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HomeMy WebLinkAbout3225 BUCK OWENS Boulevard _UST SB989 6.21.11Still! os HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: 3054, Address: �32;zC5' c.K S 8LVC-( Bakersfield, CA 933 Date Received: 6 -;Z / -- Business Name: n)AI y 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 ❑ 0?� Other: S a - SQ'5 Comments: Building Sq. Feet: Calculation Bldg. Sq. Ft: 1. 2. 3. 4. Date Time Signature 10 CONSTRUCTION PERMIT 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 BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES R S P I D 1501 TRUXTUN AVENUE, IT FLR F /RE BAKERSFIELD, CA 93313 =RTM T Office Phone: (661) 326 -3979 11- 10000217 Date 6/21/11 3225 BUCK OWENS BLVD 332- 162- 16 -00 -8 FIRE DEPT 0 Contractor ------------------ - - - --- OWNER ---------------------------------------------------------------------------- Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code 1107259 Permit Fee 96.00 Plan Check Fee 96.00 Issue Date 6/21/11 Valuation . . . . 0 Expiration Date 12/18/11 -------------------------------------------------------------------- -------- 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 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 Agenf 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 Date WORKERS COMPENSATION DECLARATION I hereby affirm that under penalty of perjury one of the following declarations: 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: Carrier 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 1 certify that I have read this application and state that the information contained herein is correct. 1 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 TRITON CONSTRUCTION CHECK # 23191 A DIVISION OF RRM, INC. Bakersfield Fire Dept. DATE: 06/10/11 REFERENCE: SB200 -3074: Test Permit AMOUNT: 192.00 COB 6/8/2011 11:36:17 AM PAGE 2/003 Fax Server BILLING & PERM17 STATEMENT BAKERSFIELD FIRE DEPARTMENT e ^ FIRE' Prevention Services PERMIT # 0 ARTmE T 2101 H Street Bakersfield, CA 93301 \� -Phone: 661- 326 -3979 o Fax: 661- 852 -2171 All permits 'must ust be reviewed, stamped, and approved PRIOR TO SEGEMMIM(G WORK. PE FEE CALCULATION TOTAL ❑ Alarm - New & Modification (minimum charge) $280 ° E. TREASURY INFORMATION SITE LOCATION OF PROIECT_, , _)2z S PROPERTY OWNER ' i O j ro,,- STARTING DATE COMPL ON TE NAME �310;� Sprinkler - New & Modification (minimum charge) $280 PROIECT NAME ^ i �� O ADDR SS 7 , �,,C �_P� U `^ PHONp ik� _ �- PROJECT ADDRESSr' �ZZS IJUCIC OC.J eN�7 W I�1 lx '/ T I ^ CITY �/"C M1-FiiW �I �C�D STATE C/T ZIP CODE CON*TRALTOR INFORMATION Minor Sprinkler Modification (<10 heads) CONTRACTOR NAME 1 CA LICENSE » I r1 CQr�s 1YvL i'� g3 6� TYPE F LICENSE EXPIRATION DATE -l4AZ PHO V I - y v w CO CrOR OMPANY NAME 60 i•rj : FAX # Rat /%A c, 0 Aj ADDRESS Sib CIiY„ / C� ZIP CO�E�� `7 $58 N v ' All permits 'must ust be reviewed, stamped, and approved PRIOR TO SEGEMMIM(G WORK. PE FEE CALCULATION TOTAL ❑ Alarm - New & Modification (minimum charge) $280 ° E. TREASURY ❑ Over 10,000 sq ft $0 .028 x Sq ft ❑ Sprinkler - New & Modification (minimum charge) $280 ❑ Over 10,000 sq ft $0 .028 x sq ft I ❑ Minor Sprinkler Modification (<10 heads) $96 (inspection only) 84 ❑ Commercial Hood (New & Modification) $470 ❑ Additional hood $58 ❑ Spray Booth (New & Modification) $470 98 ❑ Aboveground Storage Tank (1 inspection per installation) AST $180 /tank 82 ❑ Additional Tank ATI $96 /tank 82 ❑ Aboveground Storage Tank (Removal /Mod /Inspect) ATR $109 /tank 82 ❑ Underground Storage Tank (Installation /Inspection) PIE $878 /tank 82 ❑ 1 Underground Storage Tank (Modification) MOD $878 /site 82 ❑ Underground Storage Tank (Minor Modification) MTM $167 /site 82 ❑ Underground Storage Tank (Removal) TR $573 /tank AMandated Leak Detection (test) /Fuel Mont Cert/SB989 TT NOTE: $96 /hr for ea type of test /per site even if scheduled at the same time $96 /hr (2 hrs minim ) =$192 84 ❑ Oil well (Installation, Inspection, or re- inspection) X $96 /hr 82 ❑ Tent # $96 /tent 84 ❑ After -hours inspection fee $121 /hr (2 hrs minimum) =$242 ❑ Pyrotechnic (1 permit per event, plus an inspection fee of $96 /hr during business hours) Py (VOTE: After hours P rotechnlc event inspection is @ $121 /hr $96 /hr + (5 hrs min standby fee/insp) =$S76 5 hrs min standby fee ins =$605 84 ❑ Re- inspection /Follow -up Inspection $96 /hr 84 ❑ Portable LPG (Propane): # of Cages? $96 /hr 84 ❑ Explosive Storage $266 84 ❑ Copying & File Research (File Research fee $50 /hr) $0.25 /page 84 ❑ Miscellaneous 84 _ _ FD2021 (Rev 04/08) COB 6/8/2011 11:36:17 AM PAGE 3/003. Fax Server UNDERGROUND STORAGE TANKS +.,. -,•' ,�-LxR.rr ta: :-:t. u:c rry; rnw:,• t�, rrLan'k".T.��4SL "13.'3Ct29.^„r' S A Sp I r APPLICATION RIRer A/RTM T TO PERFORM ELD /LINE TESTING/ SB989 SECONDARY CONTAINMENT TESTING/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION (Please note that these are separate individual tests and will be charged per separate type test accordingly.) PERMIT # ❑ ENHANCED LEAK DETECTION ❑ TANK TIGHTNESS BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661 =352 -2171 Page 1 of 1 ❑ LINE TESTING ❑ FUEL MONITORING CERTIFICATION i SB -989 SECONDARY CONTAINMENT SITE INFORMATION CT 011oo -so NAM & PHONE F OF CT A P N C) ►".-1 3/- 2-2 _ 9? 3 ADDRESS 32L S tick OcsLJ �4u3 �j iv'C� �ak- evs{� c.�cQ OUlNqR NAM �� �'V l��� � ��✓ OPERATOR NAME r� _ (1 v PERMIT TO OPERATE # #k OF TANKS TO BE TESTED: 3 35 PIPING GOING TO BE TESTED? $_YES ❑ NO TANK #. VOLUME CONTENTS / 1 TANK TESTING COMPANY TESTING COMPANY► NAME £a PHONE R OF CONTACT PERSON MAILING A Cr (- Ca. NAMME& PHONE 4V OF TEA OR SPECIAL SPECTOR :j7(> h n � d ^d C c l� -PV CERTIFICATION 3� 5 DATE & T ME T ST TO BE CON ED Alk ICC tt C7� ( gO / - ( TEST METHOD -CN lJt�sfdl APPL T iGJATURE DATE / THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE F02095 (Rev 03/08) BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work Inspection Request Phone No. (661) 326 -3979 UST NEW INSTALL DESCRIPTION DATE SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF TANK TESTING UST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE MISC. ACTIVITY REMARKS: AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR AST REMOVAL DESCRIPTION DATE SIGNATURE PRIOR TO OPERATION OF ANY SYSTEM, ALL UST AND /OR AST SYSTEMS SHALL BE INSTALL, COMPLETE AND ACCEPTED BY THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL) BUILDING ADDRESS: 3ZZ $' l g ni JOB DESCRIPTION: - OCCUPANCY TYPE: ,a OWNER: �a ,/► PERMIT NO. -/ CONTRACTOR: ,�► ; ip,,,j