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HomeMy WebLinkAboutTENT INSPECTION (2)INSPECTIONS (FIRE SAFETY INSPECTIONS) HAZARDOUS CONDITIONS PERMIT APPLICATION .................. ............... II H E R S F I D FIRE AIV rM r l� BAKERSFIELD FIRE DEPT. PREVENTION SERVICES 1501 Truxtun Ave. Bakersfield, CA 93301 Tel: (661) 326 -3979 Fax: (661) 852 -2171 a-7 -3 Page 1 of 1 PERMIT: # I IIIIIII IIIIINIIIII 37 IE In conformity with provisions of pertinent ordinances, codes and/or regulations, application is made by.- Name of Company Address City, State, Zip <F'3/ -2365' a.-.2 -/ — en, -2 31s Contact Name Phone No. Cell No. To display, store, install, use, operate, sell or handle materials or processes involving or creating conditions deemed hazardous to life or property as follows: A PERMIT WAS ssued on 3d ZD By; 0 Denied Date inspecting Vtticer /rare marsnai FD 2099 White Copy to File Card Copy to Permittee for Display I IIIIIII VIII III IIII 38 IE TENTS ALL OTHER PERMITS See attachments LOCATION OF INSTALLATION: Q Nc EVENT DATE & PURPOSE: SET UP: TAKE DOWN: READY FOR INSPECTION: AFTER HOURS / WEEKENDS NUMBER OF TENTS: SIZE: NUMBER OF TENTS: SIZE: _ PYRO TECH NAME: PYRO TECH PHONE #: PYRO LIC #/ A PERMIT WAS ssued on 3d ZD By; 0 Denied Date inspecting Vtticer /rare marsnai FD 2099 White Copy to File Card Copy to Permittee for Display I IIIIIII VIII III IIII 38 IE BILLING & PERMIT STATEMENT PERMIT # B B R S F I D P/RB AR 111 T BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue, 1St FLR Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 •.. •. LOCATION OF PROJECT Golden West Casino PROPERTY OWNER STARTING DATE 4/30/10 COMPLETION DATE 5/1/10 NAME Ter y PROJECT NAME ADDRESS PHONE # 324 -6936 PROJECT ADDRESS 1001 S. Union Avenue CITY gAi<ER,SFIEI_D STATE CA ZIP CODE 93307 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 01NUIVOU • ❑ Alarm - New & Modification (minimum charge) $280 • • • ❑ 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 0 Minor Sprinkler Modification ( <10 heads) $96 (inspection only) 84 ❑ Commercial Hood (New & Modification) $470 ❑ Additional hood $58 ❑ Spray Booth (New & Modification) $470 98 ❑ Aboveground 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 NOTE: $96 /hr for each type of test/per site even if scheduled at the same time TT $96 /hr (2 hrs minimum) =$192 84 ❑ Oil well (Installation, Inspection, or re- inspection) X $96 /hr 82 X 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 during business hours) PY NOTE: After hours Pyrotechnic event inspection is @ $121 /hr $96 /hr + (5 hrs min standby fee /insp) =$576 5 hrs min standby fee ins = 605 84 ❑ 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 PERMITS A ENTERTAINMENT i BAKERSFIELD FIRE DEPT. Prevention Services TENT & CANOPY PERMITS I f �— 1501 Truxtun Ave., l9Y Floor Bakersfield, CA 93301 APPLICATION FORM pIR° � ; ARTIII T Tel.: (661) 326 -3979 PROCEDURES, & INSTRUCTIONS Fax: (661) 852 -2171 Page 1 of 1 PLOT PLAN MUST PROVIDE THE FOLLOWING INFORMATION (Any temporary membrane having an area in excess of 200 sq. ft. and /or Canopy /s (top only) in excess of 400 sq. ft. requires a permit (UFC §2.101) Application for a tent permit must be made at least 24 hours prior to the Fire Safety Inspection and the fire safety inspection must be completed and approved prior to operation. Please Note: If tents are not ready for inspection at the time stated, there may be a re- inspection fee charged or an after -hours inspection fee charged. 1. Location of tent or tents In respect to the following, a. Property Lines b. Building Structures C. Vehicle Parking d. Liquefied Petroleum Gas Containers e. Flammable and Combustible Liquids NOTE: Tents and canopies SHALL not be located within (20) feet of property lines, buildings, temporary membrane structures, other tents and canopies, parked vehicles or internal combustion engines. 2. Location of NO SMOKING signs, FIRE EXTINGUISHERS. NOTE: One Class 2 -A fire extinguisher shall be provided in every tent having a floor area between 500 sq. ft. and 1000 sq. ft. plus one 2 -A fire extinguisher in each auxiliary adjacent tent. One additional extinguisher shall be provided for each 2000 square feet or fraction thereof. 3. Exits: No point in tent to be more than 100 ft. from an exit 4. Seating plan: With minimum Isle measurements provided. (If applicable) NOTE: No flammable vegetation within (50) feet of any tent. Hay, straw, trash, or other flammable material shall be stored more than (50) feet from any tent. NOTE: If tent or canopy does not meet the above requirements, a permit will not be Issued and a re- inspection fee will be required. APPLICATION PERMIT: # NAME OF COMPANY / PERSON REQUESTING TENT APPLICATION Walker -Lewis PHONE 831 -7368 ADDRESS 4501 Ride Street �my Bakersfield TATE CA zip 93313 NAME OF COMPANY OR LOCATION OF INSTALLATION Golden West Casino PHONE NUMBER 324 -6936 ADDRESS 1001 S. Union Ave. �iTy Bakersfield TATE CA zip 93307 UMBER OF TENTS TO BE INSTALLED: _1_ ENT SIZE: ( ) 20 FT. X 60 ( ) FT. X ( ) FT. X FT. FT. FT. ET UP DATE TENT(s) TO BE INSTALLED: 4130110 TAKE DOWN DATE TENT(s) TO BE REMOVED: 611/10 ENT READY FOR INSPECTION ON (Date): 4/30110 APPROXIMATE TIME: 3pm AFTER HOURS /WEEKENDS ENT READY FOR INSPECTION ON (Date): AFTER HOURS /WEEKENDS (Date): OCCUPANCY USE OF TENT(s) [explain]: party VENT DATE(e): 4130/10 RE THERE TO BE INSIDE DECORATIONS? ❑ YES x NO NOTE-, State Fire Marshal Certificates of Flame Resistance for all tent fabrics and all interior decorative fabrics shall be provided prior to issuing of permits. RE LIGHTS BEING INSTALLED: xYES ❑ NO HEATING: ❑ YES x NO COOKING APPLIANCES: NOTE_ Explain type of equipment to be used for heating and cooking appliances. ❑ YES xNO FD 2063 (Rev. 09/05) PERMITS A ENTERTAINMENT r TENT & CANOPY PERMITS PROCEDURES, & INSTRUCTIONS FOR APPLICATION FORM B P riee A� f BAKERSFIELD FIRE DEPT. Prevention Services 1501 Truxtun Ave., 1s1 Floor Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of 3 Application for a tent permit must be made at least 24 hours prior to the Fire Safety Inspection and the fire safety inspection must be completed and approved prior to operation. Please Note: If tents are not ready for inspection at the time stated, there may be a re- inspection fee charged or an after -hours inspection fee charged. TENT: A temporary structure, the covering of which is made of pliable material that achieves its support by mechanical means such as beams, columns, poles, or arches, or by rope or cables, or both. (NFPA 