Loading...
HomeMy WebLinkAboutUST 5/2010HOODS ALARMS SpG°3NKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: -1QQ cggO Address: /O l,N�o� AAA, Bakersfield, CA 933.. Date Received: Business Name: C_ka v 005 "j Comments: 1. 2. 3. 4. INSPECTION L ®G Date Time Signature SYSTEM: BUILDING SQUARE FEET: New Mod. ❑ ❑ Commercial flood System Building Sq. Feet: ❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft: ❑ ❑ Fire Sprinkler System ❑ ❑ Spray Finish System ❑ ❑ Aboveground Storage Tank ❑ ❑ Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank ❑ 2,- Other: ,4GUl C� Comments: 1. 2. 3. 4. INSPECTION L ®G Date Time Signature IE 05/01/2010 12:36 9516764061 TANKNOLOGY PAGE 01101 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD I LINE TESTING -SB989 SECONDARY CONTAINMENT TESTING I /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO, I ENHANCED LEAK DETECTION ❑ LINE TESTING S9489 SECONDARY CONTAINMENT TESTING TANK TIGHTNESS TEST R1 TO PERFORAA FUEL MONITORING CERTIFICATION FACILITY NAME PHONE NUMBER OF CONTACT PERSON 3 C) ADDRES5 BAKERSFIELD FIRE DEPT. OWNERS NAME Prevention Services Iev NUMBER OF TANKS TO BE TESTED IS PIPING G 01 N G TO sir TESTED? — 0 YES,, O NO 1501 Truxtu.n Ave. First Floor ---3LQLUm —E Bakersfield, CA 93301 TO- (661) 326-3979 Un 1, ocJ e4. Pax, (661) $52-2171 Page 1 of 1 PERMIT NO, I ENHANCED LEAK DETECTION ❑ LINE TESTING S9489 SECONDARY CONTAINMENT TESTING TANK TIGHTNESS TEST R1 TO PERFORAA FUEL MONITORING CERTIFICATION FACILITY NAME PHONE NUMBER OF CONTACT PERSON 3 C) ADDRES5 gg-x OWNERS NAME OPERATORS NAME r) k PERMIT TO OPERATE NO, N-4 ron Iev NUMBER OF TANKS TO BE TESTED IS PIPING G 01 N G TO sir TESTED? — 0 YES,, O NO TANK # ---3LQLUm —E CONTENTS Un 1, ocJ e4. e, . .............................. NAME OF TESTING COMPANY =E & PHONE NUMBER OF Michelle Cleghorn-Young Tanknology, Inc. CONTACT PERSON $00-666-1130 ........ .... MAILING ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 —"ME & PHONE NUMBER OF CERTIFICATION #: TESTER OR SPECIAL INSPECTOR DATE & TIME TEST TO OF- L T TEST CONDUCTED: L Q (U-n METHO D S1 OFJIkPPLICANT DATE: DATE '*1- SKoOA h&).P- O-re J'Lf- o n -Pil e, * 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 BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF AST_ S ALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR—/MAJOR PRIOR TO OPERATION OF ANY SYSTEM, ALL UST AND/OR AST SYSTEMS SHALL BE INSTALLED, COMPLETE AND ACCEPTED BY THE BAKERSFIELD CITY FIRE DEPARTMENT. A.Ir JOB DESCRIPTION OCCUPANCY TYPE OWNER i^p PERMIT NO. 16 CONTRACTOR –' IAJ K G© PHONE ' f FD 1743 UNDERGROUND STORAGE TANKS A BAKERSFIELD FIRE DEPT. It AA Ilk 3 7 VC— ^V . FIRS Prevention Services S%A R rN. T 1501 Truxtun Ave., First Floor 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 D To PERFORM FtJFL MONITORINn. rFRTIFI(-ATInN "'Iff" SIT, t I N- FOR 0"T, 10 FACILITY V NAME & PHONE NUMBER OF CONTACT PERSON ADDRESS 0 wl)(On BO-HerS tel d 93307 OWNERS NAME,,- - OPERATORS NAME,-Pk PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ❑ YES 1 ❑ NO TANK # VOLUME I CONTENTS CXU e0J eA I es e,, "M�' 0111, TAN k'TE TESTING N G 0 M �#N NAME OF TESTING COMPANY, Tanknology, Inc NAME & PHONE NUMBER OF Michelle Cie ghorn-Youn CONTACT PERSON g 800-6 66-1130 MAILING.ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF Daniel Visse*- TESTER OR SPECIAL INSPECTOR: C151 _Gip CERTIFICATION #: DATE & TIME TEST TO BE CONDUCTED: rnav o, I c) q, ivam 'c'#:!5c9Lkoc3qa - LAT TEST METHOD SIGNA E OF PPLICANT DATE: 41LIO 1,14ts(A.FrOLICATION RtdOMFES �� WHEN APPROVED APPROVED BY �DATE Li.ty of Naker.fieId -. Ut; err '3+ ARRI:LO - iyaeo +?L . Dray.erc.' l Ntes i3�.Ylo 01 Receipt rood , VAN . � ,: s ri t.ihn avu ntity .' A' "unt e' 1 ,' 10:+00027 ;_ � BUILDING PEIRMl iS_ ;L 6t_ail, lo:al' terFifel -ed. t coral. F'4` ®e M. sig2.10 i IY6114�.•''-.Ti me. ls,:s�:4�+�.. ';P �tY iii +L;1D't i'S CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B E R S P I D 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 ARTM T Office Phone: (661) 326 -3979 Application Number . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name Property Use . . . . . Application valuation . . . . Owner JACK IN THE BOX INC 9330 BALBOA AV SAN DIEGO CA 92123 -1516 SAN DIEGO CA 92123 10- 10000027 10 UNION AVE 139- 370- 06 -00 -7 FIRE DEPT 0 Date 5/11/10 Contractor ------------------ - --- -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code . 974642 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date . . . . 1/25/10 Valuation . . . . 0 Expiration Date . . 7/24/10 -=-------------------------------------------------------------------------- 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 (661) 326 -3479 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: 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 Agendfit`i - _ ; -r_° =' s ` -= =Na - 77777 7 . ' ° = 7 lPhone 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 7006 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 Signaturer°�,:. -_ �` ^�; -:� 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' jf Date