MISCELLANEOUS DETAILS • Added to set(previously deferred submittal). SHEET FS4—MISCELLANEOUS FASCIA DETAILS AND SIGN POST • Added to set(previously deferred submittal). MODULAR BUILDING SHEET FKCS—COVER SHEET • Added to set(previously deferred submittal). SHEET FKA1 —FLOOR PLAN AND ELEVATIONS • Added to set(previously deferred submittal). • 4"X 4"gutter behind fascia represented in dashed lines on BACK ELEVATION. • Roof and gutter represented in dashed lines on LEFT SIDE ELEVATION and roof slope noted. SHEET FKA2—INTERIOR ELEVATIONS • Added to set(previously deferred submittal). SHEET FKA3—FRAMING PLAN • Added to set(previously deferred submittal). SHEET FKA4—BUILDING SECTION • Added to set(previously deferred submittal). SHEET FKA5—BUILDING SECTION • Added to set(previously deferred submittal). SHEET FKA6—BUILDING SECTION • Added to set(previously deferred submittal). SHEET FKE1 —ELECTRICAL • Added to set(previously deferred submittal). SHEET FKF1 —FOUNDATION • Added to set(previously deferred submittal). SHEET FKM1 —MECHANICAL • Added to set(previously deferred submittal). • SECTION 1 shows method of attachment of RTU to curb. • Added TABLE M-1 DUCT CONSTRUCTION MINIMUM SHEET METAL GAGES. • Added DUCT VELOCITY TABLE. • Added conformance statement and instructions to GC regarding vent of the condensate drain. • Noted the condensate drain is%" metallic pipe. • Added H.V.A.C. NOTE 8: "ROOF ACCESS LADDER SHALL BE PROVIDED BY OWNER." SHEET FKP1 —PLUMBING • Added to set(previously deferred submittal). SHEET FKSP1 —SPECIFICATION SHEET • Added to set(previously deferred submittal). End of Revision 1 3 HAS R TSON FRENCH & A S S O C I A T E S, LTD. Architects Engineers Planners Landscape Interiors To: David C.Weirather Bakersfield Fire Department Re: Sam's Club Fueling Station, Club No.4819 5625 Gosford Rd. Bakersfield, CA. Subject: Response to Fire Prevention comments dated August 19, 2008. Plans: Complete plans and specifications for fire alarm systems;fire extinguishing systems, including automatic sprinklers and wet and dry standpipes; FM-200 systems and other special types of automatic fire-extinguishing systems; basement pipe inlets; and other fire-protection systems and appliances thereto shall be submitted to the fire department for review and approval prior to system installation. Plans and specifications for fire alarm systems shall include, but not be limited to, a floor plan, location of all alarm-initiating and alarm-signaling devices, alarm control; and trouble-signaling equipment; annunciation; power connection; battery calculations; conductor type and sizes; voltage drop calculations; and manufacturer, model numbers and listing information for all equipment, devices and materials ATTN: David A.Weirather(661)326-3706. Response: No change in drawings-the Fueling Station Service Building and Canopy does not require a wet or dry overhead Fire Protection system. Dry chemical fire extinguishers are used: (3) located on the camera/signage posts (in cabinets) under the Canopy and (1) in the Office of the Service Building. These fire extinguishers are in compliance with the requirements listed(see"Fire Extinguishers" below). Post"NO SMOKING"signs per California State Labor Code, Section 6404.5. Response: No change in drawings - regulatory signage is posted between all dispensers ref 6-FSA1 and 1-FSA3. Note—the Service building is not accessible to the public. Addresses: It shall be the duty of every person owning, occupying or controlling any building or store fronting on a public street or avenue in the city to number the same or cause the same to be numbered correctly and in accordance with this chapter, and it shall be the duty of any person owning, occupying or controlling any building hereafter erected within the city to so number the same within ten days after its completion or occupancy. Response: Address letter size and location have been indicated above the Office door of the Fueling Station Service building ref 2-FSA2. Key Boxes: Section 506 of the CA Fire Code, requires the addition of a key box for the use of emergency responders after closing hours. Applications for key boxes shall be made to the Bakersfield Fire Department, Fire Prevention Services, 1501 Truxtun Avenue, Bakersfield, California 93301. Response: A Knox Box and location has been indicated near the Office door of the Fueling Station Service building ref 2-FSA2. 