102:2.2) CANOPY: A temporary structure, enclosure or shelter constructed of fabric or pliable materials supported by any manner, except by air or the contents it protects, and is open without sidewalls or drops on 75% or more of the perimeter. (CFC 3202.2) TEMPORARY MEMBRANE STRUCTURE. A building or portion of a building incorporating an air - inflated, air - supported, tensioned - membrane structure; a membrane roof; or a membrane - covered ridge frame to protect habitable or usable space that is in place for a period of 180 consecutive calendar days or less. (NFPA 102:2.2) PERMIT: A permit shall be obtained from the Bakersfield Fire Department Fire Prevention Services to erect or operate an air - supported temporary membrane structure or tent having an area in excess of 200 sq. ft. or canopy /(s) in excess of 400 sq. ft. (CFC 105.7 -t. 1) Tents, Canopies, or Membranes shall be permitted only on a temporary basis not to exceed 180 days In a 12 month period. (NFPA 102: 8 -1; CFC 3204) LOCATION OF TENTS, CANOPIES OR TEMPORARY MEMBRANES: Tents, Canopies, or Membranes shall not be located within (20) feet of property lines, buildings, other Tents, Canopies, or Membranes, parked vehicles, or internal combustion engines. (NFPA 102: 8 -5.3; CFC 3205.2) Tents, Canopies, or Membranes shall not be located within (50) feet of flammable and combustible liquids storage or vegetation. (CFC 3217.2) Flammable vegetation may be present Ntreated with approved fire- resistive treatments. FD 2063a (Rev. 09/05) PERMITS & ENTERTAINMENT TENT & CANOPY PERMITS n BAKERSFIELD FIRE DEPT. PROCEDURES, & INSTRUCTIONS I FOR APPLICATION FORM w/RR 1501 Truxtun Ave., 191 Floor • Sidewalls, drops, and tops of Temporary Membrane Structures, Tents, and Canopies shall be composed of flame- resistant material. (CFC 3207) 8 A 1 D Prevention Services ARTeI f Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 2 of 3 • The Bakersfield Fire Department requires a certificate or other evidence of approved by a laboratory of recognized standing that the tent fabric materials has the required flame resistance (State of California Fire Marshal's Seal). (NFPA 102: 8 -4; CFC 3207) • Tents, Canopies, or Membranes shall have a permanently affixed label with the following information: (CFC 3207) • Identification of size and fabric or material type. • The date they were last treated with an approved flame retardant. • The trade name and type of flame retardant utilized in the treatment. • The name of the person and firm that applied the flame retardant. • No hay, straw, shavings, or other combustible material shall be permitted within any structure used as an assembly unless it has been treated with an approved fire retardant. (NFPA 102: 9 -2.3) FIRE EXTINGUISHERS: • Fire extinguishers shall be provided in every Tent, Canopy, or Membrane structure at: (NFPA 102:9- 3.3) • Under 500 sq. ft. of floor area; One (1) 2 -A; 10 -BC • 500 — 1,000 sq. ft. of floor area; Two (2) 2 -A; 10 -BC • Each additional 1,000 sq. ft. of floor area; One (1) additional 2 -A; 10 -BC [ i [ •> F� : i L • I :1 I : I �� L r7 : F� • Smoking shall NOT be permitted in Tents, Canopies, or Membrane Structures or in adjacent areas where hay, straw, sawdust or other combustible materials are used or stored. (NFPA 102: 9 -2.4; CFC 3215.1) FLAME RESISTANCE: FD 2063a (Rev. 09/05) BAKERSFIELD FIRE DEPT. PERMITS & ENTERTAINMENT Prevention Services TENT & CANOPY PERMITS g E it g p 1 1501 Truxtun Ave., 1St Floor — Ir/8� Bakersfield, CA 93301 PROCEDURES, & INSTRUCTIONS F Tel.: (661) 326 -3979 FOR APPLICATION FORM Fax: (661) 852 -2171 U Page 3 of 3 SEATING ARRANGEMENTS • Spacing: • When seating in rows that have 14 or less seats, the minimum clear width between rows shall not be less than 12 inches. • If the seating exceeds 100 total seats, width between will increase by .3 inches for every seat beyond 14, not to exceed 22 inches. (CFC 2501.10.1) • Bonding: • Loose seats, folding chairs in excess of 300 and not fixed to the floor, shall be bonded together in groups of three or more. (2501.10.2) • Exit Slans: • Exit signs shall be required when necessary to clearly indicate the direction of egress when the exit serves an occupant load of 50 or more. (CFC 3214.1) COOKING AND HEATING: • Tents where cooking is performed shall be separated from other Tents, Canopies, or Membrane structures by a minimum of 20 feet. (CFC 3216.3.2) Electrical heating equipment shall not be located within 20 feet of an exit. (CFC 3216.3. 1) • Electrical systems and equipment shall be isolated from public by proper elevation or guarding, and all electrical fuses and switches shall be enclosed in approved enclosures. Cables on the ground in areas traversed by the public shall be placed in trenches or protected by approved covers. (NFPA 102: 10 -1.3) • No fuel fired heaters shall be permitted within any tent, canopy, or membrane structure. (NFPA 102: 10- 2.1.2) FLAMMABLE AND COMBUSTIBLE LIQUIDS: • Flammable and combustible liquids shall be stored outside in an approved manner not less than 50 sq. ft. from any Tent, Canopy, or Membrane structure. (CFC 3217.2) • Refueling shall be performed in an approved location not less than 20 ft. from any Tent, Canopy, or Membrane structure. (CFC 3217.3) • Generators and other combustible power sources shall be separated from Tent, Canopy or Membrane structure by a minimum of 20 ft. and isolated from contact with the public. (CFC 3219) FD 2063a (Rev. 09/05) C� t R gip` o fJ - rk, C* t ZE 4Qj Certif trate of iffame Re .5imance : REGISTERED ISSUED BY: Oats treated or APPUCATION AZTEC TENTS manutaaurea`r 'G CONCERN NO' 490 ALASKA AVENUE fr`` y TORRANCE, CA 90503 0312006 I*2 CAL COMB F- 419.01 (310)328 -6060 This is to certify that the materials described below hereof have been flame retardant treated (or are inher- ently nonflammable). FOR WALKER LEWIS RENTS ADDRESS 4501 RIDE STREET - ; CITY BAKERSFIELD STATE CA, 93313 �: > Certification is hereby made that: (check "a" or "b ") (a) The articles described below this certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in confor- F-1 with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Nameof chemical used ............. ............................... Chem. Reg. No......................... Meathodof application ................................................................. ............................... a (b) The articles described below hereof are made from a flame - resistant fabric or material registered and approved by the State Fire Marshal for such