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Home My WebLink About3221 H Street _UST MINOR MOD 7.16.10NFIIII 55 IE MOODS ALARMS SpG°3N[ LER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: '316 Q"' Address: ts Bakersfield, CA 933 Date Received: :2- z& -16 Business Name: A-r - t INSPECTION � ®G SYSTEM: L BUILDING SQUARE FEET: New Mod. ❑ ❑ Commercial Hood System Building Sq. Feet: Date Time ❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft: ❑ ❑ Fire Sprinkler System 2. ❑ ❑ Spray Finish System 3. ❑ ❑ Aboveground Storage Tank 4. ❑ Underground Storage Tank minor Signature modificatio Underground Storage Tank removal Underground Storage Tank ❑ C&- Other: itf j 7" Comments: �^1 Signature - - - BAKERSFIELD-FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention Services 2101 H Street PERMIT APPLICATION s Bakersfield, CA 93301 TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW Phone: 661 - 326 -3979 • Fax 661 - 852 -2171 TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD w r Page 1 of 1 Permit # TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY (CHFCK ONF ONI Y) rl M(IIITFTrATTr)N r1F Farm TTY ft MTNf1R MnnTFTrATTnN nF FarTI TTV STARTING DATE/ PROPOSED �( �l COMPLETION DATE `y T�j ,� ` FACILITY NAME EXISTING FACILITY/ PERMIT # FACILITY ADDRESS CITY - 29( 5 •- N 5 -TaCE* - Bh-�E2S +� ZIP C DE TYPE OF BUSINESS APN # TANK OWNER PHONE # ADDRESS CITY ZIP CODE C ONTRACTOR _ - •'�' A I C LCENSE # .IC 88oa S C # - . _ ADDRESS - --� -' �' CITY '.. c', ZIP C PHONE # - BAKERSFIELD'•CITY BUSINESS LICENSE - #' 60053 Qa WORKMANS COMP # INSURER - BRIEFLY DESCRIBE THE WORK TO BE DONE: j'i4CC -r.p-17t/ S)MD fcf-)E s.� `$6_'C Alai> `-�) `�'G .lf�wvC C ��11 ++�� . /�� 1�.' -Ala i> C�TStti� i s �- WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ' ARE THEY FOR MOTOR FUEL? ❑ YES ❑ NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECT -ION IS FOR STORAGE TANK IDENTIFICATION TANK # :'.` _e . , VOLUME UNLEADED;` -� . b REGULAR PREMIUM�o ': " DIESEL �° �� t OTHER 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 FOROFFICI LLISkONLY -DATE APPROVED ZS AtPROVk BY - — FUZU86 (Rev U8/U9) CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B E R S F I D 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 AR TM T Office Phone: (661) 326 -3979 o Application Number . . . . . 10- 10000221 Date 8/10/10 Property Address . . . . . . 3221 S H ST ATN (11 Digits): 023 - 172- 20 -01 -8 Application type description FIRE DEPT Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . 0 Owner Contractor --- --- --------- -- - - - - - -- ------------------ - - - - -- PACIFIC TEL & TEL CO OWNER 140 NEW MONTGOMERY ST # 818 SAN FRANCISCO CA 94105 (800) 303 -3000 ---------------------------------------------------------------------------- Permit . . . . . . UNDGRND SIR TANK MINOR MODIFY Additional desc . Phone Access Code 1021880 Permit Fee . . . . 83.50 Plan Check Fee 83.50 Issue Date . . . . 8/10/10 Valuation . . . . 0 Expiration Date . . 2/06/11 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due -- --------- - - - - -- ---- - - -- -- --- - - - - - -- ---- - - - - -- - --- - - - - -- Permit Fee Total 83.50 83.50 .00 .00 .Plan Check Total 83.50 83.50 .00 .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 Permif expires after180 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. Lie. Class Lie. 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 �-.; ��° "� -�, : �;: - ��.a,x �� ..:��: - .,. _�� .�.� - g�� ,�s��" . �-- � 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 - - - -- �_CZ4 - - - - - -- - -_ ... .. 