809 Southwest A Street,Suite 201 Phone: 479.273.7780 Bentonville,Arkansas 72712 Fax: 479.273.9436 I r '�• � � � ' } r' • Page 2 September 10,2008 Fire Extinguishers (in cabinets if outdoors): A minimum of one 2A10BC extinguisher not to exceed seventy-five (75) feet travel distance from any point in the building. For further extinguisher requirements, see Section 906 of the 2007 edition of the California Fire Code. Response: No change in drawings - 2A10BC Dry chemical fire extinguishers are used: (3) located on the camera/signage posts in cabinets under the Canopy and (1) (wall-mounted) in the Office of the Service Building ref 6-FSA1, FSA1 SHEET NOTE 2, 1-FSA2 and FSA2 SHEET NOTE 2. Motor Vehicle Fuel-Dispensing Stations: This project is to comply with Chapter 22 of the 2007 California Fire Code. Response: Section 2203.1.1 - Drawings have been revised to show 6" diameter straight bollards at dispensers ref 1-FSA1, 2-FSA1, 3-FSA1, 4-FSA1 and 5-FSA1. "Hoop" bollards have been omitted from the EQUIPMENT SCHEDULE item 34. Section 2203.2— No change in drawings. The signage at the emergency stops located on the front corners of the Service Building reads: "EMERGENCY FUEL SHUTDOWN DEVICE LIFT COVER AND PUSH BUTTON). Section 2206.7.3 — This section indicates dispensers are on concrete islands with bollard protection per Section 312. The dispensers are on a 6"tall pedestal in lieu of a concrete island and 6" bollards are utilized per Section 2203.1.1. See reference drawings regarding Section 2203.1.1. HazMat Business Plan: File a Hazardous Material Plan Response: Refer to plan submitted for the Sam's Club. Fire Hydrants: Approved plan shall show all required and private fire hydrants conforming to the 2007 California Building Code. Response: Refer to civil plans submitted for the Sam's Club. Sincerely, Terry Hesseltine Mechanical Designer t 479.696.0372 f 479.696.0365 terry.hessletine(o-)hfa-ae.com www.hfa-ae.com i -. �.� ' � I �i I i ota ENHANCED LEAK DETECTION UST System Post Installation Test Report ELD Test Date: November 11, 2009 Customer: JAUREGUI & CULVER, INC 959 WEST MISSION AVE ESCONDIDO, CALIFORNIA 92025 Location: SAM'S CLUB #4819 5625 GOSFORD ROAD BAKERSFIELD, CA 93313 Tested By: CGRS, Inc. 5444 Dry Creek Road Sacramento, CA 95838 Project No: 6-8673-12266-8371 CGota 5444 Dry Creek Road Sacramento,CA 95838 CNHAWCCO Lc DCrCCnoH 800-288-2657 Test Certification Post Installation Enhanced Leak Detection (ELD) Location: CGRS Project No : 6-8673-12266-8371 SAM'S CLUB#4819 Test Date: November 11, 2009 5625 GOSFORD ROAD CGRS Techs: Tony Oddo BAKERSFIELD, CA 93313 This document certifies that the UST systems listed below at the above referenced location have been tested and passed the iota® VaporTite V005 tightness test. CGRS further certifies that the iota®VaporTite V005 meets the post installation testing requirements for post installation testing for newly installed underground storage tank systems as per the California Health and Safety Code, Chapter 6.7, section 25290.10)(1). Post Installation ELD Test Results 87 N Primary Containment System PASS 87S Primary Containment System PASS 91 Primary Containment System PASS DIESEL Primary Containment System PASS IOTA Tech Signature: 11/11/2009 Tony Od CA Tester No#05-1703 Date Reviewed by: 11/11/2009 Chris Murp y- CA Oerations M ag Date ®� CG 5444 Dry Creek Road Sacramento,CA 95838 800-28&2657 Final ELD Test Project Worksheet Final Test Date: 11/11/2009 IOTA Technicians: Tony Oddo Site Information Installation Contractor Information Facility: SAM'S CLUB#4819 Customer Name: JAUREGUI&CULVER,INC Address: 5625 GOSFORD ROAD Address: 959 WEST MISSION AVE City,State,Zip: BAKERSFIELD,CA 93313 City,State,Zip: ESCONDIDO,CALIFORNIA 92025 County: KERN COUNTY Contact: MATT JAUREGUI CUPA Contact Joe Canes TelephonelEmail 760-743-0518/JAUREGUICULVERINC @YAHOO.COM CUPA Phone: 661-862-8756 1 Joec co.kem.ca.us TANKS Tank No. Ca ac I. Product Type Manufacturer Brine Test Resuk TANK 1 20,000 87 N DW FIBERGLASS XERXES