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Home My WebLink About3001 SILLECT Avenue_UST MINOR MOD 4.7.11HOODS ALARMS SpG° NKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: jWa8"1S/ 27 Address: Date Received: y- 7 —// Business Name: Bakersfield, CA 933 SYSTEM: BUILDING SQUARE FEET: New Mod. ❑ ❑ ❑ ❑ joi'�ii oCm ation removal Commercial Blood System Fire Alarm System Fire Sprinkler System Spray Finish System Aboveground Storage Tank Underground Storage Tank Underground Storage Tank Underground Storage Tank ❑ ❑ Other: Comments: Building Sq. , Feet: Calculation Bldg. Sq. Ft: 9. a. 3. 4. BPdSPEGTM LOG IE' -j HOODS ALARMS SpG° NKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: jWa8"1S/ 27 Address: Date Received: y- 7 —// Business Name: Bakersfield, CA 933 SYSTEM: BUILDING SQUARE FEET: New Mod. ❑ ❑ ❑ ❑ joi'�ii oCm ation removal Commercial Blood System Fire Alarm System Fire Sprinkler System Spray Finish System Aboveground Storage Tank Underground Storage Tank Underground Storage Tank Underground Storage Tank ❑ ❑ Other: Comments: Building Sq. , Feet: Calculation Bldg. Sq. Ft: 9. a. 3. 4. BPdSPEGTM LOG Signature IE Signature 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[ 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. 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 I Date CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B E R s P i D 1501 TRUXTUN AVENUE, IsT FLR FIRE BAKERSFIELD, CA 93313 ARTM T h. Office Phone: (661) 326 -3979 Application Number . . . . . 11- 10000123 Property Address . . . . . . 3001 SILLECT AVE ATN (11 Digits): 332 - 580- 27 -00 -8 Application type description FIRE DEPT Subdivision Name . . . . . Property Use . . . . . . . . Application valuation . . . . 0 Date 4/08/11 Owner Contractor -- ---------------- -- - - -- ------------------ - -- - -- HEART HOSPITAL OF BK LLC OWNER 14400 METCALF AV OVERLAND PARK KS 66223 ---------------------------------------------------------------------------- Permit . . . . . . UNDGRND STR TANK MINOR MODIFY Additional desc . . Phone Access Code . 1086503 Permit Fee . . . . 83.50 Plan Check Fee 83.50 Issue Date . . . . 4/08/11 Valuation 0 Expiration Date 10 /05 /11 - -------------- ----- -- -- ------------ ------ --- ------- - - - - -- --------------- -- Fee summary Charged Paid Credited Due ---------- - - - - - -- ---- - - - - -- --- - -- -- -- ---- - - - - -- ---- - - - - -- Permit Fee Total 83.50 83.50 .00 .00 Plan Check Total 83.50 83.50 .00V .00 Grand Total 167.00 167.00 .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 afterl80 days of inactivity. I have reviewed the above application, and find it to be correct/complete. Permittee: Date: UNDERGROUND STORAGE TANK PERMIT APPLICATION 5_ E R S F] P TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW AFIRd DEPARTM AIT TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD p (Permit # TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY WHFCK 01\1 F nN1 Y) M MC1r1TFT(- ATTCIN nF FAr TI TTY BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 Page 1 of 1 �� . X3707 1b7.� ❑ NEW TANK INSTALL/ EXISTING FACILITY [X MTNnP MIIIITFTrATTnNI n;: ParTI TTY STARTING DATE/ 4/12/2011 PROPOSED COMPLETION DATE 4/19/2011 FACILITY NAME Bakersfield Heart Hospital EXISTING FACILITY PERMIT# FACILITY ADDRESS 3001 Sillect Ave. CITY Bakersfield ZIP CODE 93308 TYPE OF BUSINESS Hospital APN # TANK OWNER Bakersfield Heart Hospital PHONE# 661- 852 -6487 ADDRESS 3001 Sillect Ave. `IT Bakersfield ZIP CODE 93308 CONTRACTOR Cal- Valley Equipment CA LICENSE #9217331C 8012401 -UT ADDRESS 3500 Gilmore Ave. CITY Bakersfield ZIP CODE 93308 PHONE # 661- 327 -9341 BAKERSFIELD CITY BUSINESS LICENSE # 1100054089. WORKMANS COMP # WSA500383400 INSURER,CW Grou P BRIEFLY DESCRIBE THE WORK TO BE DONE: Install 2 new sump sensors in 2 transion sumps. Install conduit and wiring for new sensors. WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED 7❑ ARE THEY FOR MOTOR FUEL? YES ❑ NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER 1 X Tank Testing Company NAME OF TESTING COMPANY PHONE NUMBER MAILING ADDRESS NAME OF TESTER ICC# 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. NAME OF TESTER ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE qUkY DATE APPROVED ci / APPRO ED BY r r