use; Fabric has been tested and passes NFPA701 -96. Trade name of flame - resistant fabric or material usedLemrnatedFan.;o . Reg. No...... ...... The Flame Retardant Process Used WILL NOT Be Removed by Washing (will or will not) • • • . David Bradley Chuck Miller - President'{ Nwm o tw or NuFsdon ti% ..................................................................................................:.................................................................... ............................... INSPECTIONS BAKERSFIELD FIRE DEPT. (FIRE SAFETY INSPECTIONS) PREVENTION SERVICES E E R s F I ° 1501 Truxtun Ave. - - - -- -- - - — - - -^ -- -1 AR TM f Bakersfield, CA e. HAZARDOUS CONDITIONS PERMIT APPLICATION I; Tel: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of 1 FPERMIT: # a.? 141 In conformity with provisions of pertinent ordinances, codes andlor regulations, application is made by: Name of Company Address 'City, State, Zip -:�S-i/— -:2':�- %g Contact Name Phone No. Cell No. To display, store, install, use, operate, sell or handle materials or processes involving or creating conditions deemed hazardous to life or property as follows: A PERMIT WAS 0 Issued on ,-/` 0 Denied Date X Auth zed Representath&AQ of Co ny Requesting, on By. Inspecting Officer /Fire Marshal FD 2039 White Copy to File Card Copy to Permittee for Display TENTS ALL OTHER PERMITS See attachments LOCATION OF INSTALLATION: .• le --17-- EVENT DATE & PURPOSE: SET UP: TAKE DOWN: READY FOR INSPECTION: AFTER HOURS / WEEKENDS /6 "-t NUMBER OF TENTS: SIZE: NUMBER OF TENTS: SIZE: / 307C Gin — PYRO TECH NAME: PYRO TECH PHONE #: PYRO LIC #/ A PERMIT WAS 0 Issued on ,-/` 0 Denied Date X Auth zed Representath&AQ of Co ny Requesting, on By. Inspecting Officer /Fire Marshal FD 2039 White Copy to File Card Copy to Permittee for Display C;tyy Of Bakersfield CUSTMR RECEIPT *# Oper: SCARRILLO Type: OC Drawer: i Date: 4/29110 01 Receipt no: W09 Description Quantity Aoount FR SAN, it INSPECTI0N4 .08 1.0® TENT Tender detail X406 M CK CHECK $56.0+ Total tendered $95.09 Total paynent Trans date: 4/2 11/10 Tioe: 15:Fw:00 HELP PLEA5E OL TOPET AT"' PERMITS & ENTERTAINMENT PERMIT # dd BAKERSFIELD FIRE DEPARTMENT TENT 81 CANOPY PERMITS A ... "Y LJ _� p -i, uj h .ail „'J � � J' i g,1 Prevention Services l T = ` Flee 1600 Truxtun Ave., suite 401 APPLICATION FORM rs AerA/ T Bakersfield, CA 93301 PROCEDURES & INSTRUCTIONS Phone: 661- 326 -3979 . Fax: 661 -852 -2171 Page 1 of 1 PLOT PLAN MUST PROVIDE THE FOLLOWING INFORMATION Any temporary membrane having an area in excess of 200 sq. ft. and /or canopy (top only) in excess of 400 sq. ft. requires a permit (UFC §2.101). Application for a tent permit must be made at least 24 hours prior to the Fire Safety Inspection and the fire safety inspection must be completed and approved prior to operation. NO If tent is not ready for inspection at the time stated, there may be a re- inspection fee charged or an after -hours Inspection fee charged. 1. Location of tent or tents in respect to the following: a. Property Lines b. Building Structures c. Vehicle Parking d. Liquefied Petroleum Gas Containers e. Flammable and Combustible Liquids No Tents and canopies shall NOT be located within twenty (20) feet of property lines, buildings, temporary membrane structures, other tents and canopies, parked vehicles, or internal combustion engines. 2. Location of NO SMOKING signs and FIRE EXTINGUISHERS. Two Gass 2-A fire extinguishers shall be provided In every dent having a floor area between 500 sq. R. and 1,000 sq. ft., plus one 2 -A fire extinguisher in each auxiliary adjacent tent. One additional extinguisher shall be provided for each 1,000 sq. ft. 3. Exits: No point in tent to be more than 100 ft. from an exit. 4. Seating plan: With minimum aisle measurements provided. (if applicable) NpTgg: No flammable vegetation within fifty (50) feet of any tent. Hay, straw, trash, or other flammable material shall be stored more than fifty (50) feet from any tent. ATE: If dent or canopy does not meet the above requirements, a permit will not be issued and a re- inspection fee will be required. APPLICATION PERMIT # ME.OF OD P /PERSON REQU TENT APP"Cmi � A t F !- - P HONe 1LL�i F l� �• �_ ... "Y LJ _� p -i, uj h .ail „'J � � J' i g,1 �♦�: .J �{ � 4 r AME OF COMPANY OR LOCATION OF INST TION PHONE J� ec4l t " L7 ADDRESS 'EAK.Fi R:59 U� P (� f f `°G� �ATECA 34=1 I U-An- BER OF TENTS TO BE INSTALLED . ENT SIZE (�) _ ft. X •A ft;. ( ) & X iR. ( ) R. X R. ET UP DATE TENT TO BE INSTALLED Q \ '^ O TAKE DOWN DATE TENT TO BE REMOVED V NT READY FOR INSPECTION ON (DATE) PPROXIMATE TIME 0 C) ll T 2 n 1 AFTER HOURS /WEEKENDS AFTER HOURS /WEEKENDS (DATE) NT READY FOR INSPECTION ON (DATE) OCCUPANCY USE OF TENT [EXPLAIN) ` \ C ENT DATE 0 1 THERE TO BE INSIDe ECORATIONST ONO State Fire Marshal Certificates of Flame Resistance for all tent fabrics and all Interior decorative fabrics shall be provided prior to Issuing of permits. RE LIGHTS BEING INSTALLE07 Q YES O NO HEATING? OYES "0 COOKING APPLIANCES? OYES NO • Explain type of equipment to be used for heating and cooking appliances. FD2063 (Rev 08,/07) Te . 1t Permit E Name of Customer and tiun: East Bakersfield Rotary / hoobele Brown Bakcafield Mumm of Ad 1930 "R" street i Bakersfield, Ca 93301 1 Tent size: I 1— 30x60 canopy with sid�wall Distance from bafldinga: E Will be against building on'one side No smoking signs: 2 will be in place Fire Extinguishers: 2 will be in place Exits: 2 — l Oft exits will be provided use or tent~ Over flow seating area Lighting: Yes Decorations: None from JoRonCo Rentals Installation Date: ' Apd��009 A4s.\ 3A,2c��o Removal Date: MCO. —/ L ) 1z)\, O Inspection Date and rime: '30, Zo 1 o ttC -k er Max Load: 100 people max Contact Person: Mchele Brown 871 -2898 - aoa� -o3 -�8 �2:4s , - ` » 6b13250fl8b P -313 s a i� It `. ISSUED By ®ago treetec0 or 1P�406�gd�C� Pacific Combining manufadured 3055 Fruitland Ave. Los Angeles, Ca. 90058 9 -25 -98 F -141 a This is PC ceir gy Mw ohs mma¢ ,gmsals dezcrihad an M3 reraroa Bidq herao§ have been R®me- Wa along ka aPad1 (or amca inheireM)y w0mlBammmmah9e). FO • Canvas Specialty ADDRESS —7344 IE Randi ri -Blvd CffY Los Angpi P4, 37.4 --- va-- €ernia -9vG49 CO r�i` Ga�vd�Uil tl� �t9BQ�4� mil l@�O �pli�8 hQ�:lt vr0" �nx OV) Tho c�iH3s dvcidbod an �ho voyomo oido of this hcnvo k�z,@ n �rGukad with m flame - retard ant 1 cherrncal approved and vd @14Poresd by %e Stato Ficc,) Aurshal and tl w the cipplicaflomo w$ said chamical. wa s dung In conforaamancz Ah thQ iaws of �ho Stwo of California and the Rulos and Regulations of iho Stab Cdr® Marshall. Nameof chemical uw d ......... ............................... ..........................Chem. Reg. No............................ Method-,of cappliceion .......................... - ..................... .. ................... .. ....... .......................................... (b) The articles described on tho reverse side hereof acre made from a flamo- resistant fabric or material registered and approved by the State fire Marshal for such case. Trade name of flame - resistant fabric or maateriasl used...... Pacifitex ..................Reg. Na... -f=mil... The Aame Uarrant Process Used..will. not. Be Removed By dashing it i ®r e.A moo) S.R. Goodson Cep Prpnident Name of Applicator or Production Superintondont Fitio �Mo heuoh'; ¢Grr 5k Phis P® be a "a dap-§ of Pic& "CCU@ OVOClaM (OF RME ROOSVANCE" iuusd % da, "(W60BRao ¢cP 'f' ®f ,zhich Woo bGgn 9W W89h Oho- C®Dif (Drama Pago Film ma,mhoo. 6QNVAS QIMMETV 1734" Eaz$ MandWO o vd.' doss anSAG3, CAW. ° n 0 �� Yvonne Cordero STAT! OF CAL FORMA- F>MrpTUMME ONOiEC"ON FIRE SAFETY INSPECTION REQUEST Aoa�cvoa�rTACrswiME Dave VoWJertlyn Step W UCEIS61NO riesus s1a>ck, Im AGENCY 1326 30d1 St Bldg. B NAIREAND Bakenfic , Ca 93301) ADDFMSS L See bobvedom on mvme. REquw oATB FROWMM 661 -324 -0638 7AV2010 Jan Shack Mobile Medical AGEWY FAOUrV 630012815 N rra�r auaoc¢ 1 1. OMaWL A FkCLFi1RANM 2 REWWAL SAFE WM 9. CmwffY GK MOE �. B. WORM CK%4W J c. NAME CMAMBE 7. MW s NIA 0 W/A 0 NIA 9 FAC UTY NAME UCEMW CATEOCRT Jesus Shack Mobile Medical pre clinic S1Mr1ACORM(A LaD0b0 N1Aa�ROPlt�t�INaB 1326 30th St 1314 B 1 aTY FASfltMrt Bakerslkld7 NIA FACUW WWWT MOO" WW FAdUTY cow#= Pamo a Tuff"am wmI HOURS Jerilyn Stewart 661,834.2799 3,Zq—p(o3g T' "' 3-7pm SPECMI. CQNOffK1A6 Mobile Medical Clinic TO BE Copptt:TEO BY 1NWtC%M AUTHOWTV at�RANCEp�.�000E CODES AUrHDRffY FiiiE fi CLEARAN�.Ti GRANTED NAM AND 2 d D1 ' yTtX.�w 2. tea: «PARAMM DENMD Ass. AL am L rKc1��s�+ , J a. COMSTRl1m" Q MW ALARM owe f or TB.EPn011ERUg9ER ommumm oocuwua.Ya,wa a aPRacat Rs R. SPECYIL F1A7i1R0 —10 - mm 12rA PMArIJ �j a OrNER 1°40Y1 �� cti,� FIRE ARTM r..:....r use Fax Cover Sheet Phone: (661) 326 -3979, Fax: (661) 852 -2171' Address: 2101 H Street Bakersfield, CA 93301 Date: 0/5 10 To: i�A -t2lij/�/ LOpEz Re: csos s Acv- n4,r3,L- MGntCAL- pppuc.o n,,j From: 90LAjazO l,.J,MCS - Fire Prevention Division Fax: �Ir- / 3Z2 _ -?g7, Phone # Pages: ,2 7b HoR C 02oc-(?- wauLr7 O X PC-C i -CO SECS Yc) u 2 MA—ie AS T4E AG£vcY ivv 7- 74c IS AS A f2CSut,i cl� TIC LMIUSUAL 1-JAV 7744= �GUUC— T IM 49cW1aM. -wft Md OAMM SWVkWaasa LICENWRE & CERTIFICATION APPLICATION OWWAN r o i r wr•. ""k ,�+o�esw� _ A APPLICATION A. •• 1. Type of appfcatlaa (check one): a a. Initial r c. Management comparry (see Sections C1 -5, F. and Attachment E -1) (' b. Change of OwnwaLp (see !2 below r d. Odher change (see Sedion A4): 2. change of Owrmstdp only - For Cerl NcWon Prnpoess: We wish to make certain that our records oorrecdy show the eftco re date of Me ownership charge for calf atia>fh. This date should reflect the actual date an which you 1100k dWV of the ftencial management of the facility rather than the date of sale or date of state license change. Effedt4e date of change: r- 3. Amount of fee enclosed: i WOOD. oo 4. Type of Change (cttecit all Cat guppy): • a. Not applicahie r f. Change of bed dassificatiorh r. b. Change of capacity (see * 8 below) (". g. Change of name r c. Change of location h. Constructon of new or replacement facility d. Change of aerviop r L Stack transfer r e. Change of faaiUltr tyP r i• other (1►) S. Type of facility, agency, or dknic (Check one) r a. Skilled Nursing Faddy (SNF) f- L Rural health dhic (for CeMfcation - only") r b. Mtermedlate Care Fadlity (ICF) r J General acute care hospbi r a:. ICF0ew&pme lly Disabled (ICF/DO) r It. Adult day health care center r d. 1CF/D13- HabiGlsdve (ICF/DD -H) r L Home Health Agency (HHA) C. e. ICF/DD-Numhg QCF/DD-N) r m. Hosploe r f. Primary care cliMc - Free r. n. Chronie diayds clinic r g. Primary care Clef - Community • a Other (spe dfy) PBUMIF Fr sy are- 7r-se MIME r h. Surgical cflft 8. a. Do you wish to appy for the Medicare program? (' Yes a No Medicare Provider IL Focal Intemhedery choice: 7. Do you wish to apply for the Meth -Cal (Medicaid) program? (- Yes 0 No 8. L Current f8C ft bed Capadty: pla b. Proposed fadity bed cap@W. 9. Age range of dlents' pirtS to EFRE 10. Days and hoans of operation: I sd,..,, uo Dry, 11. Is construction required? r Yes *No If yes-. sub, copy of'OSHPD' form (see inskudkM on page 6) if yes-, date construction to begin: If yes -, date corrstraictlon to be completed: AUG 9 2010 H$ 200 (0¢005) David Voss From: Jerilyn Stewart Derilyns @bak.rr.com] Sent: Thursday, November 04, 2010 4:52 PM To: 'David Voss' Subject: RE: the last thing for license That is correct. 1A and #1 and a new date and signature is all that we need. Maybe the big guy in a uniform that came with Ron to the inspection would be able to sign the form? If you do get this signed tomorrow, would you fax to Kathryn Lopez? Fax number. 916 - 322 -7879 Sorry for the illness at home, Jerilyn From: David Voss Lmailto:davidv @jesusshack.coml Sent: Thursday, November 04, 2010 7:07 AM To: 'Jerilyn Stewart' Subject: RE: the last thing for license Good Morning — Sorry for delay had 2 sick children and a dental appointment for the third yesterday. So to understand our needs correctly in the request code box he needs to write 1A? And then on the Clearance /denial code to just put #1? Or are there actual code #s they are looking for? Ron is gone and I do not know the new chief. So maybe this is the time! Cast your cares on the Lord and He will sustain you; he will never let the righteous fall!" Ps 55:22 Dave Raising A Generation to Reach This Generation Jesus Shack, Inc David Voss President davidvi@iesusshack.com 1326 30th St. Bldg. B Bakersfield, Ca 93301 tel: (661) 324 -0638 fax: (661) 324-0556 From: Jerilyn Stewart fmailtoJerilyns(ftak.rr.com1 Sent: Tuesday, November 02, 2010 6:57 PM To: davidv jesusshack.com Subject: the last thing for license Hi Dave, I think that we are getting close. We just need one more correction.... on the permit from the fire department, there is one box that they did not fill in... The clearance /denial code. This is something that they must fill in. I don't know if Ron Fraze can do this, or since he has retired if the other guy that came that day can fill out the form. Give me a call and we can discuss