YES PASS TANK2 20,000 87S DW FIBERGLASS XERXES YES PASS TANK 3 12,000 91 DW FIBERGLASS XERXES YES PASS TANK 8000 DIESEL DW FIBERGLASS XERXES YES PASS COMPONENTS IN CONTAINMENT Tank Top Sums Diameter in. Depth in. Volume al. Description Test Result S1 48 60 470 87 TS PASS S2 48 60 470 87 FS PASS S3 48 60 470 87(2)TS PASS S4 48 60 470 87(2)FS PASS S5 48 60 470 91 TS PASS S6 48 60 470 91 FS PASS S7 48 60 470 DSLTS PASS Be 48 60 470 DSLFS PASS Junction Boxes with Tank Connection Description Test Resuk S TANK PROBE AND TURBINE J-BOX Open During Test PASS S TANK PROBE AND TURBINE J-BOX Open During Test PASS S TANK PROBE AND TURBINE J-BOX Open During Test PASS S TANK PROBE AND TURBINE J-BOX Open During Test PASS UDCs Len in. Width In. Depth in. Volume al. Description Test Result UDC1 36 28 40 175 LOCI PASS UDC2 36 28 40 175 UDC 2 PASS UDC3 36 28 40 175 UDC 3 PASS UDC4 36 28 40 175 UDC4 PASS UDC5 36 28 40 175 UDC 5 PASS UDC6 36 28 40 175 UDC6 PASS Transition sump Length in. Width in. Depth in. Volume I. Description Test Resul! TS1 38 24 36 142 VENT UDC PASS PIPING Product Piping Manufacturer Type Size in. Length ft. Test Result 87 N SMITH FIBERGLASS 3"OVER 2" 205 PASS 87S SMITH FIBERGLASS 3"OVER 2" 200 PASS 91 SMITH FIBERGLASS 3"OVER 2" 200 PASS DIESEL SMITH FIBERGLASS 3"OVER 2" 130 PASS Vent Pi in Manufacturer Type Size in. Length(fL) Test Result 87 N. SMITH FIBERGLASS 3"OVER 2" 75 PASS 87S. SMITH FIBERGLASS 3"OVER 2" 85 PASS 91 SMITH FIBERGLASS 3"OVER 2" 95 PASS DIESEL SMITH FIBERGLASS 3"OVER 2" 100 PASS [vapor Piping Manufacturer Type Size in. Len it Test Result 87191 SMITH FIBERGLASS 4"OVER 3" 210 PASS Leak Logs/Repair Tested All Pipelines,Sumps,Vents,Vapor Recovery,UDC's,and Tanks c:--6 ne -(/f_ _�: 11/11/2009 011703 11!112009 Revlewe y Date IOTA Tech Sig CA License No. Date UNDERGROUND STORAGE TANKS � $ � n BAKERSFIELD FIRE DEPT. -------- --- -- -------- F/RC Prevention Services 4?ARTME T 1600 Truxtun Ave., Ste. 401 APPLICATION Bakersfield, CA 93301 TO PERFORM ELD/LINE TESTING Tel.: (661) 326-3979 /SB989 SECONDARY CONTAINMENT TESTING Fax: (661) 852-2171 /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Page 1 of 1 PERMIT NO. ❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT TESTING ❑ TANK TIGHTNESS TEST X TO PERFORM FUEL MONITORING CERTIFICATION ❑ Cathodic Protection Testing SITE INFORMATION FACILITY ARCO NAME&PHONE NUMBER OF CONTACT PERSON ADDRESS 3125 California Ave. 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 U/L 2 87 U/L 3 91 U/L 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 Rafael Martinez DATE&TIME TEST TO BE CONDUCTED 12/17/2009 08:00 ICC#: SIGNATURE OF APPLICANT DATE 12/2/2009 den T IS,APPLI C-A ilO.Ni R.ECOMES,A PERMIT,WHEN APPROVED, APPROVED BY DATE FD 2095 (Rev. 09/05) BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT B. R R s F 1' - D Prevention Services PERMIT # �i1S l FIRE `11'V 1501 Truxtun Avenue, 1st Floor O AR7MA; r Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 SITE INFORMATION LOCATION OF PROJECT PROPERTY OWNER co STARTING DATE COMPLETION DATE NAME i•2-I�-2�0 PROJECT NAME ADDRESS PHONE# PROJECT ADDRESS m. gAK ETA SFl ELD STATE �'�} ZIP CODE 2-5- Ca/ OYH'a CONTRACTOR INFORMATION CONTRACTOR NAME CA LICENSE# TYPE OF LICENSE EXPIRATION DATE PHONE# CONTRACTOR COMPANY NAME FAX# ADDRESS CITY ZIP CODE All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. • G PERMIT TYPE FEE CALCULATION TOTAL DUE ACCT • ❑ Alarm - New&Modification (minimum charge) $280 0 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 ❑ boveground 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 ❑ Underground 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 Cert/SB989 $96/hr(2 hrs minimum)=$192 82 NOTE: $96/hr for each type of test/per site even if p1�) cyst# 1 Z46 scheduled at the same time TT • Oil well (Installation, Inspection, or re-inspection) X $96/hr 82 • 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+ (5 hrs min standby fee/insp)=$576 84 $96/hr during business hours) PY NOTE: After hours Pyrotechnic event inspection is @ 121/hr 5 hrs min standby fee ins = 605 ❑ 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 BAKERSFIELD CITY FIRE DEPARTMENT— INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work