HomeMy WebLinkAbout3225 BUCK OWENS Boulevard_UST FMC 10.25.10lean .s ,
HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No.. Permit No. Permit No. Permit No.
/D 73
File Number: 11b34c Address: ��a� j� 0u�le,n9 S
Bakersfield CA 933._.
Date Received:
Business Name: eX-nj
SYSTEM: L 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
❑ OR Other: 061---w-1 (Z---
Building Sq. Feet:' _
Calculation Bldg. Sq. Ft:
9.
2.
3.
4.
Date Time
Signature
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UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD I LINE TESTING
I SO M9 SECONDARY CONTAINMENT TESTING
1TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO.
r MWiIF
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BAKERSFIZW FM DZPT.
Prevention Services
1501 Truxtun Ave., First Floor
Baeld, CA 93301
Tel.: (661) 326 -3979
Fax:. (661) 852 -2171
Page 1 of i
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT TESTING
❑ TANK TIGHTNESS TEST — i TO PERFORM FUEL MONITORING CERTIFICATION
FACAITY
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1111111,19,111,11111,11111,11 9" 0 11
NAM 4 PHONE NUMBER OF CONTACT PERSON
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29
ADDRESS '
322 s 130, -I,-
< 330
OWNERS NAME
.
OPERATORS NAME
PERMIT TO OPERATE 140.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED?
1W NO
TANK #
VOLUME
CONTENTS
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at rc
NAME OF TESTING COMPANY TaflICflOI NAME & PHONE NUMBER OF — - - -
�y, Inc' CONTACT PERSON �'- S / MH f
MAILING ADDRESS I I I IO r - - -- ` - -`O -- - -- - - - -- - - -- �- - - -
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NAME & PHONE NUMBER OF
TESTER OR SPECIAL INSPECTOR: ��-�Gl
CERTIFfCArN9N #
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DATE & TIME TEST TO BE
CONDUCTED:
ICC #:
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TEST
METHOD m
SIGNATURE OF APPLICANT
DATE: Ih W I � 1
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CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT
PREVENTION SERVICES
rg�nAR D 1501 TRUXTUN AVENUE, 1sT FLR
BAKERSFIELD, CA 93313
T Office Phone: (661) 326 -3979
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
---------------- -- - - - - --
VALERO CALIFORNIA RETAIL CO
1 VALERO WY
78249
10- 10000331 Date 11/04/10
3225 BUCK OWENS BLVD
332 - 162- 16 -00 -8
FIRE DEPT
0
Contractor
------------------ - - - ---
OWNER
Permit . . MANDATED LEAK DETECT TEST
Additional desc .
Phone Access Code 1046010
Permit Fee 96.00 Plan Check Fee 96.00
Issue Date 11/04/10 Valuation . . . . 0
Expiration Date 5/03/11
------------------------------------------------------- 7 --------------------
.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
10F416MaTO;AIM9 DIN IICOM
(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 afterl 80 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.
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. 8c 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 certi)� 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