HomeMy WebLinkAbout3200 PANAMA Lane_UST FMC 8.11.10HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
/d -/w a-z
File Number: .y& 51 / Address: ,3 -2VQ yQq.,i/,c -A— 4.10
Bakersfield, CA 933
Date Received: fir- ZI — /p
Business Name:1,4r�'s
SYSTEM: BUILDING SQUARE FEET: INSPECTION LOG
New Mod.
❑
.e
Commercial Hood System
❑
HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
/d -/w a-z
File Number: .y& 51 / Address: ,3 -2VQ yQq.,i/,c -A— 4.10
Bakersfield, CA 933
Date Received: fir- ZI — /p
Business Name:1,4r�'s
SYSTEM: 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
' C'
❑
E31
Other: "
Comments:
Building Sq. Feet: _
Calculation Bldg. Sq. Ft: �' 1
e
V
Date Time
Signature
UNDERGROUND STORAGE TANKS y =j BAKERSFIELD FIRE DEPARTMENT
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
FUEL MONITORING CERTIFICATION
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
PERMIT # �,
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
Prevention Services
e s x s r I: n 1600 Truxtun Ave.,. Suite 401
FIRE Bakersfield, CA 93301. •
i0R1M f
Phone:. 661-326,-3979 e Fax: 661- 852 -2171
Page 1 of 1
SITE INFORMATION
FACILITY
at
NAME & PHONE # OF CONTACT PERSON
ADDRESS X200 A-f�ERSFI ELD, CA
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
{ 'TANK TESTING'COMPANY
TESTING COMPANY
C' ncp. US— : ,z I(Vc,
NAME & PHONE # OF CONTACT PERSON
rrl
MAILING ADDRESS r
1. .250 5tie.• C(-1 �3
NAME & PHONE # OF TE TER OR SPECIAL INSPECTOR
CERTIFICATION #•
DATE & TIME TEST TO BE CONDUCTED
10 o
ICC #
622.
TEST METHOD
APPLICANT SIGNATURE
DATE
5
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
�OY+I G� s
DATE
FD2095(Rev 06/07)
CONSTRUCTION PERMIT
BAKERSFIELD FIRE DEPARTMENT
► PREVENTION SERVICES
E R S F I D 1501 TRUXTUN AVENUE, 1sT FLR
FIRE BAKERSFIELD, CA 93313
PARTM T Office Phone: (661) 326 -3979
Application Number. . . . . . 10- 10000270 Date 8/31/10
Property Address . . . . . . 3200 PANAMA LN
ATN (11 Digits): 372- 021- 33 -00 -1
Application type description FIRE DEPT
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . . 0
Owner
Contractor
---- --------------
PANACO LLC
- - - - --
------------------------
OWNER
10511 ROSEDALE HW
BAKERSFIELD
CA 93312
( 66) 827 -1010
=
-------------------------------------------------
Permit . . . . .
------=-------------------
. MANDATED LEAK DETECT TEST
Additional desc .
.
Phone Access Code
1029685
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:
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 Kem 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 _ 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 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
Insoection Reauest Phone No. (661) 326 -3979
PRIMARY PIPE
SECONDARY PIPE
SECONDARY CONTAINMENT,
SENSORS
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK OFF
1
DESCRIPTION DATE SIGNATURE
F PERATION OF ANY_SYST_EM,
D /OR AST SYSTEMS SHALL BE
_COMPLETE AND ACCEPTED BY
SFIELD CITY FIRE DEPARTMENT.
{FIRE DEPARTMENT (FINAL),
.�44 -wA G
-=O
DESCRIPTION ., G
OCCUPANCY TYPE
FguiLniNaADngEss
NER
PERMIT NO. /d -� l0 Q a?D
NTRACTOR 0 u c -e— PHONE # 7 28
FD 1743
BILLING & PERMIT STATEMENT
PERMIT #
1. 'ta6.0: @4;o 4 'BAKERSFIELD FIRE DEPARTMENT
.1 �' ` ,1 ° Prevention •Services
1 FIRE U"p
�AR•TMF�A/ 1600 Truxtun Avenue, Suite 401
DDDDD}:�Iga��t? Bakersfield,'CA 93301
Phone: 661 - 326 -3979 • Fax: 661- 852 -2171
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. ■ •
;.
TOTAL
DUE ACCT NO
❑
SITE
INFORMATION
■ 98
LOCATION OF PROJECT
Over 10,000 sq ft
$0 .028 x sq ft
PROPERTY OWNER
84
98
i
■
NAME
STARTING DATE BATE- -nikl 1
PROJECT NAME
Sprinkler - New & Modification (minimum charge) `
t
ADDRESS
PHONE #
■
❑
Over 10,000 sq ft
PROJECT ADDRESS
��� Q" ,�
Q 1
I
S
CITY �/` \K.FiTt SF I& l. -p STATE Ci/'C
ZIP CODE 2
.
•l \3.
■
❑
Minor Sprinkler Modification ( <10 heads) {
$96 (inspection only)
'
•
• R INFORMATION
CONTRACTOR NAME
CA LICENSE 11
Commercial Hood (New & Modification) I
TYPE OF LICENSE EXPIRATION DATE
PHONE #
84
CONTRACTO COMPANY NAME
FAX #
■
ADDRESS
Additional hood j
CITY
ZIP CODE
Ci
` ,1
� w
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. ■ •
;.
TOTAL
DUE ACCT NO
❑
_
Alarm - New & Modification (minimum charge) i $280
■ 84
■ 98
❑
Over 10,000 sq ft
$0 .028 x sq ft
■
84
98
i
■
❑
Sprinkler - New & Modification (minimum charge) `
$280
°
98
■
❑
Over 10,000 sq ft
$0 .028.x sq ft
■
98
■
❑
Minor Sprinkler Modification ( <10 heads) {
$96 (inspection only)
'
84
98
M
❑
Commercial Hood (New & Modification) I
$470
s
84
98
■
❑
Additional hood j
$58
■
84
98
❑
Spray Booth (New & Modification)
$470
or
■
84
98
i
■
r
❑
Aboveground Storage Tank (Installation /One Inspection) f
$180
■
■
82
❑
Additional Tank
$96
'
82
•
Aboveground Storage Tank (Removal /Inspection)
$109
;
82
•
Underground Storage Tank (Installation /Inspection)
$878 /tank
o
82
❑
Underground Storage Tank (Modification) (
$878 /site
o
82
•
Underground Storage Tank (Minor'Modification) j
$167
e'
■
82
•
Underground Storage Tank (Removal)
$573 /tank
■
•
84
•
Oil well (Installation)
$96
■
84
9,
Mandated Leak Detection (test) /Fuel Mont Cert /SB989
$96 /site
82
NOTE:_ $96 for each type of test /per site even if
■
scheduled at the same time
■
s
❑
Tent
$96 /tent
■
■
84
■
❑
After -hours inspection fee
$121
■
❑
Pyrotechnic (per event, plus inspection fee of $96 /hr)
$96 + (5 hrs min standby fee /insp) =$576
®
84
❑
^
Re- inspection /Follow -up Inspection
$96 /hr
o
84
❑
Portable LPG (Propane): # of Cages?
$96
■
84
t
❑
Explosive Storage
$266
■
84
❑
Copying & File Research (File Research. fee $34 /hr)
$0.25 /page
■
84
❑
Miscellaneous ;
84
i
1 - ORIGINAL WHITE (Treasury) 11-YELLOW (File)
1 -PINK (Customer)
FD2021(Rev 06/07)