HomeMy WebLinkAbout2301 PANAMA Lane_UST FMC 9.13.10HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
/D- i�OC1.2G
File Number: 60 Address: �3Q/ -�PA.04u4 4 G.w
Bakersfield, CA 933
Date Received:
Business Name: L' G e.0WIG 0.3
SYSTEM: L BUILDING SQUARE FEET: INSPECTION LOG
New Mod.
❑
❑
Commercial Flood 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
❑ 04"" Other:
Comments:
�A_WCI
Building Sq. Feet:
Calculation Bldg. Sq. Ft: IWO` 1.
2.
\b 3.
4.
Date Time
Signature
46
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD / LINE TESTING
I SB989 SECONDARY CONTAINMENT TESTING
RANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO.
❑ ENHANCED LEAK DETECTION ❑ SB -989 SECONDARY CONTAINMENT TESTING
❑ TANK TIGHTNESS TEST 51---TO PERFORM FUEL MONITORING CERTIFI ON
FACILITY
BAKERSFIELD FIRE DEPT.
lei FIRE
Prevention Services
ARM r
900 Truxtun Ave., Ste. 210
PERMIT TO OPERATE.NO.
Bakersfield, CA 93301
IS PIPING GOING TO BE TESTED? ❑ -YES ❑ NO
Tel.: (661) 326 -3979
VOLUME
Fax: (661) 852 -2171.
Page 1 of 1
PERMIT NO.
❑ ENHANCED LEAK DETECTION ❑ SB -989 SECONDARY CONTAINMENT TESTING
❑ TANK TIGHTNESS TEST 51---TO PERFORM FUEL MONITORING CERTIFI ON
FD 2095 (Rev. 09/05)
FACILITY
NAME HONE NUMBER OF CON CT PERSON
ADDRESS a30\ l0_V\_Q_
OWNERS NAME
OPERATORS NAME
PERMIT TO OPERATE.NO.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ -YES ❑ NO
TANK#
VOLUME
CONTENTS
g
C,
TANK.TESTING COMPANY
NAME.OF TEST,g COMPANY
I ENV 120N�JVTWL
NAME & PHONE NUMBER OF CONTACT PERSON
J�rn� �� -SCo�%
MAILING ADDRESS
eta 3 r . Ca- 93 of
NAME & P E NUMBER 0,,k TESTER OR SPECIAL IN P CTOR
CERTIFICATION #:
�SO9�Sa
DATE & TIME T#ST TO BE CONDUCTED
ICC #: �� /� - v%
TEST METHOD
1 /t,7 Go
SIGNATURE OF APPLICANT
DATE O
APPROVED BY DATE
FD 2095 (Rev. 09/05)
BILLING & PERMIT STATEMENT
PERMIT NO.:
BAKERSFIELD. FIRE DEPT.
B E R S F 1 D Prevention Services
FIRE
ARTM T 1600 Truxtun Ave Ste 401
Bakersfield CA 93301
Tel.: (661) 326 -3979 • Fax: (661) 852 -2171
FD 2021 (Rev. 06/07)
1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer)
SITE INFORMATION
LOCATION OF PROJECT
rp Y1
PROPERTY OWNER
�(�S�noLGtJL
STARTING DATE COMPLETION DATE
NAME
PROJECT NAME - ^ ^ -
Y Y \'
ADDRESS I\ I` �-� /
PHONE NO.
qmm-
PROJECT ADDRESS 1
CITY STATE
ZIPCQPE
CONTRACTOR
CONTRACTOR NAME CA LICENSE NO.
J pem4I c_s �c $�9 SCE
INFORMATION
TYPE OF LICENSE. EXPIRATION DATE
1 �40f}H�I 3o icy
PHONE NO.
g 2 -S� gi
CONTRACTOR COMPANY NAME
I
FAX NO.
z -oc�a r
ADDRESS
51Q y
CITY
C_ PC
ZIP CODE
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. ■
5 � �
❑ Alarms - New & Modifications - (Minimum Charge) $280.00 • ■
■
•
84 •
9a_
❑
Over 10,000 Sq. Ft
Sq. Ft x.028 = Permit fee
8
❑
Sprinklers - New & Modifications - (Minimum Charge)
$280.00
■
■
98
0
Over 10,000 Sq. Ft.