InsDection Reauest Phone No. (661) 326-3979 DESCRIPTION DATE SIGNATURE DESCRIPTION DATE SIGNATURE BACKFILL CRASH POSTS PRIMARY PIPE OVERFILL PROTECTION SECONDARY PIPE ELECTRICAL SEAL-OFF SECONDARY CONTAINMENT SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAL-OFF LPG INSTALL TANK TING MODIFICATIONS MINOR/MAJOR DESCRIPTION DATE SIGNATURE DESCRIPTION DATE SIGNATURE F GRADE PRIOR TO OPERATION OF ANY SYSTEM, ALL UST AND/OR AST SYSTEMS SHALL BE INSTALLED, COMPLETE AND ACCEPTED BY MISC.ACTIVITY THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL)�-�- REMARKS- C.t 1 JOB DESCRIPTION ?,f't .C. OCCUPANCY TYPE OWNER PERMIT NO. 0 - / CONTRACTOR PHONE# t5/-676-y060 FD 1743 BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANKS Prevention Services �� a l D Truxtun Ave., APPLICATION FIR! Bakersfield, CA 93301 ARTM T TO PERFORM ELD/LINE TESTING/ I<• Phone: 661-326-3979 • Fax: 661-852-2171 SB989 SECONDARY CONTAINMENT Page 1 of 1 TESTING/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION PERMIT# 1 —71 ❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT ❑ TANK TIGHTNESS FUEL MONITORING CERTIFICATION SITE INFORMATION FACILITY / C L/ �I AME 4 V1�,-Q&PHONE I�eiOF^CtO,NTACT�PE�RSON��/� ADDRESS `//lJ Ce f�E IW^F E LYT'[.tC/"C^ OWNER NAME �^ / OPERATOR NAME PERMIT TO OPERATE# - # OF TANKS TO BE TEST IS PIPING GOING TO BE TESTED? ❑ YES NO TANK # VOLUME CONTENTS �a a©C) 9011 ql *Cje TANK TESTING COMPANY TESTING COMPANYt--� A E&PHONE#'OF CO TACT PERSON a rt1l/ aZ©,� q S - C76 O- �l0 C MAILING ADDRESS N _ C e s e ��c f r,o�D e e j C (7 S9 NAME&PHONE # F TESTER OR SPECIAL IN PECTOR CERTIFICATIO # 1; rr -G3Y-t�� 33`( t3 DATE&TIME TEST TO BE CONDUCTE ICC# TEST METHOD 4ls/aa,a qal� sags�ge L� s®co � _ APPLICANT SIGNATURE DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APP VED BY DATE FD2095(Rev 06/07) i Cigf o¢ Bakersfield CUSTOihER RECEIPT Dom T VANFOSSEN Type: OC Drawer: 1 i Date: 12/15!09 lei Receipt no: 55773 Description auantity AQount l ?009 10000344 BP BUILDING PERMITS 1.60 8192.00 Tonder detail CK CHECK 4795 8192.00 Total tendered x192.00 Total payoent $192.00 ' Trans date: 12115/09 Time: 14:11.00 i "HAPPY HOLIDAYS" CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B rAR I D 1501 TRUXTUN AVENUE, 1sT FLR BAKERSFIELD, CA 93313 T Office Phone: (661) 326-3979 Application Number . . . . . 09-10000344 Date 12/15/09 Property Address . . . . . . 4101 CALLOWAY DR ATN (11 Digits) : 449-181-11-00-3 Application type description FIRE DEPT Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . 0 Owner Contractor ------------------------ ------------------------ BAKERSFIELD 32241 LLC OWNER P O BOX 711 DALLAS TX 75221 ---------------------------------------------------------------------------- Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code . 966093 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date . . . . 12/15/09 Valuation . . . . 0 Expiration Date . . 6/13/10 ---------------------------------------------------------------------------- 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 DECLARATIONS Permit is issued in accordance with all applicable (661) 326-3979 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. Please state the Permit Number,the Job address, and I have reviewed the above application, and find it to the Type of Inspection. Requests for inspections be correct/complete. should be made at least 48 hours in advance. 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.regarding hazardous materials. Owner or Authorized Agent"I' 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 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 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 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 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 °' 7--1 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 of the 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,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 1S 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 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 of the city to enter the above mentioned property for inspection purposes. Signature of Applicant or A ent F ,. Date