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 DATE r IMARY PIPE CONDARY PIPE CONDARY CONTAINMENT AUTHOR2ATION FOR FUEL ELECTRICAL SEAK -OFF DESCRIPTION DATE SIGNATURE MAJOR DESCRIPTION DATE SIGNATURE PRIOR TO OPERATION OF ANY SYSTEM,, ALL UST-AND /OR AST SYSTEMS SHALL BE INSTALLED, COMPLETE AND ACCEPTED BY" THE BAKERSFIELD CITY FIRE DEPARTMENT. �3,a S, 4 w ST-- JOB DESCRIPTION OCCUPANCY TYPE OWNER !g �-_ PERMIT NO. 1,6-16666 CONTRACTOR Vs PHONE i/y 3loQ' ,�Q0 FD 1743 8 7 6 5 4 3 2 REVISIONS REV. DESCPoPBON DAZE APPROVED I F. F i f A 1/A D P D r 01.90— � r —r 0 1.45 C c o . 5.04 B 04.63 B 0 7.87 SECTION A -A UNLESS OTHERWISE SPECIFIED: NAME DATE 1 DIMENSIONS ARE IN INCHES DRAWN TOLERANCES: OH 1211/W Line FRACTIONAL- ANGULAR: MACH- BEND - CHECKED TWOPLACEDECIMAL Technologies, LLC THREE PLACE DECIMAL ± ENG APPR. A TM-E: A PROPRIETARY AND CONFIDENTIAL MATERIAL MFG APPR. SBL4.8X 1.9X I THE INFORMATION CONTAINED IN THIS 8•A• DRAWING IS THE SOLE PROPERTY OF SIZE DWG. NO. REV' BLUEUNETECHNOLOGIESLLC. ANY FINISH COMMENTS: REPRODUCTION IN PART OR AS A WHOLE C SBL4.8xl .9x 1.4 ' WITHOUT THE WRITTEN PERMISSION OF BLUENNE TECHNOLOGIES LLC IS PROHIBITED. DO NOT SCALE DRAWING SCALE. 1:1.5 WEIGHT: SHEETIOF.1 8 7 ,6 5 4 3 2 '1 8 7 6 5 - 4 3 2 1. REMSIONS REV. DESCfIFTION DATE APPROM:D I F F { rz t ' 1 I 1 D. V - _ ... I D I A f� 3.56 C i C I 2.54 f B I � I A f� 4.63- B 7.84 SECTION A -A UNLESS OTHERWISE SPECIFIED: NAME DATE , DIMENSIONS ARE IN INCHES DRAWN DH 1211104 TOLERANCES: ' FRACTIONAL! ' ' ANGULAR: MACH! BEND ! CHECKED ueline Technologies, LLC A TWO PLACE DECIMAL. THREE PLACE DECIMAL ! ENG APPR. A TIRE: PROPRIETARY AND CONFIDENTIAL MATERIAL MFG APPR. SBL3.5 THE INFORMATION CONTAINED IN THIS Q.A. DRAWING IS THE SOLE PROPERTY OF SIZE DWG. NO. REV FINISH _ BWENNE TECHNOLOGIES U.C. ANY COMMENTS: REPRODUCTION IN PART OR AS A WHOLE C SBL3.5 " I WITHOUT THE WRITTEN PERMISSION OF ' BLUEIINE TECHNOLOGIES LLC IS PROHIBITED. DO NOT SCALE DRAWING SCALE: 1:1.25 1 WEIGHT: SHEET 1 OF 1 8 7 6 5 4 3 2 1 B l 6 5 4 3 2 REMO% DESC —ON DATE APPROVED F F I ' E E A D D 2.40 c C 3.00 B A r -- 3.50 B SECTION A -A UNLESS OTHERWISE SPECIFIED: NAME DATE DIMENSIONS ARE IN INCHES DRAWN DH 6 /IN4 TOLERANCES: FRACTIONAL! ., .. ANGULAR: MACH- BENDS CHECKED uei rte Te 6h 1OBieI; LLC A TWO PLACE DECI M A - THREEPLACEOECIMAL ! ENG APPR. TITLE ' A PROPRIETARY AND CONFIDENTIAL MAT&kL MFG APPR. SR3.5x2.4A THE INFORMATION CONTAINED IN THIS O.A DRAWING IS THE SOLE PROPERTY OF BLUEUNETECHNOLOGIESLLC. ANY HN6H SIZE DWG NO. REV COMMENTS: REPRODUCTION IN PART OR AS A WHOLE C SR 3.5x2.4A ` W RHOUT THE W RRTEN PERMISSION OF BLUEUNE TECHNOLOC4 S LLC IS PROHIBRED. DO NOT SCALE DRAWING SCALE. I:1 WEIGM: SHEET I OF I 8 7 6 5 T 4 2 �"..s5.:lv.� ?.�.,5:�' •;ii�'�d�i�„+ -� ='iii N��,..y.,_,;e' m� .✓m• ':b -:..Y� �Y <y'- ;.'.ci!:i;,a J. -- Wi Blueline Technologies, f 4:4^+u[ ^+ ,ate• _ 265- Buriisx•Di`.v "e " Y'° - _,. -. �:. �Y,<:.•_ ,� �1�:50,60?.. Fax:''530' -'$71 =5208 �{ i eei o _ 5.�- e: an' ' ^ewsoiiicr- AB2481:- Certified 7 a C O� Tat�;E' nviroriin'ertal='Sei�v�es ' -Iic. a :r C s. ed=T - ertify ' raiinedIns ` #tiller; A; Card #: C 1874 �•r Expires-: "4 :. � 201Q` :, Noyeml eir l e f •. ;tu3F rf �i -ts� =' .. -..�` "S'v''7 yv <x`. � a: '�'�" "� .�,�,L.,..{ J<.iL`.c �n� `�•ue,^,- ..;f - .svar<�:n,'?%'- a.d = -r"u ,��,r �,�< u:�a:�,y�..,, `t «. •::�':` ..<�` rC - e�t.Ff:'"./.Ai.c,s » ':.ia`':i`d °m:9nr•.rf la _Y� _•H- e:rn:sG` d'.., ' - �'G�v COOECOUNCIL' +f FRANK NEWSOM '. CALIFORNIA UST SERVICE TECHNICIAN ! The individual named hereon is CERTIFIED in the category shown, having been so certified pursuant to successful F completion of the prescribed written examinations. E Expiration date: May 19, 2011 t: No. 525679a-UT r Not Valid unless s igned by certificate holder. ', ICC certification attests to competent knowledge of codes and standards t.