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Home My WebLink AboutFMC 2011111111111 27 IE MOODS ALARMS SPG3UKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. � / -ie000 ic9 5� File Number: 31 ep co Date Received: f — i t'— !/ Address: Bakersfield, CA 933 Business Name: SYSTEM: BUILDING SQUARE FEET: New Mod. ❑ ❑ Commercial mood System ❑ ❑ Fire Alarm System ❑ ❑ Fire Sprinkler System ❑ ❑ Spray Finish System ❑ ❑ Aboveground Storage Tank ❑ ❑ Underground Storage Tank minor modification underground Storage Tank removal Underground Storage Tank ❑ LY Other: ?Zw G Comments: Building Sq. Feet: Calculation Bldg. Sq. Ft: I. 2. 3. 4. INSPECTION L ®� Date Time zoagneYure Signature =a gnou 1 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD / LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ❑ ENHANCED LEAK DETECTION ❑ TANK TIGHTNESS TEST LINE TESTING BAKERSFIELD FIRE DEPT. B R R FP I D FIRE Prevention Services ARTM T 2101 H Street Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of 1 ❑ SB -989 SECONDARY CONTAINMENT TESTING X TO PERFORM FUEL MONITORING CERTIFICATION ❑ Cathodic Protection Testino SITE INFORMATION FACILITY Pan Pacific Petroleum NAME &PHONE NUMBER OF CONTACT PERSON ADDRESS 1850 Coffee Rd. 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 Diesel TANK TESTING COMPANY NAME OF TESTING COMPANY Cal - Valley Equipment TBruce W. Hinsley 661- 327 -9341 MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308 Bruce W. Hinsley 661 -327 -9341 CERTIFICATION #: 548333761 DATE & TIME TEST TO BE CONDUCTED Icc #: 5270921 -UT SIGNATURE OF APPLICANT W DATE 3/10/2011 000f:!h TIM, APP i MES E APPROiED IT APPROVED BY '71 1 ` DATE 12-V /,( FD 2095 (Rev. 09/05) 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 Agerif hone 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 I Date WORKERS COMPENSATION DECLARATION I hereby affirm that under penalty of perjury one of the following declarations: Carrier 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: 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. [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 I Date CONSTRUCTION PERMIT Application Number . . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . Owner ------------------ - - - - -- COFFEE BRIMHALL LLC 9302 S GARFIELD AV SOUTH GATE CA 90280 BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES 6 R S P I D 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 Ar h.- Office Phone: (661) 326 -3979 11- 10000104 Date 3/28/11 1850 COFFEE RD 368 - 021- 30 -00 -1 FIRE DEPT 0 Contractor ------------------ -- -- -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code . 1083369 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date . . . . 3/28/11 Valuation . . . . 0 Expiration Date . . 9/24/11 ---------------------------------------------------------------------------- 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 -3979 Plea_ se state -the Permit Number, the Job address, and the Type of Inspection. Requests for inspections should be made at least 48 hours in advance. DECLARATIONS Permit is issued in accordance with all applicable Federal, State and Local Ordinances. The permittee has properly signed and dated the reverse side of this form. This Permit expires after180 days of inactivity. I have reviewed the above application, and find it to be correct/complete: Permittee: Date: BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT _ 8 B A$ F I L D. Prevention Services PERMIT # FIRE A/RPL r 2101 H Street ,,q Bakersfield, CA 93301 Dhnnn• Ar.1 -17A -1070 . Fav• Ar..1 -Ac;?-7171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. ❑ 1 Alarm - New & Modification (minimum charge) 1$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 ❑ Minor Sprinkler Modification (<10 heads) $96 (inspection only) 84 ❑ Commercial Hood (New &Modification) $470 ❑ 1 Additional hood 1$58 ❑ Spray Booth (New & Modification) SITE INFORMATION LOCATION OF PROJECT PROPERTY OWNER Pati► aCl�'�'G f � o /etctaT $180 /tank STARTING DATE COMPLETION DATE NAME PROJECT NAME ADDRESS PHONE # PROJECT ADDRESS SSO C0 �f2e /�vl. STATE C� CITY gAl- _ERS�lC-L D ZIP CODE CONTRACTOR INFORMATION $109 /tank CONTRACTOR NAME CA LICENSE # TYPE OF LICENSE EXPIRATION DATE PHONE # C'al 1/� 92173 1 1-30-:Z012- - CONTRACTOR COMPANY NAME FAX # e✓q - a c, eH i:a6 /- 32S -ZS2 ADDRESS 35'00 G I, ffe 4t/t- C � �� f / ZIP CODE 933 a All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. ❑ 1 Alarm - New & Modification (minimum charge) 1$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 ❑ Minor Sprinkler Modification (<10 heads) $96 (inspection only) 84 ❑ Commercial Hood (New &Modification) $470 ❑ 1 Additional hood 1$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 JK 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 minimu =$192 ^ ' 82 ❑ 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 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 BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work Inspection Request Phone No. (661) 326 -3979 UST NEW INSTALL JOB DESCRIPTION: DESCRIPTION DATE SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF TANK TESTING UST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE MISC. ACTIVITY T AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR AST REMOVAL DESCRIPTION DATE SIGNATURE PRIOR TO OPERATION OF ANY SYSTEM, ALL UST AND /OR AST SYSTEMS SHALL BE INSTALL, COMPLETE AND ACCEPTED BY THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL) BUILDING ADDRESS: JOB DESCRIPTION: OCCUPANCY TYPE: OWNER: ; PERMIT NO CONTRACTOR: �' PHONE 7 If f ' �3�77- 4162q- FD 1743 0