or if you can get Ron to do it great, it not let us chat. All the other paper work is finished, and accepted. Blessings, Jerilyn Stewart H 661 - 834 -2799 M 661 - 599 -0306 K4YI6 Cell g6 S- �Z7 -oz3g S (�l-3zy -0638 STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST STD. 860 (REV. *=M See imiftc0ons on reverm AGENCY GONTAGM NAVE TELEPHONE NUMBER REQUEST DATE PROGRAM Dave Voss/Jerilyn Stewart 661- 3240638 11/8/2010 Jesus Shack Mobile Medical EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE NAME AND IA 2 FRE CLEARANCE DENIED CODES 1. ORIGINAL A FIRE CLEARANCE - -� I LIt:@N81 2. RENEWAL S. LIFE SAFVY AGENCY Y NAME AND 3. CAPACRYCHANGE ADDRESS 4. OWNERSHIP CHANGE C. FIRE ALARM 6. ADDRESS CHANGE LR NAME CHANGE O. SPRINKLERS 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PgEVKM CAM" CAPACITY PW%%=CA0A0ry CAPACITY PI -WouG GVMCT/ 8 N/A 0 N/A 0 N/A 8 FACILITY NAME LICENSE CATEQORY Jesus Shack Mobile Medial pre clinic STREET AOORE8S (Achrd►LeG" INAAAGR OF BUMMINGa 1326 30th St Bldg B I CITY RESTRAINT Bakersfield IDA ic—w ACT PERSONS NAME FACILITY CONTACT PERSONS TELEPHONE NUMBER HOURS Jerilyin Stewart 661 - 834 - 2799/661- 599 -0306 1Lesday 3 -7PM SAL C NdUTIONB Mobiel Medical Cliaic TO BE COMPLETED BY INSPECTING AUTHORITY r I CLEARANOeoENIPILGODE CODES 1. FIRE CLEARANCE GRANTED FIRE AUTHORITY NAME AND 2 FRE CLEARANCE DENIED ADDRESS A EXIT'S I__•_ I J 9. CONSTRUCTION C. FIRE ALARM O. SPRINKLERS INSPECYOIMNAME(T)Ved -P TELEPHONENUMB&R CFIRSNUMB6R OCCUPANCY CLASS E HOUSEKEEPING F. SPECIAL HAZARD G. OTHER INSPECTM DATE $1SPECTORS SIGNATURE IT)W W P*jW .. • .'... �i....:n'� -'M.K: �: � .. Vii.. _♦ . � ♦ T . �.. _ . r .. > . v . • S .. - •y .. 1 ... • ... STATE, OF' CAUFaWA - 'FORESTR'/ ANDARE PROTECTION ( oleo_ FIRE SAFETY INSPECTION REQUEST �— 'G /7A �S STD. 880 (REV. 42000) See InSTEf1lCtlonS OA /6VelSe. / AGENCY CONTACT S NAME TELEPHONE NUMBER ' REaIEST CKM CFIRS NUMBER pave vosvieril3m Stewart 661- 324 -0638 7/8/2010 Mobile: edical EVA"TOR'S NAME RMMSTTNO AWNCY FACIUTY NUMBER ePROGmm F. SMALF GATE 4 0 INSPE S�GW► - -a or'vArts�p ES 1. ORIGINAL A FIRE CLEARANCE (� UGENSING � •Jo311S Shack, Inc 2. RENEWAL B. LIFE SAFETY AGENCY 1326 30th St Bldg. D _ NAINEAND BakMfield,Ca.93301J B, CAPACITY CHANGE ADDRESS 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE J e NAME CHMGE 7. OTWR AMBULATORY NONAMBULATORY BEDRIDDEN• TOTAL CAPACITY CAPACITY serous c~0i oaenwn C.IPACAY plem us CAPAOnn . s N/A. 0 • • Nip, 0 N/A . 8 FACILITY NAME . i LICENSE CATEGORY Jesus Shack Mobile Medical' •. • pre clinic STREET NMES9 (AGArsILOW&V NUMBER OP BUTAINGS 1326 30th.St Bldg B ' 1 Cm RESTRAINT Bakemfield7 • NIA s NAME RAM4V CONrAGT PERSONS TaEMM NUMBER HOURS Jerilyn Stewart: 661-934 -2799 T,Th 3 -7pm . Mobile Medical Clinic FIRE AUTHOPrFY NAME AND 2 �. r�t • .T it .I ADDRESS TO Bt? COMIPI.E MD BY INSPECTING AUTHORITY CLEARAPAMODENLALCM f ' 1. PIKE Ct.6ARANCfi GRAIrTEO Z, FIRE CLEARANCE DENIED A. EWS IL CONMTRUCTTON C. FIRE ALARM Arpd a" TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS D. SPRINKLERS F. SMALF GATE 4 0 INSPE S�GW► - -a or'vArts�p G. OTHER. . IN DENIAL OR LIST SPlCUa GONOr pm i _ _ SCHOOL INSPECTION CHECKLIST Bakersfield Fire Dept. Prevention Services 900 Truxtun Ave., Ste. 210 ' Bakersfield, CA 93301 Tel: (661)326 -3979 SCHOOL NAME Ch / INSPECTION DATE /o- A io ADDRESS C! e J INSPECTION TIME INSPECTION DATE f` HONE NO. C V C=Gompfiince OPERATION COMMENTS l� ❑ EXIT OBSTRUCTIONS 4/ ❑ EXIT STAIRS ❑ ILLUMINATE EXIT & DIRECTIONS SIGNS I� ❑ NON- COMBUSTABLE WASTE CONTAINERS [;I/ ❑ HOUSEKEEPING ELECTRICAL ROOM 93/ ❑ ELECTRICAL - USE OF EXTENSION CORDS 1!d ❑ HOUSKEEPING GENERAL Ld' ❑ HOUSKEEPING BOILER ROOM / CLEARANCES plx ❑ CLEARANCE AROUND ELECTRICAL PANEL BOARD g/ ❑, FIRE DRILLS /RECORDS ❑ FLAME RETARDENT DECORATIVE MATERIAL ❑ ASSEMBLY AREAS W ❑ FIRE ALARM SYSTEM (SERVICED) ❑ ❑ SPRINKLER SYSTEM (SERVICED) G7/ ❑ COMMERCIAL HOOD SYSTEMS ❑ FIRE APPARATUS ACCESS EDP ❑ STAGE AREA J IF VIOLATION NOTICE CORRECTION: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (6 61 ) 3 2 6 - 3 9 7 9 Ad I dl 7 Ile- Inspector Badge No./Stabon While • School Copy Yellow - Station Copy 1. ro� K - ct, Responsi le arty Pink - Prevention Srvices V Te c security systems, inc. Quality nz Smiry, Q-1ky ru Seraur Bakersfield Fire Department 900 Truxtun Avenue — Suite #210 Bakersfield, CA 93301 Phone (661) 326 -3979 Fax (661) 852 -2170 To Whom It May Concern: Effective immediately Tel -Tec Security Systems, inc. will no longer be providing the fire alarm monitoring services for the following address. South Kern Machinery 520 South Mt Vernon Ave Bakersfield CA 93307 The contact person for this site is JD @a 661 - 833 -9900. S' We ; g E. ayton President Tel -Tee Security Systems, Inc. Phone 661 - 397 -5511 Fax 661 - 834 -3616 5020 Lisa Marie Court - Bakersfield, California 93313 • (661) 397 -5511 - License #472338 L'd 9 L9E -bE8( 1, 99) 'swe}sAS 4.jnoeg oel-lel dtq :t O O L ti0 po Tel -T ec security systems, Inc. Q-alay =n S"Aawy, Query . S". Bakersfield Fire Department 900 Truxtun Avenue — Suite #210 Bakersfield, CA 93301 Phone (661) 326 -3979 Fax (661) 852 -2170 To Whom It May Concern: Tel -Tee Security Systems, inc. is not providing the fire alarm monitoring and annual certification services due to the absence of phone lines for the following address. Bombay Palace and Cocktail 254 White Lane Bakersfield CA 93307 The contact number is 661- 303 -1260 r Sincerely, Morgan E. Clayton President Tel -Tee Security Systems, Inc. Phone 661 - 397 -5511 Fax 661 - 834 -3616 5020 Lisa Marie Court - Bakersfield, California 93313 • (661) 397 -5511 - License #472338 L -d 9L9£-b£8(L99) 'swe}sAS 4.jnoeg oel -lel d9£ :£0 OL t L AoN .......................................................................................................... ............................... INSPECTIONS (FIRE SAFETY INSPECTIONS) B E R S F I D - - — -- - - FIRE ARTM T HAZARDOUS CONDITIONS PERMIT APPLICATION PERMIT: # _ 04 3-3 .......................... ............................... BAKERSFIELD FIRE DEPT. PREVENTION SERVICES 1501 Truxtun Ave. Bakersfield, CA 93301 Tel: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of 1 In conformity with provisions of pertinent ordinances, codes and/or regulations, application is made by: S, /00 / 772 J ei ✓•,1 4-4 '2�h . CA , 9330 / Name of Company Address City, State, Zip 4'SZ- -7366 gCF66t -55d S� Contact Name Phone No. Cell No. To display, store, install, use, operate, sell or handle materials or processes involving or creating conditions deemed hazardous