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Home My WebLink About3225BUCK OWENS BOULEVARD_UST MINOR MOD 6.17.11FLOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. 1111111111111111 45 Permit No. Permit No. Permit No. IE //- /000CI.?/ File Number: 3& Ca Date Received: 6, _ / 7 - // Address: 32Ra?' y -(< &uje ris. Bakersfield, CA 933 Business Name: ❑ ❑ Other: Comments: nnDate Time JE 9. a. 3. 4. -INSPECTION LOG Signature SYSTEM: BUILDING SQUARE FEET: New Mod. ❑ ❑ Commercial Hood System Building Sq. Feet: ❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft: ❑ ❑ Fire Sprinkler System ❑ ❑ Spray Finish System ❑ ❑ Aboveground Storage Tank ❑ Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank ❑ ❑ Other: Comments: nnDate Time JE 9. a. 3. 4. -INSPECTION LOG Signature UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD IPermit # TYPE OF APPLICATION: CHECK ONE ONLY BAKERSFIELD FIRE-DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 RFIR! Phone: 661- 326 -3979 . Fax: 661-852-2171 AN r Page 1 of 1 ❑ NEW TANK INSTALL/NEW FACILITY ❑ MODIFICATION OF FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY I— MINOR MODIFICATION OF FACILITY STARTING DATE/ 06/17/2011 PROPOSED COMPLETION DATE 06/21/2011 FACILITY NAME Valero California Retail 9I ING FACILITY PERMIT # FACILITY ADDRESS 3225 Buck Owens Boulevard CITY Bakersfield ZIP CODE 93308 TYPE OF BUSINESS Service Station APN # TANK OWNER Valero California Retail PHONE # (559) 583 -3231 ADDRESS 625 W. Third Street CITY Hanford ZIP CODE `%320 CONTRACTOR Triton Construction CA LICENSE # 693807 ICC # 5252286 -U1 ADDRESS 2560 Soquel Avenue #202 CITY Santa Cruz ZIP CODE 95062 PHONE # (891) 227 -4729 BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # SCO01113001 INSURER Mid Century BRIEFLY DESCRIBE THE WORK TO BE DONE: Replace flexible vapor recovery boot immediately prior to entering Bravo secondary containment pan on Gilbarco MPD dispenser WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? 113 YES ❑ NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK if VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER Tank Testing Company NAME OF TESTING COMPANY Triton Construction PHONE NUMBER (631) 2274729 MAILING ADDRESS 2560 Soquel Avenue #202 NAME OF TESTER Rudy Chavez ICC# 5252286 -U1, VT THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL RE GULATIONS. THIS FORM HAS BEEN COMPLETEDUNDER PENALTY OF PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER Frank Bohnet ICC* 5242482 -U1, VT THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE. DATE APPROVED I — D2UU6 (Kev uu /U9) 8 �17F C;ty of SNisersfield U -S-T► R= .ELTEIPT tax Oper: S::#itRIL1•L� .. Type: W Drawer: 1 i Oate: .If /li 01 Receipt. no: 126217 Des& at:ti►n Quantity A ®o�mt Vii. s INOV. iE BVILDINE PER11ITiS 1,m t167.dR � fes:9er latail • 4167.06 total tendered #167.P:0 i Total. psvie.n - 1157.09 i franc dale: 5/17/1,1 Tice: 13:29:49 iitlP LWROL T1# . pi f�PLiPCiL TION F�ER ii :if AYI *. Zia IMIr9NATI0NAt coorcacir RUDY CHAVEZ VAPOR RECOVERY SYSTEM TESTING AND REPAIR The individual named hereon is CERTIFIED in the category i shown, having been so certified pursuant to successful completion .of the prescribed written examinations. Expiration date: March 3, 2012 No. 5252286 -VT Not valid unless signed by certificate holder. ICC certification attests to competent knowledge of codes-and standards RUDY CHAVEZ 2560 SOQUEL AVE SUITE 202 SANTA CRUZ, CA 95062 From: Certification and Testing Department Date: March 29, 2010 Subject: MARCH 3, 2010 ADMINISTRATION Examination: VAPOR RECOVERY SYSTEM TESTING AND REPAIR Birmingham District Office Certification and Testing Department 900 Montclair Road �L51 Birmingham, Alabama 35213 ® _ Tel: 888 422 -7233 extension 5524 Fax: 205-599-9897 111T NATIONAL www.iccsafe.orq CODE COUNCIr Congratulationsl You have demonstrated' a commitment to the code enforcement profession by successfully achieving ICC certification. Your wallet card is enclosed. Your certification information will be posted on the Certification Website as an Active Certification. htto : / /www.iccsafe.6rg /ACCREDITATION RENEWAL: Prior to the expiration date shown on your wallet card, we will mail you a reminder notice with information on, certification renewal to your address on record. If your address has changed, please see CHANGE OF ADDRESS below. Unless otherwise specified, we will mail the renewal reminder notice 6 months before.your. Certification expiration date. This is done so far in. advance because we want to help ensure you have sufficient time to accrue the necessary Continuing Education Units (CEUs). AST /UST certification renewal - Certification is valid for a two