HomeMy WebLinkAbout2010 FMC RESULTS BOOS ALARMS SPG3UKLER SYSTERAS AST MST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
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File Number: 166-?Iygt ( Address: 32-Z.. I
Bakersfield, CA 933
Date Received: /-T - /0
Business Name:
SYSTEM: BUILDING SQUARE FEET: OMSPIEC` M LOG
New Mod.
❑ ❑ Commercial Hood System Building Sq. Feet: Date Time
❑ ❑ Hire alarm System Calculation Bldg. Sq. Ft: 19<
❑ ❑ fire Sprinkler Systems
❑ ❑ n �o
❑ ❑ Aboveground Storage Tank i` 4.
❑ C?' Underground Storage Tank -
minor ` v ��flaturrs
modification Underground Storage Tank
removal Underground Storage Tank
❑ ❑ Other:
Comments: F
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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 Reauest Phone No. (661) 326-3979
USLhjF.WNSTALL A NS ALL
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 T STING MODIFICATIONS MINOR/MAJOR
LI ---1- I
DESCRIPTION DATE SIGNATURE DESCRIPTION DATE SIGNATURE
RADE
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-
2 ST.
JOB DESCRIPTION TOCCUPANCY TYPE
OWNER /.4c. .t�,e I PERMIT NO. — 160tOO 4& _
CONTRACTOR At l .✓virc7 PHONE /S/ di/5 �oSa
FD 1743
Y
Tait Environmental Services
UST Construction • Design • Maintenance • Compliance
Transmittal
Fed EX Number: 7982 8423 0203
TO: UST Compliance Department FROM: Matthew Denison
COMPANY: Bakersfield Fire Department PHONE: 714-560-8200x404 FAX: 714-978-2615
1501 Truxton Ave.
Bakersfield, CA 93301
FAX: 661-852-2171 DATE: 1/7/2010
RE: AT&T Annual Monitor Certification, & Spill Bucket Testing
GEO: SA098
Hello. Tait will be on-site at the date and time indicated below in order to conduct the annual
monitor certification, and spill bucket test. Following this cover sheet will be the application and
check in the amount of$192.00. Please contact me with any questions and/or comments.
SA098 3221 S. H BAKERSFIELD 93304 9:00
STREET 2/3/2010 AM
CA Lic #588098 • AZ Lic #095984 • NV Lic #0049666
2131 South Dupont Drive • Anaheim, California 92806 • 714.560.8222 • 714.685.0006 Fax
11280 Trade Center Drive • Rancho Cordova, California 95742 • 916.858.1090 • 916.858.1011 Fax
www.tait.com
UNDERGROUND STORAGE TANKS vo'�_�� ��., d, ., BAKERSFIELD FIRE DEPT.
B H R 9 A I D Prevention Services
ARTAI f 900 Truxtun Ave., Ste. 210
APPLICATION Bakersfield, CA 93301
TO PERFORM ELD/LINE TESTING Tel.: (661) 326-3979
/SB989 SECONDARY CONTAINMENT TESTING Fax: (661) 852-2171
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION Page 1 of 1
PERMIT NO.
A5 ENHANCED LEAK DETECTION .e5 LINE TESTING .e5 SS-989 SECONDARY CONTAINMENT TESTING
A5 TANK TIGHTNESS TEST X TO PERFORM FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY NAME&PHONE NUMBER OF CONTACT PERSON
Pacific Bell Telephone Co. dba AT&T California Grant Armstrong (661) 327-6903
ADDRESS
3221 South H Street
OWNERS NAME
Pacific Bell Telephone Co. dba AT&T California
OPERAT R$NAME PERMIT TO OPERATE NO.
Ju ie Khdryan
NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? es YES NO
TANK # VOLUME CONTENTS
SA098UO01 6, 016 Gallons Diesel
TANK TESTING COMPANY
NAME OF TESTING COMPANY NAME&PHONE NUMBER OF CONTACT PERSON
Tait Environmental Services, INC. Matt Denison (714) 345-8080
MAILING ADDRESS
2131 South Dupont Drive, Anaheim CA 92806
NAME&PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR CERTIFICATION#:
Dragan Pesic Incon TS-STS 2756333760
DATE&TIME TEST TO BE CONDUCTED ICC#: TEST METHOD
5240928-UC
SIGNATURE OF APPLICANT DATE 0 1/0 7/2 O 10
A
APPROVED BY ' DATE
FD 2095 (Rev. 09/05)
Account Number: 03026 039640
TAIT-AIVIRONMENTAL SERVICES,INC. P.O.Box 11118*Santa Ana,CA 92711-1118 V PLEASE DETACH AND RETAIN FOR YOUR RECORDS 0
o ' JQ i�M Maw
010410 1/4/2010 1430 192.00
TOTAL: 192.00
QQ of Bakersfield
4* C63TOMER EJ!@ w,
Gy: tA» 6 %R; ± Drawer: !
L'
a w RIy @ @ w2I/ gi 6394
#Sri, #bn GaGR Agog!
, G2 !m%G5
6 bRgm PERM!TS
IA,e &G3
2 ['a g $192.
m
w } // |19/&
a date: 1/15/12 Tine: G;q;g .
.+m mgm6"
CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT
PREVENTION SERVICES
rA i D 1501 TRUXTUN AVENUE, 1sT FLR
FIRE BAKERSFIELD, CA 93313
T Office Phon e: (661) 326-3979
Application Number . . . . . 10-10000015 Date 1/20/10
Property Address . . . . . . 3221 S H ST
ATN (11 Digits) . 023-172-20-01-8
Application type description FIRE DEPT
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . . 0
Owner Contractor
-
------------------------
-----------------------
PACIFIC TEL & TEL CO OWNER
140 NEW MONTGOMERY ST # 818
SAN FRANCISCO CA 94105
(800) 303-3000
----------------------------------------------------------------------------
Permit . . . . . . MANDATED LEAK DETECT TEST
Additional desc . .
Phone Access Code . 973487
Permit Fee 96.00 Plan Check Fee 96.00
Issue Date . . . . 1/20/10 valuation . . . . 0
Expiration Date . . 7/19/10
----------------------------------------------------------------------------
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 W ill 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 .-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 ,-.,. 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 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 of the city to enter the above mentioned-property for inspection purposes.
Signature of Applicant or Agent .,_ , ., << ; Date
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