to life or property as follows: A PERMIT WAS Issued on l - I —1 � I By: Denied Date Inspecting Officer/Fire Marshal FD 2039 White Copy to File Card Copy to Permittee for Display TENTS ALL OTHER PERMITS See attachments LOCATION OF INSTALLATION: EVENT DATE & PURPOSE: SET UP: TAKE DOWN: READY FOR INSPECTION: AFTER HOURS / WEEKENDS NUMBER OF TENTS: SIZE: NUMBER OF TENTS: SIZE: PYRO TECH NAME: l��g•Je PYRO TECH PHONE #: PYRO LIC #/ Gpp— Ot Z0 A PERMIT WAS Issued on l - I —1 � I By: Denied Date Inspecting Officer/Fire Marshal FD 2039 White Copy to File Card Copy to Permittee for Display r _ � MV of Bakersfield *vi C.1I;210 -h REMIPT ;?1LLU Type-.. M . Drar2ro l Lam � l f IlM l 0l Htt�ipt �.r�o:.,. fit 144 1 description Quaniit.yy, Aao +iii; 6-*, F@ FE':Y J?W.EMOlds PY :11 tr7 ;131 Total tudered S6Q15 >� Intal payunt; 6 .119 franc dete Roe o- .l3,5ta14: } �HRPPY HII.CLIDO" 1 PERMITS & ENTERTAINMENT PYROTECHNICS PUBLIC FIREWORKS DISPLAY (Indoor/Outdoor) APPLICATION SPECIAL EFFECTS PERMIT PERMIT #: DATE: COORDINATING AGENCY: ATTACHMENTS: B E R S F I D FIRE ABTM T BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 Fax: 661 - 852 -2171 Page 1 of 2 COMPANY NAME: Rabobank Arena PHONE NO.: 661 -852 -7300 PAGER NO.: FAX NO.: 661 - 861 -9904 COMPANY ADDRESS 1001 Truxtun Ave CITY Bakersfield STATE CA ZIP CODE 93301 PROJECT PROJECT: Disney Live PERSONNEL: TITLE: UPM TYPE: LOCATION MGR AUTOS OTHER LOCATIONS Rabobank Theater ACTIVITIES See Attached. SHOOT DATES: BETWEEN THE HOURS: 1.1114/11 3 pm and 8 pm 2. 3. AUTOS 4. PICTURE CARS TOTAL NUMBER OF DAYS: 1 TOTAL NUMBER OF PERSONNEL: TRANSPORTATION PYROTECHNIC SPECIAL FX TRUCKS MOTOR HOMES OPERATOR See Attached AUTOS PICTURE CARS LICENSE # VANS CAMERA CARS F.D. PERMIT # CATERER GENERATOR PHONE NO. MONITORS # DEPARTMENT APPROVAL BY: FSO CHP / POLICE INSURANCE COMPANY: EXP DATE: RANGERS ESTIMATED DEPARTMENT / PERSONNEL COST: PERMITTEE AGREES TO ALL OF THE TERMS AND CONDITIONS OF THIS PERMIT INCLUDING PROVISIONS ON THE REVERSE E OF THIS FORM AND ATTACHMENTS. COMPANY REPRESENTATIVE BAKERSFIELD CITY FIRE DEPARTM NT FD 2068 (Rev. 04/08) PERMITS & ENTERTAINMENT PYROTECHNICS PUBLIC FIREWORKS DISPLAY (Indoor/Outdoor) REQUIREMENTS SPECIAL EFFECTS PERMIT BAKERSFIELD FIRE DEPARTMENT "FIREPrevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 Fax: 661-852-2171 Page 2 of 2 State Law requires that whenever pyrotechnics special effects are used during events or production, a permit shall be issued from the authority having jurisdiction to a State Fire Marshal Licensed Pyrotechnic Operator. Pyrotechnic Special Effects is defined in the California Health and Safety Code, Section 12532 (see section on Special Effects). It is important to understand what pyrotechnic special effects are and are not. The following requirements shall be obtained from the authority having jurisdiction prior to the issuance of a special effects permit: 1) A valid Pyrotechnic Operator's License issued by the State Fire Marshal, 2) Only Pyrotechnic Operators who possess a valid 1St or 2nd Class License shall be allowed to apply for a special effects permit. Pyrotechnic Operator V Class is a.trainee license and must be under direct supervision of a 1st or 2"d Class Licensee. 3) After the Fire Department has seen proof of the license, several points shall be discussed: a) Name, address, license #, phone number, and fax number of permittee. b) Assistant's names and license numbers. c) Special effects activity, location, and plot plan (if necessary). d) Proof of insurance (usually provided by Production Company). e) Conditions [i.e., standby fire safety officer(s), fire protection equipment, area of operation limitations, testing (if necessary), storage and transportation requirements...]. f) Pyrotechnic special effects materials list (total quantities of each device). g) Issue and expiration dates. h) Signatures — licensee and authority having jurisdiction. i) Ensure they have a copy on site at all times. FD 2068 (Rev. 04/08) Feld Entertainment.. Inc Presents 2010 - 2011 Production STATEIFIRE MARSHAL CALIFORNIA DEPARTNENT OF FORESTRY and FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIREWORKS LICENSE License Type: GPD -0520 Issue Date: 04/29/2010 Licensee: RINGLING BR/B&B OOMBINED SHOWS ATTN -. JEROME SONRLSRY 8607 WESTWOOD CENTER DR. VIENNA, VA 22182 -0000 The named licensee is authorized to perform all acts permitted a fireworks PUBLIC DISPLAY (GENERAL) pursuant to Part II, Chapter I of the Health and Safety Code of the State of California. Expires: 6/30/2011 Dr- -putt' 3tata Fire Maraha3 rn -:o IUZ-:4-o:) License AT -1199 Issue Date:. 09/29/2010 Type: Licensee: ULTRATEC SPECIAL EFFECTS INC ATTN:-.'.ADRIAN SE.GEREN 146 MOON :,DRIVE, cis CROsSROAsDS, AL 35763 M_ 10102 -L+ -811 The nained licensee is authorized to perform all acts permitted a fireworks U"ORTEWE"ORTER pursuant to Part II, Chapter I pf the `Health.and Safety Code of the State of California. Expires: 6/30 /2011 Deputy State Fire marshal M-10 102 -la -all SHOW SCHEDULE Engagement Information Disney Live! Mickey's Magic Show - 2010 -2011 Bakersfield, CA (48) 1/14/2011 - 1/14/2011 (661)852 -7300 Performance Schedule Rabobank Theater 1001 Truxton Avenue Bakersfield, CA 93301 Date Morning fternoon Late Afternoon Evening (1) (2) Fri 01/14/11 :00 PM 6:00 PM Shows listed in Red (if any) are not confirmed or are educational shows not open to the public. ACORDr CERTIFICATE OF LIABILITY INSURANCE DATE 2/101010 12110!2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 11 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Wells Fargo Insurance Services USA, Inc PHONE FAX NO - 1544AIL, 1401 H Street, NW, Suite 750 ADDRESS' FELDENT CUSTOMER To #_- Washington, DC 20005 NS S AFFORDING COVERAGE NAIC a INSURED Feld Entertainment, Inc_, Ringling Bros&Bamum & Bailey INSURER A: National Union Fire Ins. Co. of Pittsburgh, PA 19445 wSImER 8 8607 Westwood Center Drive INSURER C: S 960A00 INSURER 0: PRODUCTS - COMPPOP AGG S 960,00 DISURERE: 3 Vienna, VA 22182 INSURER F: LNBMM ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COVERAGES CERTIFICATE NUMBER: 2105BUl REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWrTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ I TYPE OF MURA14CE INSR WVD POLICY NUMBER W F LUMTS A ce1ERAL LIA13Im X COMUERCIAL GENERAL LIABILITY CLAINL%ANADE � OCCUR X SIR 360A00 GL4572872 1112011 111/2012 EACH OCCURRENCE $ 950000 ; 950.00 MED EXP (Any me prim) $ 0 PERSONAL 8 ADV INJURY S 950A0 GENERAL AGGREGATE S 960A00 GENL AGGREGATE LIMIT APPLIES PER