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Home My WebLink About2929 BRUNDAGE Lane_UST MOD 11.27.07Two IIIIIIIIIIIIIIIIIIII 13 IE File # Date Rec. Permit # w -r )M — 01�;*bo (6 C6 >1 U) 0 z 2 ❑ ❑ Commercial Hood Sys. ❑ ❑ Fire Alarm'Sys. Address: Bus. Name: Bldg. Sq. ft. IN& LOG TIME Fire Sprinkler Sys. ❑ Calculation Bldg. Sq. Ft. SIGNATURE SIGNATURE Spray Finish Sys. Other: 1 &,,3 IIIIIIIIIIIIIIIIIIII 14 IE BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention Services 1600 Truxtun Ave., Suite 401 PERMIT APPLICATION >i B A g p t D Bakersfield, CA 93301 TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW FJI� Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 TANK INSTALL EXISTING FACILITY )/MOD MOD *ARr'N1f1 n/� (EXISTING Page 1 of 1 hermit # , , `�� TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY CFItLK UNt UNLY U MUUIFICA 11UN Ur FAC1L11 Y LJ M1NUK MUUIFICA I IUN UI- FAL1L1 I Y STARTING DATE/ PROPOSED COMPLETION DATE " _^ «rte , AG ILITY NAME EXISTING FACILITY P ERMIT # `F � J- �a TF FACILITY ADDRESS � �- . ��.J�.G� E �-^� • CITY ��s -F-L E L� � GA ZIP CODE al 3� TYPE OF BUSINESS APN # `TANK OWNER \ P/HONE 1G IADDRESS TE �O CnKt�� Yll�.�._] �•O �C��J�i CIF.A�(.,C� 4 Z ZIP !I—l6 �y ADDRESS CITY K�.�'��,.�'t ` w�� \�WI y�� ' ��..!Jj �YS2'��. `.C�T ✓� ZIP,�I.�� .7(� PHONE - s:-,� t,�a'% t,�a a- BAKERSFIELD CITY BUSINESS LICENSE #" 4. tWORKMANS COMP #g,,�. • INSURER BRIEFLY DESCRIBE THE WORK TO BE DONE: �-k- =�r�l�oc��- '2�c1 � v�. � v�v �raa�.lc . �nti.J c>L,✓- ?QA&k00e- WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? �zr ❑ YES ❑ NO ❑ YES ❑ NO THIS SECTION IS FOR MOTOR FUEL STORAGE TANKS VOLUME s UNLEADED < REGULAR =° ORE MIUM DIESEL AVIATION a �4�'s� n THIS SECTION IS FOR NON -MOTOR FUEL STORAGE TANKS TANKS # - .VOLUME UNLEADED REGULAR '} PREMIUM DIESEL a wt 'w, AVIATION FOR OFFICIAL USE ONLY APPLICATION, DATE FACILITY # . # OF TANKS FEES $ THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. APPR VED BY APPLICANT NAME (PRINT) APP SIGNATURE C e-,74) C Cf dos �� THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FD2086 (Rev 06/07) Z•d Z699- L£9 -8L8 8'869 L8 NOUV1S 3*11=1 106 809:60 LO £L BnV � . I... . ., i I. . ,rUt '4O n, �Y Applie'ci Underwriters 7/3/2007 9:58 AM PAGE 1 /001 Fax Server ACORD ' CERTIFICATE -OF LIABILITY INSURANCE ° 07 /0 /2 0"7 PRODUCER AV Insurance Services" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Sox 3646 Omaha, NE 68103'-0646 HOLDER. 'THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # (877)234-442.0 INSURED �ialists, Inc- Tank S INSURERA;Caltfornia Insurance Co. 238910 INSURER B; S ecialistS of California. dba Tank P 560 Sire St Ste 3 INSURERC; PREMISES Eacocurence Lake SISynore, CA 92530 -2726 INSURER 0: S CTL 1273 379350 INSURER I- 09N'LAGOREGATEPURMITAPPUESPER POLICY JECT LOC -e-_ VTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N()TW1TH,5TAr401 NG ANY REOUIREM ENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUM ENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEEp OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L R NS 'fYPEOFINSURANCE POUCYNUMBER POU DATE DIY POLICY I ATE /DD UMRS GENERALLI461UTY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑OCCUR EACHOCCURANCE $ . PREMISES Eacocurence $ MED EXP an one rson S PERSONAL a ADV INJURY $ 09N'LAGOREGATEPURMITAPPUESPER POLICY JECT LOC GENERALAGGREGATE III PRODUCTS - COMP R�PAGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON- ONJNEDAUTOS . COMBINED SINGLE LIMIT (Ea acddero) $ BODILY INJURY (Per person) $ BODILY INJURY (Peracdderd) $ PROPERTYDAMAGE (Per accldeM $ GARAGE LIABILITY ANY AUTO AUTO ONLY- 'EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG S $ EICC,sSlUMSRELLAUABIUTY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION S - - EACHOCCURENCE $ AGGREGATE $ $ $ $ li WOR KERSCOMPENSATIONANO EMPLOYERS- LIABILITY OFIPROPEMBEAExCLUOEDPECUTVE ttyes,de3ME under SPECIAL PROVISIONSDelow - 46- 005688 -01 -03 06/01/07 - 06101108 X WCS A'U- E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000'' E.L.DIS EASE • POLICY LIMIT $ 1,000,000 OTHER - - DESCRIPTION OF OPERATIONS I LOCATIONS I VE41CLES I EXCLUSIONS ADDED BY E14DORSEMENT I SPECIAL PROVISIONS - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 560 girth St Ste 3 Tank Specialists Of California DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTE N NOTICE Lake Elsinore, CA 92530-2726 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OFIANY KIND UPON THE INSURER, ITS AGENTS OR Attn:.project Manager REPRESENTATIVES AUTHORIZED REPRESENTATIVE �� Ar^nnn,A (2001108) ®ACORD CORPORATION 1988 v ^� ,� A, ✓ r �.I r "'!;. ^ �'L'�i'.. ,. �hF. �A .,: �.. I .. ,�- . �. �,1 ertif fc has 1a�eew` itle 8 of the C( 111 C' ' `{� _' g'° +4jr' l.-rk y I�'''� Syr , fi M x�llis day Februa t Refresh r �-n -a & Title 29 of ake Elsinore, Q 2nd 2008 : f NI ROW RIAL OUBOURCE, INC. :0tf 4 J: Instructor i — Rob t Refresh r �-n -a & Title 29 of ake Elsinore, Q 2nd 2008 : f NI ROW RIAL OUBOURCE, INC. :0tf i . i J Y:. 6055 Eas- �Nashirigton Boulevard, Suite 360 Los Angeles, CA 90040 (323) 728 -4492 AppliOd'Underwriters 7/3/2007 9.58 AM PAGE 1 /001 Fax Server THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NoTV,nTHSTA(V DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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.. AGGREGATE LIMITS SHOWN MAY HAIVE BEEN REDUCED BY PAID CLAIMS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SR TYPEOFINSURANC£ - POLICYNUMBER POLPOUCY DATE DIY EXPIRATION A E /DD LIMITS'- L AUTHORREDREPRESENTATIVE /> OD78336 13ENERALLIABIUTY COMMERCIALGENERALLIABILITY CLAIMS MADE ❑OCCUR - EACHOCCU _ $ . PREMISES Eac=rence MED EXP (any one persoml S 'PERSONALBADVINJURY S GEN'LAGGREGATELIMITAPPUESPER - GeNERALAGGREGATE POLICY PECT LOC PRODUCTS - COMPIOPAGG S AUTOMOBILE LIABILITY - ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS WNED AUTOS _ COMBINED SINGLE LIMIT (Es acddem) $ BODILYINJURY (Per person) $ BODILY INJURY (PeraccldarM $ PROPERTYDAMAGE •(Per accldstj $ ABILITY UTO AUTO ONLY - �EAACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG S $ RELLALIABIUTY R CLAIMS MADE tAA CTIBLE TION S EACHOCCUREN_CE__ $ AGGREGATE S S S A ENSATI0NAN0 SILITY ANYPROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBER EXCLUDED? a yes, describe under SPECIAL PROVISIONSbelow . 46- 005688 -01 -03 - 06/01/07. 06/01/08 X( U- �� E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE • EA EMPLOYEE 000' $ 1,000,000'' E.L.DIS EASE • POLICY LIMIT S 1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENOORSEM ENT/ SPECIAL PROVISIONS � �fAl f.1C6 PARIn CI 1 AT1/1R1 ' - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Tank Specialists Of California St Ste 3 560 Birch 191 nore, CA 92530 --2726 Lake Elsi DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTOMAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE - NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Attn: Project Manager REPRESENTATIVES AUTHORREDREPRESENTATIVE /> OD78336 ACORD 25 (2001/08) ® ACORD CORPORATION 1.988 : Flw--Fp "IM- _ ,.,1 ,.. _.,.. ,, ,' t�; . �:; "�,. -.� .., �� _` � I t' i a