year period. You may renew by retaking and passing the exam. State licensing may vary. Contact the appropriate state agency in charge of AST /UST work for information on licensing requirements. ICC California UST Inspector certification renewal - Certification is valid for a two year period. Renew by retaking and passing the exam or by fulfilling the continuing educational requirements approved by the State Water Resources Control Board, Underground Storage Tank Program Manager. Contact the appropriate state agency in charge of UST work for information on certification requirements. NAFED certification renewal - NAFED must receive your application for recertification and documentation within 60 days prior to the expiration date of the current certification. htto: //www.nafed.org /certification/ Renewal of certifications is the responsibility of the certified individual. Please make sure you keep track of your renewal da te(s). CHANGE OF ADDRESS: It is extremely important that you notify ICC Renewal Department of any change of address to avoid the . possibility of your renewal information not being received. The change of address form is• located on the ICC website at htti):l /www.iccsofe.orq'/AccreditationiPaaes/safetv.asr)x. If you have achieved a NAFED certification you must notify NAFED of any change of address. http: / /www.nafed.or Best wishes for continued success in your career, and thank you for your interest in the Certification Programs of the International Code Council. Yours very truly, Certification and Testing Department Enclosure Birmingham District Office ► \�� Certification and Testing Department �- ®o-.A 900 Montclair Road Birmingham, Alabama 35213 Tel: 888- 422 -7233 extension 5524 ��a� W.. MM Fax: 205- 599 -9897 I N fEN NA1 IONAI. www.iccsafe.ora CODE COUNCIL° RUDY CHAVEZ 2560 SOQUEL AVE SUITE 202 SANTA CRUZ, CA 95062 From: Certification and Testing Department Date: January 28, 2010 Subject: JANUARY 8, 2010 ADMINISTRATION Examination: UST INSTALLATIONIRETROFITTING Congratulations! You have demonstrated a commitment to the code enforcement profession by successfully achieving ICC certification. Your wallet card is enclosed. Your certification information will be posted on the Certification Website as an Active Certification. http: / /www.iccsafe.om /ACCREDITATION RENEWAL: Prior to the expiration date shown on your wallet card, we will mail you a reminder notice with information on certification renewal to your address on record. If your address has changed, please see CHANGE OF ADDRESS below. Unless otherwise specified, we will mail the renewal reminder notice 6 months before your Certification expiration date. This is done so far in advance because we want to help ensure you have sufficient time to accrue the necessary Continuing Education Units (CEUs). AST /UST certification renewal — Certification is valid for a two year period. You may renew by retaking and passing the exam. State licensing may vary. Contact the appropriate state agency in charge of AST /UST work for information on licensing requirements. ICC California UST Inspector certification renewal — Certification is valid for a two year period. Renew by retaking and passing the exam or by fulfilling the continuing educational requirements approved by the State Water Resources Control Board, Underground Storage Tank Program Manager. Contact the appropriate state agency in charge of UST work for information on certification requirements. NAFED certification renewal — NAFED must receive your application for recertification and documentation within 60 days prior to the expiration dale of the current certification. htti): / /www.nafed.org /certification/ Renewal of certifications is the responsibility of the certified individual. Please make sure you keep track of your renewal date(s). CHANGE OF ADDRESS: It is extremely important that you notify ICC Renewal Department of any change of address to avoid the possibility of your renewal information not being received. The change of address form is located on the ICC website at http://www.iccsafe.org/Accreditation/Pages/safety.asl)x. If you have achieved a NAFED certification you must notify NAFED of any change of address. http: / /www.nafed.org Best wishes for continued success in your career, and thank you for your interest in the Certification Programs of the International Code Council. Yours very truly, Certification and Testing Department Enclosure NO MUM ae =: n +llae,.twxu coot comtur RUDY CHAVEZ UST INSTALLATION /RETROFITTING The individual named hereon is CERTIFIED in the category shown, having been so certified pursuant to successful completion of the prescribed written