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HomeMy WebLinkAbout3300 WHITE Lane_UST FMC 12.3.10iem HOODS ALARMS F"RNE`.1_E f' SYSTEMS SPRAY BOOTH AT UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. r vv4♦ I File Number: 49,VW Address: :3 3 n n cA WL-;C-e LoJ • ism Bakersfield, CA 933... _ Date Received: 1.7,.3 — /p 38 IE Business Name: S INSPECTION LOG L BUILDING SQUARE FEET: SYSTEM: New Mod. ❑ ❑ Commercial Hood System Building Sq. Feet: Date Time ❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft: 1. 12123110 % ❑ ❑ Fire Sprinkler System 2. ❑ ❑ Spray Finish System 3. ❑ ❑ Aboveground Storage Tank 4. ❑ ❑ Underground Storage Tank ` minor Signature modification Underground Storage Tank removal Underground Storage Tank Signature ❑ M,- Other: Comments: " ism _ 38 IE i CONSTRUCTION PERMIT Application Number . . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . , Owner ------------------ -- - - -- SERVICE STATION HOLDINGS LLC 310 MT LOWE DR BAKERSFIELD CA 93309 BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES R S F I D 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 'Rr r Office Phone: (661) 326 -3979 10- 10000387 Date 12/08/10 3300 WHITE LN 403 - 012- 44 -00 -2 FIRE DEPT 0 Contractor ----------------- --- - - -- OWNER -------------------------------------------------- - ------------------ - ------ Permit. . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code . 1055599 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date 12/08/10 Valuation 0 Expiration Date 6/06/11 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 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. & 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: 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 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 p�F�pF�I► OPUST `10E5+ "COMPLIANCE WITH CONFIDENCE" December 3, 2010 CITY OF BAKERSFIELD Attn: David Weirather Off ice' of Environmental' Servides Fire Department /UST Program 2101 H Street Bakersfield; CA .93301 To Whom It May Concern: Enclosed for your approval, please find Application to Perform Fuel Monitoring 'Certification and Billing and Permit Statement, along with our check in the amount of $192.00. Please fax the approved Application;: .and permit fee receipt to our office at 661- 587 -9758. Should you have any questions, please feel free to contact me at 631 -3870. Thank you for your attention herein. Enclosures Yours truly, 'CONFIDENCE UST SERVICES, INC. Karli Karns, Dispatch Coordinator 16250 Meacham Road • Bakersfield, CA 93314 (661)•631 -3870 or (800) 339 -9930 FAX (661) 587 -9758 .. , .. ��: 4 -� •� ,. .. . � t .. � {. �S .: J • .. Z �IAKERSFXELDEIRE DEPARTMENT 13-ILLINGA-PERMIT. STATEMENT 'NS6. i v nt.inn Qp_rwicias H�A H R a V I FIRE I i- 1600 Truxtun Avenue, Suite 401 PERMIT # PARTAW - r Biiikersfield, CA 93301 Phone..6.61,:326=39.7.9..*..Fax.,6—.6..lm8q?,n.7.-1,-.. SITE INFORMATION LO . ON OF PROJECT +e _L ------------ Xk� — ------- wit zw PROPERTY OWNER STARTING DATE Cs9MPtETlDICDfft TIME NAME 12=/ N51 k U R-.6QaCn PROJECT NAME ,�Oma ADDRESS PHONE culak 'Y35i_ IN IS -6c PROJECT ADDRESS 1crrY STATE CA ZIP CODE CONTRACTOR INFORMATION C­ ­ R­A'-C­T'09'NrMi CA LICENSE # TYPE OF LICENSE EkPfRATibiti DATE.' • ­r ------- 46NE'i PH I CONTRACT COMPANY NAME <,T FAX # ADDRESS CITY ZIP CODE lu')_156 -MjLCLe,�1.dA1 9,na Ci All permits must be reviewed, stamped, and a _4 a approved PRIOR TO BEGINNING WORK. r ..... U-1 1114111 WIN I to] V1 �:..a :.e ❑ ..!r'�; -kew , .