POLICY PRO LOC PRODUCTS - COMPPOP AGG S 960,00 3 AUTOMOBILE LNBMM ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea acddsd) BODILY UUURY (Pa person) ; BODILY INJURY (Per a=akn) ; PROPERTY DAMAGE (Pef -dd-Q _ = i UMBRELLA LWB EXCESS LIAR HCLAIMS4WADE OCCUR EACH OCCURRENCE S AGGREGATE i DEDUCTIBLE RETENTION f ; S WORKERS COMPEENSATION AND EMPLOYERS' LIABaM YIN ANY PROPRIETORiPARiNERqDE-Cli1VE❑ OFRCERIMEbSER EXCLUDED? jYarda}nry in NH) I describe under DESCRIPTION OF OPERATIONS below N!A YC STATU- OTH- S EL EACHACCIDENr EL DISEASE - EA EMPLOYEE 3 EL DISEASE - POLICY LIMIT S DESCWTION OF OPERATIONS 1 LOCATIONS N VE1111Ci ES {ACaah ACORD 101. Adfff= al Remarks ecIzerule. if mac space is regtmed) SMG, Bakersfield Fire Dept., The State of Cafdomia, City of Bakersfield, its Mayor, Council, officers, agents, employees and volunteers are additional insured with respect to liability arising from incidents which occur as a resuit of the Nsured's negligence for pyrotechnical display. CERTIFICATE HOLDER CANCELLATION Rabobank Arena Theatre and Convention Center 1101 Truxtun Avenue Bakersfield, CA 93301 ffhrs cenirrate renlaces oerrt5r a 2097n5 issued an 12MM 101 ACORD 25 (2009109) SHOULD ANY OF THE ABOVE DESCILBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORII® REPRESENTATIVE ©1988 -2009 ACORD CORPORATION_ All rirthtc racorvPd The ACORD name and logo are registered marks of ACORD THIS F111OMEM1ENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ENDORSEMENT #1 This endorsement, effective 01/0112011 12:01 A.M. forma a part of Policy No. GL 457 28 72 i9sued to FELD ENTERTAINMENT, INC. by NATIONAL UNION WE INSURANCE COMPANY ADDITIONAL INSURED - WHERE REQUIRED UNDE19 CONTRACT OR AGREEMENT This andors&vent modffies insurance provided under the loft wing: COMMERCIAL GENERAL LIABIUTY CGVEkAQE FORM SECTION II - WHO IS AN INSURED, is emended to add: f} Any person or organization to whom you becorne oblfgated to include as an additional insured under this policy, but only to the extant that any contract or agreement you enter Into requires you to furnish insurance to that person or organization of the type provided by this policy. However, the insurance provided to such person or organization will not exceed the lesser of: The coverage and /or limits of this policy, or • The coverage and/or limits required by said contract or agreement. No coverage exists under this policy for the liability of any parson or organization you area obligated to include as an additional insured arising out of or reiatiing to such person's or organkation"o operations independent of (i) property held, or (ii) operations engaged in on your behalf. ulthit�'C Packaging Work Sheet special effects Inc_ Part Number FELD 1 FIRE 16 Show Name Micke s Magic Show -DL2 Per Show Total Show Demo Total Qty Qty Set City Qtv Qtv Q1v Lot # Packed Received Location Part # DescriDtion QTYQi NEQ per Total Device NEQ 11 1 1 21 Wand CPPGOB1212S 1/2 X 12 LMH Silver Gerb 1.3 2.6 2 2 1 Top of Carriage CLP- AF2951 AF 12' Capless Star Mines w/Tail - Blue 5 15 1 1 1 Cannon/Finale CPP- AF3206N AF 29 Tracer Comet Red 2 - 2 1 Target CPPA120 SMALL SILVER AIRBURST SINGLE LMH 2.4 7. 2 21 1 3 Alladinrrarget CLP1235 Smoking Device 6 Seconds 1.5 4.5 11 11 1 2 1 Top of Carriage CLP- AF2954 I AF 12' PINK Capless Star Mines wlfail - Pink 1 10 9 TOTAL PIECES PER SHOW Total NEQ 45.3 Mickeys d Minnie's Magic Show Running Order, Description and Detonation Distances Effect Description Product Distances 1 Fairy Wand {1} 1 x12 LMH Gerb CS, Approx 12' from stage edge20' + from Audience 2 Top of Cinderella's Carriage {3} AF Mines USR, Approx 12' from stage edge20' + from Audience 3 Washing Machine {1} 6 Second Smoking Device C5, Approx 22' from stage edge 30'+ from Audience INTERMISSION 4 Cannon Shot {1} AF Red 20' Tracer Comet USR, Approx 12' from stage edge20' + from Audience {2} Small Silver Airburst, single LMH U5L, Approx 10' from stage edge18' + from Audience 5 Aladdin's Lamp {1} 6 Second Smoking Device BSR, Approx 22' from stage edge 30' + from Audience Distances may vary; however, there will NOT be any devices placed closer than 15' from the audience. Effect #5 (1 } White Smoke Placed Here on Aladdin's Lamp. Effect #2 — (3} AF Mines shot from top center of Cinderella's Carriage i Effect #4 (1} Red Tracer Comet shot toward Target opposite stage Detonation Plot (Top view) no 4 10 Effect #1 (1 ) '/2 x 12 Gerb, from hand held Fairy Wand, fired upward. I 0 Cinderella's Carriage ❑ � I \ I \ Effect #3 1) White Smoke. Inside washing machine prop 47' Effect #4 (2) Small Airburst, from top corners of Target Pyrotechnician History Report Permanent Address: Justin R Thomas 1985 Brittainy Oaks Warren, OH 44484 Experience: 2005 - Electrician /Pyrotechnic Shooter, Disney on Ice 2009 - Current Electrician /Pyrotechnic Shooter, Disney Live Summary: - Justin has been employed by Feld Entertainment, Inc. DBA Disney Live as the shows pyrotechnic shooter. - He has successfully completed an in house pyrotechnic training course. - Justin was trained by a licensed pyrotechnician on the firing system as well as the loading /firing /disposal of the pyrotechnics that are being used in this performance. - The training he has received includes: a pyro safety course, and the safe use of pyrotechnics in the performing arts before a proximate audience, performers or support personnel using the NFPA -1126 as a standard. - Justin has shot over 800 shows without incident and is licensed in Lakeland, FL. Texas State Drivers' license: (Image may not be visible if faxed) Name: Thomas, Justin R DL #: R5995525 Exp: 09/28/2011 DOB: 09/28/1982 Ht: 6'2" Wt: 185 Eyes: Brown Hair: Brown Sex: Male Pyrotechnician History Report Permanent Address: Matthew Stoner 1313 17th Street East Palmetto, FL 34221 Experience: 2006 - Current Backup Pyrotechnic Shooter, Disney Live Summary: - Matthew Stoner was employed in December 2006 by Feld Entertainment, Inc. DBA Disney's High School Musical, first as the shows Asst. Pyrotechnic shooter and then as the Lead Pyrotechnic Shooter. He is currently the shows backup shooter. - He has successfully completed an in house pyrotechnic training course by the shows pyrotechnic shooter /electrician. Since he completed his training he has been loading /firing /unloading the shows pyrotechnics. - The training he has received includes: a Pyro safety course, and the safe use of pyrotechnics in the performing arts before a proximate audience, performers or support personnel using the NFPA -1126 as a standard. - Matthew Stoner has loaded and /or shot over 1000 shows without incident. Wisconsin state Drivers License Name: Stoner, Matthew DOB: 9/25/82 Ht: 5'9" Wt: 160 Eyes: Brown Hair: Brown Sex: Male X rid cw.ii.r..w aoN no `mHRU a.peffW wbw250 00 09- 25.1981 E. k" M25 -2049 MATTHEW D STONER "Of N 07TH sr �- WAUWATOSA, W1 53213 auruaca -� LEAD SHOOTER: SHOOTER A%us '29, Zola LakelAnd fire, Depart.Mint This aaffm that W i/ MY EPA AO ! !