examinations. Expiration date: January 8, 2012 No. 5252286 -U1 Not valid unless signed by certificate holder. ICC certification attests to competent knowledge of codes and standards :iG1 roorcouxcrc RUDY CHAVEZ CA LIFORNIA UST SERVICETECHNICIAN ��The individual named hereon is CERTIFIED in the category shown. having been so certified pursuant to successful completion of the prescribed written examinations. Expiration date: July 2, 2012 No. 5252266 Not valid unless signed by certificate holder. ICC ceniricafion arrests to competent knowledge of codes and standards RUDY CHAVEZ 2560 SOOUEL AVE SUITE 202 SANTA CRUZ, CA 95062 From: Certification and Testing Department . Date: July 12, 2010 Subject: July 2; 2010 ADMINISTRATION Ezdfiii' ation:' ' - C- A-LiFORNWA UST -SERVICE TECHNICIAN— Birmingham District Office Certification and Testing Department 0-00 Montclair Road Birmingham, Alabama 35213 Tel: 888- 422 -7233 extension 5524 Fax: 205 -599 -9897 ' INTERNAMONAL www.iccssfe.oro CODE COUNCIL! 0T, v-� JUL 15 2010 Congratulations! You have demonstrated a commitment to the code enforcement profession by successfully achieving ICC certification. Your wallet card is enclosed. Your dertification information will be posted on the Certification Website as an Active Certification, http: / /www.iccsafe.org /ACCREDITATION RENEWAL: Prior to the expiration date shown on your wallet card, we will mail you a reminder notice with information on certification renewal to your address on record. If your address has changed, please see CHANGE OF ADDRESS below. Unless otherwise specified, we will mail the renewal reminder notice 6 months before your Certification expiration date. This is done so for in advance because we want to help ensure you have sufficient time to accrue the necessary Continuing Education Units (CEUs). AST /UST certification renewal — Certification is valid for a two year period. You may renew by retaking and passing the exam. State licensing may vary. Contact the appropriate state agency in charge of AST /UST work for information on licensing requirements. ICC California UST Inspector certification renewal — Certification is valid for a two year period. Renew by retaking and passing the exam or by fulfilling the continuing educational requirements approved by the State Water Resources Control Board, Underground Storage Tank Program Manager. Contact the appropriate state agency in charge of UST work for information on certification requirements. NAFED certification renewal — NAFED must receive your application for recertification and documentation within 60 days prior to the expiration date of the current certification. http: / /www.nafed.org /certification/ Renewal of certifications is the responsibility of the certified individual. Please make sure you keep track of your renewal date(s). CHANGE OF ADDRESS: It is extremely important that you notify ICC Renewal Department of any change of address to avoid the possibility of your renewal information not being received. The change of address form is located on the ICC website at httr)://www.iccsafe.or,q/Accreditation/Pa-ges/safety.aspx. If you have achieved a NAFED certification you must notify NAFED of any change of address. http:/ /LA nafed.org Best wishes for continued success in your career, and thank you for your interest in the Certification Programs of the International Code Council. Yours very truly, Certification and Testing Department Enclosure INTERNATIONAL'CODE COUNCIL FRANK BOHNET N�- Adolf Zubia President, Board of Directors ACC 1] XN1 _:... _.._._:.:_. . . - .:..- .- _ -:... Given this day o October 2, 2009 IF Certificate No. 5242482- 1 This certijswte is the property of ICC and must he returned to ICC in the event of suspension or revocation of the certificate. Richard P. Weiland Chief Executive Officer air= FRANK wruranoxet APOR RFC BOHNET OVERY SYSTEM REPAIR The individual named hereon is CERTIFIED in the catege show having been so certified Prescribed written pursuant to successful completion of the n Expiration date: June 11 ations. No.5242482 2012 'CC certification attests tro coarid unless signed b rnPetent knowfed b certificate holder. 