Sq. Ft. x.028 = Permit fee
:
84
98
❑
Minor Sprinkler Modifications (< 10 heads)
$ 96.00 [Inspection Only]
■
■
84
98
❑
Commercial Hoods — New & Modifications
$ 470.00
■
■
84
98
❑
Additional Hoods
$ 58.00
■
■
84
98
❑
Spray Booths - New & Modifications
$470.00
84
98
❑
Aboveground Storage Tanks (InstallafioNlnsp. -1" Time)
$180.00
;
82
❑
Additional Tanks
$ 96.00
;
82
❑
Aboveground Storage Tanks (RemovaYInspection)
$109.00
N
82
❑
Underground Storage Tanks (Installadon.11nspection)
$878.00 (per tank)
■
82
❑
Underground Storage Tanks (Modification)
$878.00'(persite)
■
82
❑
Underground Storage Tanks (Minor Modification)
$167.00
■
82
•
Underground Storage Tanks (RemovA
$573.00 (per tank)
■
84
•
Oilwell (Installation)
$ 96.00
84
Mandated Leak Detection (Testing) Fuel Monit.Ce SB989.
Note. $96.00 for each type of test / per " ev edu/ed
at the same time)
O C�
$' 6e {persiteL 9 0� ,
■
82
•
Tents
$ 96.00 (per tent)
'
84
•
Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour)
$ 96.00 + (5 hrs. min. standby fee /Inspection)-_$576_00
;
84
❑
After hours inspection fee
$121.00
:
84
•
RE- INSPECTION(S) /FOLLOW -UP INSPECTION(S)
$ 96.00 (per hour)
■
84
•
Portable LPG (Propane): NO. OF CAGES?
$ 96.00
•
84
•
Explosive Storage
$266.00
■
84
❑
Copying & File Research (File Research Fee $50.00 per hr)
250 per page
;
84
❑
Miscellaneous
84
FD 2021 (Rev. 06/07)
1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer)
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 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 I I 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
1 certify that 1 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 I Date
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
------------------------
BARRETT MARGERY F SEPARATE PRO
5471 PASEO DEL LAGO # B
92637
10- 10000266 Date 8/31/10
2301 PANAMA LN
515- 060- 04 -00 -3
FIRE DEPT
0.
Contractor
---------------- -- - - - - --
OWNER
-----------------------------------------------------'------------'-----------
Permit . . . . .
. MANDATED LEAK DETECT TEST
Additional desc
.
Phone Access Code
1029610
Permit Fee . . .
. 96.00
Plan Check Fee 96.00
Issue Date . . .
. 8/31/10
Valuation 0
Expiration Date .
. 2/27/11
----------------------------------------------------------=-----------------
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
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 after 180 days of inactivity.
I have reviewed the above application, and find it to
be correct/complete.
Permittee:
Date:
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
UST NEWJNSIA -L
DESCRIPTION DATE SIGNATURE
BACKFILL
PRIMARY PIPE
SECONDARY PIPE
SECONDARY CONTAINMENT,
SENSORS
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK -OFF
LL
DATE
PRIOR =TO OPERATION=OF- ANY;SYSTEM- .
ALL UST_ANDLOR-AST SYSTEMS "$HALL -BE, n
INSTALLED.-COMPLETE AND ACCEPTED ^BY
THE BAKE_RSFIELD CITY FIRE DEPARTMENT. E
FIRE DEPARTMENT -(FINAL
FD 1743
,4- 6.tt C.
OCCUPANCY TYPE
=DESCRIPTION
a e,6
PERMIT NO. D - _O
' rc. PHONE # 3 2- $2c 7
FD 1743