PHONE # FD 1743 STATE OF CALIFORNIA >I a � h� x Z �: � g • � � �6 t , IN Pursuant to Chapter 9 of Division 3 of the Business and Professions Code and the Rules and Regulations of the Contractors State License Board, the Registrar of Contractors does hereby issue this license to: REMEDIATION RISK MANAGEMENT INC DBA TRITON CONSTRUCTION to engage in the business or act in the capacity of a contractor in the following classification(s): A - GENERAL ENGINEERING CONTRACTOR HAZ - HAZARDOUS SUBSTANCES REMOVAL B - GENERAL BUILDING CONTRACTOR ,_ASB - ASBESTOS Witness my hand and seal this day, February 2, 2007 Issued August 3, 1994 SIGNATURE OF LICENSEE SIGNATURE OF LICENSE QUALIFIER This license is the property of the Registrar of Contractors, is not transferrable, and shall he returned to the Registrar upon demand when suspended, revoked, or invalidated for any reason. It becomes void if not renewed. Stephen P. Sands Registrar of Contractors 693807 License Number 13L-2.1 (REV. 7-01) 05P 05 90638 - AUDIT NO: 60W62 Policy Number: SISIEIL70035611 Date Entered: 06/10/2011 ACORN® CERTIFICATE OF LIABILITY INSURANCE GATE (MM /DD/Y`/YY) 6/10/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER KING INSURANCE SERVICES 7 397 Soquel Dr Aptos, CA 95003 CONTACT NAME: FAX PH(AT"Afl,M• (831) 688 -1434 Ne), (831) 662 -9635 E -MAIL ADDRESS: SISIEIL70035611 ' /24/2011 ' INSURER($) AFFORDING COVERAGE NAIC S INSURER A: Starr Indemnity & Liability CO 1 MED EXP (Any one person) INSURED Remediation Risk Management, Inc. INSURER B: Granite State Insurance Co 1 INSURER C: Mid-Century Insurance Company GENERAL AGGREGATE Triton Construction dba RRM Inc. INSURER O.: PRODUCTS - COMP /OP AGG 2560 Soquel Ave #202 INSURER E: I Santa Cruz, CA 95062 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A OL SUBR POLICYNUMBER POLICY EFF MM /DD POLICY EXP MM /DD _ LIMITS A GENERAL. LIABILITY I COMMERCIALGENERALLIABILITY I� CLAIMS-MADE ®,OCCUR Cant Pollution SISIEIL70035611 ' /24/2011 /24/2012 EACH OCCURRENCE S1,000,000 _13AMKGnO RENTED PREMISES (Ea occurrence) 550,000 MED EXP (Any one person) S5,000 PERSONAL & ADV INJURY 1$1,000,000 GENERAL AGGREGATE (S2 , 1700 , 000 GEN*L AGGREGATE LIMIT APPLIES PER: n PRO- POLICY LOC PRODUCTS - COMP /OP AGG S2 , 000 , 000 1 S C C AUTOMOBILE LIABILITY I ANY AUTO IALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED I HIRED AUTOS I AUTOS I I 604818589 /11/2011 /11/2012 O BINEDt SINGLE LIMIT (Ea 1 $ 1,000,000 BODILY INJURY (Per person) 1 S BODILY INJURY (Per occident) i S PROPERTYD Per accidentAMAGE 1 S IS A 6�UMBRELLA LIAR I 1 OCCUR EXCESS LIAB 1 CLAIMS -MADE SISIXNV71015411 /24/2011 /24/2012 EACH OCCURRENCE I S4 , 000 , 000 AGGREGATE 154,000,000 I DED I RETENTION S is B WORKERS COMPENSATION AND EMPLOYERS' LABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? 0 (Mandatory In NH) It Yes, describe under DeSGP,IPTION OF OPERATIONS below N/A WC001113001 /1/2011 /1/2012 WC STATU- 0TH -I E.L. EACH ACCIDENT I S1,000,000 E.L. DISEASE - EA EMPLOYEE S 1 , 000, 000 E.L. DISEASE - POLICY LIMIT 5 1 000 , 000 A Prof Liability SISIEIL70035611 /24/2011 /24/2012 Occurrence $1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Produced using Forms Sass Plus software. wwwYormsBoss.com: Impressive Publishing 800 - 208 -1977