9 • of codes and standards FRANK BOHNEi 2560 SOQUEL AVE STE 8 SANTA CRUZ, CA 95062 From: Certification and Testing Department 2010.. . Subject: June 11, 2010 ADMiRISTRATiON- Examination: VAPOR RECOVERY SYSTEM REPAIR Birmingham District Office Certification and Testing Department 900 Montclair Road Birmingham, Alabama 35213 Tel: 888- 422 -7233 extension 5524 Fax: 205- 599 -9897 www.iccsafe.org JUL 12 2019 INTERNATIONAL CODE COUNtIl" Congratulations! You have demonstrated a commitment to the code enforcement profession by successfully achieving ICC certification. Your wallet card is enclosed. Your certification information will be posted on the Certification Website as an Active Certification. http: / /www.iccsafe.org /ACCREDITATION RENEWAL: Prior to the expiration date shown on your wallet card, we will mail you a reminder notice with information on certification renewal to your address on record, If your address has changed, please see CHANGE OF ADDRESS below. Unless otherwise specified, we will mail the renewal reminder notice 6 months before your Certification expiration date. This is done so far in advance because we want to help ensure you have sufficient time to accrue the necessary Continuing Education Units•(CEUs). AST /UST certification renewal — Certification is valid for a two year period. You may renew by retaking and passing the exam_ State licensing may vary. Contact the appropriate state agency in charge of AST/UST work for information on licensing requirements. ]CC California UST Inspector certification renewal — Certification is valid for a two year period. Renew by retaking and passing the exam or by fulfilling the continuing educational requirements approved by the State Water Resources Control Board, Underground Storage Tank Program Manager. Contact the appropriate state agency in charge of UST work for information on certification requirements. NAFED certification renewal — NAFED must receive your application for recertification and documentation within 60 days prior to the expiration date of the current certification. htto : //www.nafed.orgfcertification/ Renewal of certifications is the responsibility of the certified individual. Please make sure you keep track of your renewal date(s). CHANGE OF ADDRESS: It is extremely important that you notify ICC Renewal Department of any change of address to avoid the possibility of your renewal information not being received. The change of address form is located on the ICC websife at !Ittp://www.iccsafe.or-q/Accreditation/Pages/safety.aspx. If you have achieved a NAFED certification you must notify NAFED of any change of address. htto: / /www.nafed.org Best wishes for continued success in your career, and thank you for your interest in the Certification Programs of the International Code Council. Yours very truly, Certification and Testing Department Enclosure INTERNATIONAL CODE COUNCIL No m' �L ::: FRANK BOHNET Adolf Zubia President, Board of Directors 11:110 Certificate No. 5242482 -U1 This ce"cate is the property ojICC end must he returned to ICC in the mat of suspension orrevmtion o(the certificate. Richard P. Weiland Chief Executive Officer 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 AST NEW INSTALL DESCRIPTION DATE. SIGNATURE AST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE P,RfOR TO- OPERATION -Of AN- Y- SYSTEM; AL'L UST AND %OR AST SYSTEMS -SHALL B_E. INST&C-C_OIAPLETE:AND ACCEPTED BY TEN.' MISC. ACTIVITY THE BAKERSFIELD'CT FiR�DEPERA ( T— IRE -DEPART-MENT-(FINAL)` ---- BUILDING ADDRESS: j JOB DESCRIPTION: OCCUPANCY TYPE: OWNER: - PERMIT NO. CONTRACTOR: =e% ; PHONE # FD 1743 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 11- 10000212 Date 6/17/11 3225 BUCK OWENS BLVD 332- 162- 16 -00 -8 FIRE DEPT, 0 Contractor ------------------ - - - - -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . UNDGRND STR TANK MINOR MODIFY Additional desc . . Phone Access Code . 1106566 Permit Fee . . . . 83.50 Plan Check Fee 83.50 Issue Date . . . . 6/17/11 Valuation . . . . 0 Expiration Date . . 12/14/11 ---------------------------------------------------------------------------- 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 Permit expires after 180 days of inactivity. I have reviewed the above application, and find it to be correct/complete. Permittee: Date: BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES R s P 11 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 �`�� r Office Phone: (661) 326 -3979 11- 10000212 Date 6/17/11 3225 BUCK OWENS BLVD 332- 162- 16 -00 -8 FIRE DEPT, 0 Contractor ------------------ - - - - -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . UNDGRND STR TANK MINOR MODIFY Additional desc . . Phone Access Code . 1106566 Permit Fee . . . . 83.50 Plan Check Fee 83.50 Issue Date . . . . 6/17/11 Valuation . . . . 0 Expiration Date . . 12/14/11 ---------------------------------------------------------------------------- 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 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 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 . r 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. 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 ' Date