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Home My WebLink About2500 WIBLE Road_UST FMC 4.12.11HOODS ALARMS SPRNKL ER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: /d0 S577 Address: �� pp /-, ,1 "6(2e 28-- Bakersfield, CA 933. Date Received: Business Name: SYSTEM: L BUILDING SQUARE FEET: INSPECTION LOG New Mod. ❑ ❑ Commercial Hood 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 ❑ Q-,O Other: ,r-"-/ L Comments: Building Sq. Feet: Calculation Bldg. Sq. Ft: 1. 2. 3. 4. Date Time Mw w, VNI, WOO,, r/1/1/L' , i 1i _ � � � i Signature Signature IE r BILLING & PERMIT STATEMENT PERMIT # 5—;Z I �/ B41.3 it a F I D F it BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 FD2021 (Rev 05/10) SITE INFORMATION LOCATIO (DOF�PRO]EC�f, - �I � W PROPERTY STARTING DATE COMPLETION DATE NAME PRO)_ ECT NAM_ E �� ADDRESS PHONE # PRO ECT ADDRESS soo UUi 1311r, crrY g4 K E2S�l E _A STATE C� ZIP C E 330 CONTRACTOR CO f f CA LICENSE # C1 INFORMATION TYPE OF LICENSE EXPIRATION DATE PH NE S 2971 C .ZIRACTOR COMPANY NAM ' it __7 FA_" A frE`+ v N . 24 t 1 CIfY T� Oj ZIP C0� J Lam- 7" All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. G PERMIT TYPE FEE CALCULATION TOTAL DUE 11 Alarm - New & Modification (minimum charge) $280 • USE ACCT NO ❑ 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 ❑ 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 /Inspect) 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 TT NOTE: $96 /hr for ea type of test/per site even if scheduled at he same time $96 /hr (2 hrs minimum) =$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 FD2021 (Rev 05/10) UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING/ SB989 SECONDARY CONTAINMENT TESTING/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION (Please note that these are separate Individual tests and will be charged per separate type test accordingly.) PERMIT # ❑ ENHANCED LEAK DETECTION ❑ TANK TIGHTNESS BAKERSFIELD FIRE DEPARTMENT Prevention Services e e r 2101 H Street /'IRS Bakersfield, CA 93301 A` f Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 T Page 1 of 1 ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT FUEL MONITORING CERTIFICATION SITE INFORMATION FAC1,i.�TX p (^ NAME & PH E # OF CONTACT PERSON— 'I �YVi ]per nrp�. ti&- 1_I_-I. -Z1 OWZLER NAhjE OPERATOR AME PERMIT TO OPERATE # # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES NO TANK # VOLUME CONTENTS 15 00o CA CU . g5 CA01 1 10 000 ad %J ek 3 .51 000 r-Md. %le. TANK_:TESTING COMPANY TE,SWG COMPANY r NAME & NE # OF CO PERSON PERSON i TL t A /� /� Mjylf�l�DDRE ) . u- 1 5 � (P 9S-- 2A NAMItIE ( PHONE # OFT STER OR SPECIAL INSPECTOR CERTIFICATION # t DATE r z TIME TAE T TO BE CONDUCTED ICC # TEST METHOD (I APPLICANT SIGNATURE DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APC BY DATE FD2095(Rev 03/08) M YOU -Tuirlm-.6vLR AK1Q:R0'B TH�,,tAo �IQ�p AN.PE-'-004'MFR0A1 ORANUI: I U-Yt:I-LUVV toj�,,Wt ��E060,Wftff---. P. 1 N '-;%VT�g4 _Q qUMf, N:r,:W 0 R, C41ifdfdW::UST, Service Techniciah'".7 ................. M -K, 'A ----------------------- XX4 341"025g*0�0*': a Name: JESUS ERA.""' Date: 10 1919 W DAKOTA-AVE 5/14/1973 We Ur N W, APT 1'5-'4,N--' n,�;W ".W 0.01 rQ110-a FRESNO C A � 93705 Z* EXAMINATION RES !;np %Uf,'�`W idcard will be forW8tr lAtions! You have. passe e1ibbve-named exarnindt!660.) 1�6�n the last d# of the month in which y'0"u'test4d. This certificate,i.4 'by ICC within six week--, '..Xg.ron o years. for tW M-u .41."XI.z. You,.may request a wall c6fti idiifi"r :16 s�wdll.Throddhout20lO..�.,.,,this-.,c -ficate will be provide af - H. ay 6:60stId.....9u, if yourequest.it,withio.90? of �Pui'exiam. unly,�bne wall cerrificate per exam pas, 'y NX will eprq Wed to you at,hbf'8`6;arge. For information on rg" I"':` ificate, go toll�llill'.Ilm o eynmq JO.?.-'�fe rg/ H n ly important tWWt161ifyTearson VUE a phanges-in name and/or all and ICC of any d' h4l;p se contact Pearson::. ***..,.,., 6' � r certificate possibility of your wallet card e not being e X and Wt at" 6k76-8301 arift..Q...' 6i m (g iccsafe.org with Ips to your,,._ is -T e spay require additional documentation): There may be Wled, if a certification hang due to amiss name or inc:at orrect correct address. g z U P jJ :,..)I "'i"!v F" v 8' LjDi8VQ HIIAlt IH01 I Cj. INC)JJ )JIN13A3 ON V Al CONSTRUCTION PERMIT Application Number . . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . Owner ------------------------ AH AD AMIN 12919 W BLUFFCREEK DR LOS ANGELES CA 90094 BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES R S P I 1 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 4RTNIWF Office Phone: (661) 326 -3979 11- 10000130 Date 4/19/11 2500 WIBLE RD 023 - 500- 24 -00 -2 FIRE DEPT 0 Contractor ------------------------ OWNER ---7------------------------------------------------------------------------ Permit . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code 1089085 Permit Fee 96.00 Plan Check Fee 96.00' Issue Date . . . . 4/19/11 Valuation . . . . 0 Expiration Date 10/16/11 ---------------------------------------------------------------------------- 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. ® e 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: 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 Agen 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 1 1 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. 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 BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work Inspection Request Plone No. (661) 326 -3979 UST NEW INSTALL DESCRIPTION DATE SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF r___ TANK TESTING UST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE MISC. ACTIVITY REMARKS: 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: 5 pQ (tJ..' ;�. JOB DESCRIPTION: OCCUPANCY TYPE: OWNER: ,ale PERMIT NO. CONTRACTOR: AcAl —Al4*6f PHONE FD 1743