� Feld Entsrttaln.ment 4313 17th St., E Paleribtto,. FL 34221 ` 941 =721 -1200 has sueoeeafigly passed` sn.�rrdrtatkn cover ft NFPA 1I Z008 :EDITION and is as a PYROTECHNICS OPERATOR wt ft th dly 11mits of L.a mbW. Ftorlda: Anium ns.2013 . 00- eeeode Lakeiand Fire Department This aeiffts that we Feld Entertainment 1313 17th St., E Palmetto, FL 34221 941-721,1 200 has simoessftdly passed an exernhWon oovmbV NFPA 1126, 2006 EDMON and Is regftied as a PYRarlmm es QPBRATOR wittdn Via Cy ftb of Udwiand, FIOM& August 26, 2010 August 296 201.3 Tat Dale Deb BACKUP SHOOTER: Lai kisla :ld Pike -ID, 16'r"t tilt-, Iftowtulmelm, 'i'lh t 941 -T4 - 21f-1100 i P 0i.0 Ot o� of E* and. Ag I -mum F• �4 o YY f John W. 0- mudine State of Georgia. Office of Georgia Safety Fire Commissioner 620 Towcr, 2 Martin Luther King, .ta-. brivc Atlanta, Georgia 30334 No. 0101 PROXIMATE ATE J ill DIENCE FIREWORKS ANDOR PIMO 'ECHNICS DISPLAY PtIVSU911t I:o O.C.C;.A. Title 25, C'haptet' 1.0. Find tilt R111e:s and Regulatiami of the Safety Tit-c Commissiotief, this license is issued for the pairpose of combicling Proximate audience Fireworks and /or Pyrotechnics Displays only for Lite following company and listed operators thereof: field Entertainment, Inc. 1.113 17 "' street Fast Palmetto, !+L 34221 This license is revocable and May Lie su54,e)[Ldtd upon violation of tiny of Ille provisions of tike. Rules and RCe 1,Hlations proinaxlgMed thereunder. Datte Issued: December 29, 2009 hxpiration Date: December 3 4, 2010 OPERATORS (se4 fit,tUChntent) Rcaulatory U. 1 ,000.00 B y: r- V Fir nimissioncr;Deslbnee Feld Entertainment (License #0107) Qualified Operators for 2010 1. Mary Anderson 2. Mario Auxilly 3. Nathaniel Beckman 4. Daniel Benjamin Benavides 5. Stuart Bertoluzzi 6. Jeff Boudreau 7. Adam Boyer 8. Walter Douglas Brown 9. Justin Cicerone 10. David Conti 11. Joel David 12. Gary Friendshuh 13. Eric Gerard 14. Mathew R. Gillet 15. John Griggs 16. Frank Heron 17. Ben Jobe 18. Mark S. Kelly 19. Angela Lopez 20. Jeremy D. Mattson 21. Eric McGee 22. Lacey Miller 23. Lani L. Nilsson 24. Andrew Nunn 25. Tim Peterson 26. Carlos Alberto Quevedo 27. Deborah P. Ramos 28. Dylan Rogers 29. Chester Ross 30. Brian Roush 31. Aaron Rubin 32. Brett Smith 33. Jesse Smithwick 34. Mathew Stoner 35. Justin Thomas 36. Aaron Vengrow 37. Dalen Vigil 38. Joshiqa Wilson ��AAO( -"AARk SAFETY FIRE COMMONER • co"NSM000 140toa John W. oxencine, Commimkww 2VAM*LdW*gk.Dr4$*D4MWmtTwo,AMWCA30M *WW4P&WUtW:....Uj Mona 404-ssass� 0 Flat 77*a444WO E-troft b"addlat 8Lg" rsivmxw I MMAWAMMOFFNMWOMAWVORPWEMiiM—ASMTMS 6tD+��i3B8F An= 0VtA,FdILNIF0IkVAC, ...... ........ . . ......... C) I Acxc-Ar� U1 1;! t1 YN CA ' My) 1313 17th STREET EAST PALMETTO "Wrm ASSISTANTS ctorgia Ucam No, LK)H 2 -9- -7 'NSN 008 -(DG --Oli2-3 state FL 34221 Age Phonic 6%21- 4q- �LikF Date ZO ti 2. hale Dtp ASSISTANT'S LIST BELOW ANY VQUIRTFS AND AMOUNT OF DAMAGM AND LOCATION of snow 1. 2- 3, 4. S. 6. NIA Lacadom of Show Fflnm *ffceLa by d.,b 6t, M—=W- -bym ft —M= W seftim—DwaWW PW4= nrAd a 0 Pitt I of I (to 011��—rll _X0, 2!�V!LW L%ba Kin Jr. Dr- &vte 620, Arlma. GA )0334 - Pb= 404-636-2U5 ,Aarnott. HOTELS & RESORTS November 21, 2010 Bakersfield Fire Department Dave Weirather Prevention Services Division 1501 Truxtun Avenue Bakersfield, CA 93301 Dear Dave, Bakersfield Marriott at the Convention Center 801 Truxtun Avenue Bakersfield, CA 93301 t: 661.323.1900 f: 661.323.2844 Marriott.com /BFLMC This let -ter, as requested, is to notify the Bakersfield Fire Department of the plan of action that we are taking in regards to the Correction Notice received on 10/6/10. The following items were noted: 1 -1St Floor fire doors do not close when fire alarm is activated in the elevator lobby. -This work has been completed on 10/20/10 2 -Fire doors to elevator lobbies on floors 2 -9 do not close when fire alarm is activated from elevator lobbies. -This work has been completed on 10/21/10 3 -A /C Fans do not shut off when duct detectors are activated. -This work will be completed by 11/8/10 by Simplex Grinnell 4 -Past due on 5 year fire sprinkler certification deficiencies -Thy work will be in the process of completion by Simplex Grinnell by 12/8/10 5- Kitchen cooking Hood Ansul systems are not UL300 compliant -This work will be in the process of completion by Simplex Grinnell by 01/31/11 If you have any questions or concerns that I can address, please do not hesitate to call me at 619 - 750 -3662 or 661.323.1900. Sincerely, dr. Philip BrneyE�' A Carlos A. Navarro CEO, Barney Hospitality Group General Manager Bakersfield Marriott Convention Center Bakersfield Marriott Convention Center Location: CORRECTION NOTICE BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES DIVISION 2101 H STREET (661) 326 -3979 1 702. t �9 "" 5 T R I You are hereby required to take the following action at the above location: CORRECT & CALL FOR REINSPECTION ❑ CORRECT & PROCEED Pi. G�o.Sc` t ^j S IA"— ,� It 4 (1 5 i &,A oPiP6- AT 7-Mc 2 A10 rcot-a ALSO PLGA5e I-A&Ft- t a 4-f ' 11V0'CAT,1,1C. aV-r1'CYzf--LY VALVC (TA Mr-C-a-SLA)17(-�ft it (P A5, STAwr4 PcPE SyF°PI -;. L0C�rC - -� AGoVE - ,-4C Z`-$ FL sour�4w6:S— S A,(L LAV0^6. -�— / Completion Date for Corrections: / A / Received by: ;fi, r ) _ Inspector: ' � L rs Initial Desk Phone: 3 2�6 3 6 S? Date: 4 /_ I?- / 41 (from 8:00am to 8:30am) KBF -9229 Location; CORRECTION NOTICE BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES DIVISION 2101 H STREET (661) 326 -3979 17 0z P9 ' s t TKE iAtDeC You are hereby required to take the following action at the above location: CORRECT & CALL FOR REINSPECTION ❑ CORRECT & PROCEED ,( PLC -0,SE t" STA« A 2 i ('6,v.1C07aV VQI-✓c' (vfq 4 " S FA&J3P�Pc AT TN (: 2'v4 SoUTI -rwc: , i S: AIa L.Ami^n � � P&lz c FG AI- So OLGASE L<1r3Et- THt 4 t1V0fCAT',1V6 a v r cyz r"�LY yA LVE (TA M PGeZ - Sw I Tcf r r+'7u,V, T'0- W--)) A5 ,r STANOP(PE �5tJPP` V r� LvC A RnVG -x u ,:- 7 Nn P-1 -, rn,j- ,wtaorrr'' C -,A , (,L LArW)tn/_ Completion Date for,Correctidns, Received by: Inspector: 4-!• �rNC Initial r Desk Phone: 326--365-'? Date: 4 / 12- / it (from 8:00am to 8:30am) KBF -9229