> I_ %:',II I DITER= Wd FRANK NEWSOM CODE CpINCIC UST INSTALLATION /RETROFITTING <;fl The individual named hereon is CERTIFIED in the category shown, having been so certified pursuant to successful "rl completion of the prescribed written examinations. Expiration date: May 31, 2010 No. $256798 -U7 Not valid unless signed by oertificate holder. ICC certification attests to competent knowledge of codes and standards i4 Wit_ COOECOUNCIL' +f FRANK NEWSOM '. CALIFORNIA UST SERVICE TECHNICIAN ! The individual named hereon is CERTIFIED in the category shown, having been so certified pursuant to successful F completion of the prescribed written examinations. E Expiration date: May 19, 2011 t: No. 525679a-UT r Not Valid unless s igned by certificate holder. ', ICC certification attests to competent knowledge of codes and standards ACORD . CERTIFICATE OF LIABILITY INSURANCE DATE(MMI °D/YY) 9 2 2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P. O. Box 10550 Santa Ana CA 92711 -0550 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY EXPIRATION LIMITS INSURERS AFFORDING COVERAGE INSURED INSURERA: Zurich American Insurance Co. Tait Environmental Services, Inc. P.O. Box 11118 Santa Ana CA 92711 -1118 INSURER B: INSURER C: $ FIRE DAMAGE (Any one fire) INSURER D: INSURER E: I COVERAGES HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. OTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 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 HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE u OCCUR MED EXP (Any one person ) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PRO LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT I (Ea accident) $ BODILY INJURY ' (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ " GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURRENCE $ I' OCCUR CLAIMS MADE AGGREGATE $ is Is DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND WC 913114 9 0 3 9/1/2009 9/1/2010 X W RYTA �T- ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1 000, 0 0 0 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1 0 0 0 0 0 0 - OTHER DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS 10 Day Notice for Non - Paymnt of Prem Evidence of coverage in force. i HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER For Proposal Use Only ILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE * ERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO * * * HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON [HE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA ACORD 25 -S (7 m ACORD J . - •�' - - ' >, i ,i' I. . -. . n ,.-. % >,;, - "F. . ., ,. +., n...., .. - -.: • I. _ ,- , . • , . . . „. f' 7 z" .,t .,: - . , '. '. . . v .._. .... - .. ... .;. ,. - . . ., -. .. _ _ -.:.z- J; _ _ : ,. ig:. - . Slat "A� , .' �• CONfRACTORSSTATE�I.ICENSEBOARD ACTNE LICENSE Y I. �. - . , -";�. w;., 588098 /+ p _. ', , 6eeq' ' 00 ,, -ir: , " % �� }},� 7AIT °ENVIRUNMEN7Af SERVICES " 1. t;, ` tNG ` 1 '� �, k ` , �. 1 f }} i, Q ,...rar..t .C1a B A AS8 HAZ' _, ,. : ,.... . ;. ., . ..... ; . ".. .. 4 . , z "E,,4, 6M 02/29J2012 il. ;..,- „, - sr+.. ^m tY ' _ y xrq ;. ' :'.' s -..... 11 . . 3 11'''_..'. .,. .." -, i .. ._ .. .: - 1. . t 1 - ,' - . ' _ ,. ,•i - - I I. e � I � , �. - - ,-. � 1�11 ; -1 -.�: � , .� i � , .- , - I - :,�. , ; � - . . I . I � , �� , 1 ,:* , - - f . . I � : , , �, '. , - .. , . - ,.G.d I. ` _ - - ._ r- �_ . - . '- �.: "i v - :. .. t ., .. UTG*R iLi7 4 Gper�. fi��HrCiRti.`":= �:::.';,7YPe..00 drawer :. 9l�i� /'iq 01 ` Receipt : -�io: �d1i57....:,, ,; ..,• ilesri;�ai -I :C U6 ant rtv R�ount z K :41$r3y ` "667.610 Total tense a Total paybent 5167:Qtq trans da,e: /.1610 Tiff °'14 � s42. HELP CDN ROI.- THE-PET; GLER;i� Sf�AY CSR :�i3TER', t,: �. Account Number: 03026 TAIT ENVIRONMENTAL SERVICES, INC. P.O. Box 11118 o Santa Ana, CA 92711-1118 073010 7/30/2010 947 1041885 ViPLEASE DETACH AND RETAIN FOR YOUR RECORDS V 7988 167.00 I', 1, IF