- .�>:..r 1,..r- r•v -.... T...T� .. .. .•. .. •. -.., S•;nt .i Ala & Modification (minimum charge) $280. °pl's cx ���' °''� 98 ■ ❑ Over 10,000 sq lit $0 .028 x sq ft ■ ■ 84 98, ❑ Sprinkler New & Modification (minimum charge) $280 ■ ■ 84. 98 ❑ Over 10,000 sq lit $0 .028 x sq ft 84 ❑ Minor Sprinkler Modification'(< 10 heads) $96 (inspection only) 84 98 ❑ commercial Hood (New & Modification) $470 ' a a- 84 98 ■ ❑ Additional hood j $58 a 84 98 of ❑ Spray Booth (New & Modlficatlon) $470 84 98 ■ ❑ Aboveground Storage Tank (Installation/One Inspection) I $180 ■ 82 ❑ Additional Tank I 1$96 ■ 82 ❑ Aboveground Storage Tank (Removal /Inspection) $109 a 82 ❑ Underground Storage Tank (Installation/Inspection) $878 /tank ; 82 ❑ Underground Storage Tank (Modification) y $678/site 82 ❑ Underground Storage Tank (Minor Modification) I $167 ■ 82 ❑ Underground Storage Tank (Removal) j 1$573/tank ■ 84 ❑ Oil well (Installation) 1 $96 ■ 84. 13V Mandated Leak De.tection.(test)/Fuel Mont Cert/SB989 $96/site 82 NOTE.. $96 for each type of test/per site even if ■ scheduled at the same time ■ ❑ Tent' I 1$96/tent ■ 84. 1 ❑ 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 /Fellow -up Inspection $96 /hr ; ❑ Portable LPG (Propane): # of Cages? 1 $96 • 84 ❑ Explosive Storage $266 84 ❑ Copying & File-Research (File Research. fee $34/hr) $0.25/page ■ .84 ❑ Miscellaneous FD2021 (ReV66j07)-` 1 - ORIGINAL WHITE (Treasury) 11-YELLOW (File) 1-PINK (Customer) I UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING/ SB989 SECONDARY CONTAINMENT TESTING/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION PERMIT # ❑ ENHANCED LEAK DETECTION ❑ TANK TIGHTNESS B B R 9 P I S n 4 pine ARrt# r BAKERSFIELD FIRE DEPARTMENT Prevention Services 1600 Truxtun Ave., Suite 401 Bakersfield, CA 93301 Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 Page 1 of 1 ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT Ql"FUEL MONITORING CERTIFICATION FD2095 (Rev 06/07) SITE INFORMATION FACILITY NAME & PHONE # OF CONTACT PERSON ADDRESS ,gW W �e 1�T1�1��F I� 1�,Al,'-ERSFIELD, aA OWNER NAME Sam 0. OPERATOR NAME PERMIT TO OPERATE # # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO TANK # VOLUME CONTENTS :TAIwTESTING COMPANY • TESTING COMPANY erg U5- Sir I11.e, NAME & PHONE # OF CONTACT PERSON rl n (16,0651-59-70, Q-KA -. MAILING ADDRESS Ile 2.5 O S -F� e.• C�1 3 NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR ''rrSS 1 tERTIFICATION # DATE & IME TEST TO BE CONDUCTED ICC # TEST METHOD APPLICANT SIGNATURE e DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APP BY 'AK DATE FD2095 (Rev 06/07) 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 UST REMOVAL DESCRIPTION DATE SIGNATURE AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR AST REMOVAL DESCRIPTION DATE " SIGNATURE EVR UPGRADE PRIOR TO OPERATION OF ANY SYSTEM, ALL UST AND /OR AST SYSTEMS SHALL BE INSTALL, COMPLETE AND ACCEPTED BY MISC. ACTIVITY THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL) REMARKS: BUILDING ADDRESS: O 4,'T-P Lri JOB DESCRIPTION: ia2-"C✓ OCCUPANCY TYPE: OWNER: Cm PERMIT NO. 16 - /QQd')0 CONTRACTOR: PHONE # «l -,39710 FD 1743 R ` -Dr er;' Opei T e.:;p�: edi Pt no• : ";53 1" Date::.i�108j10 -0'1 R .:,''r: }:;:; . eSCT'1 $P...1@ ;i gUILUIp :PE0 t4t ?S fender detail ::30156 • "s1 fL CK ,(•= .Tine,:.a5.�1�5,. Alp*.