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Home My WebLink About2600 WHITE Lane_UST FMC 7.22.10IN111111111111 53 Commercial Hood System Building Sq. Feet: ❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft: ❑ ❑ Fire Sprinkler System HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH ASS' UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: 311 ?77 Address: a &od Bakersfield, CA 933... Date Received: — z. z. — /p Business Name: SYSTEM: BUILDING SQUARE FEET: INSPECTION LOG New Mod. ❑ ❑ Commercial Hood System Building Sq. Feet: ❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft: ❑ ❑ Fire Sprinkler System ❑ ❑ Spray Finish Systern ❑ ❑ Aboveground Storage Tank ❑ ❑ Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank ❑ [G- Other: 7X-L." C' Comments: 1 2 3 4 Date Time Signature FD 2095 (Rev. 09/05) FACILITY w . UNDERGROUND STORAGE. TANKS PHONE U BER OF C TA T PERSON r(0 BAKERSFIELD'FIRE DEPT. . Nae'. s,• rT.;` J/ a:•: r. �a.: msixs' t'. cYrsaA. rzrx<! wr.. cr.:, �a`. sr!}. vrJ�cC 's:S:�cs+..+Ltc'«.•acy+.is�rcl.: s • �,R� Prevention! Services _ NUMBER OF TANKS TO BE TESTED AR1r T 900 Truxtun Ave., Ste. 210 APPLICATION CONTENTS Bakersfield, CA 93301 TO PERFORM ELD / LINE TESTING '" Tel.: (661.) 326 -3979 I SB989 SECONDARY CONTAINMENT TESTING Fax: (661) 852 -2171 /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Page 1 of 1 PERMIT N0. -TANK :TESTING COMPANY ❑ ENHANCED LEAK DETECTION ❑ ❑ SB-989 SECONDARY CONTAINMENT TESTING ❑ TANK TIGHTNESS TEST PTO PERFORM FUEL MONITORING CERTIFICATION ICC #- Ib�t3 -� FD 2095 (Rev. 09/05) FACILITY w . NAME PHONE U BER OF C TA T PERSON r(0 ADDRESS 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 l -TANK :TESTING COMPANY NAME AF TESTI COMPANY A NAME & PHONE NUMBER OF CONTACT PERSON t I �vv.i2oiv�-k C_Aj J*V- J�>m� �C 3a(o-B�fC MAILING ADDRESS NAME & PHONE "BER OF TESTE OR ECIAL INSPECTOR I ^ lSJ CERTIFICATION, #. DATE & TIME TEST T BE CONDUCTED . ICC #- Ib�t3 -� TEST METHOD In C-0 SIGNATURE OF APPLIC DATE 41--N —91-J'A'AP-PLICATIONBECOMES----.mrrWHEt4'AppRovED APPROVED BY DATE C:;,— , 9 ,/V FD 2095 (Rev. 09/05) HAZARDOUS MATERIALS STATEMENT - —Yes—No Will the applicant onfuture 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 Aged 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 fora 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 theirsole compensation, will do the work and the structure�is,h&'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 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: Y 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. 1 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 - Date BAKERSFIELD CITY FIRE DEPARTMENT — INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for of Work Insoection Reauest Phone No. (661) 326 -3979 PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF DESCRIPTION DATE SIGNATURE MINOR/ MAJOR DESCRIPTION PRIOR TO- OPERATION OF ANY SYSTEM, ALL UST AND /OR AST SYSTEMS SHALL BE INSTALLED, COMPLETE AND ACCEPTED BY THE BAKERSFIELD CITY FIRE DEPARTMENT. �vd .� r B DESCRIP ION F ?� G OCCUPANCY TYPE WNER eC.0 S �� •� PERMIT NO. ONTRACTOR c G (A- PHONE # 206 FD 1743 Cit of h4ersfiald *i# C65TGP1ER RECEIPT. # Cper: SCARRILLC Type: CC .Drawer: I Date: 8/13111 01 Receipt no: 21544 D3 scriotion tlaantity AP BUILDINS, PERMITS 1.0�+ Tender detail CK CHECK N c Total tendered. Total Payment Amount €192. IN 1192.00 WE'. N 1921. 00 Trans date: 8113110 Tine: 14:12:57 HELP.CONTROL T'FiE PET P9F'ULATiON PLEASE SPA7Y OR NEUTER J