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HomeMy WebLinkAbout3360 PANAMA Lane_UST SB989 4.27.11_I'�RNPA�tlY <_ 46 IE UNDERGROUND STORAGE TANKS APPLICATION 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 J BAKERSFIELD FIRE DEPARTMENT Prevention Services sRSPI n 2101HStreet PARR Bakersfield, CA 93301 ARTM T Phone: 661 - 326 -3979 • Fax: 661- 852 -2171 Page 1 of 1 ❑ LINE TESTING I sB -989 SECONDARY CONTAINMENT ❑ FUEL MONITORING CERTIFICATION ��VV = SITE INFORMATION FACILITY ©^ f ` I�/1\y /I NAME &,PHONE # OF CONTACT PERS ` 7JO ADDRESS 3 ,ne Q e OWNER NAM OPERATOR NA p �01 PERMIT TO OPERATE # # OF TANKS TO BE TESTED: IS PIPING GOING TO.BE TESTED? YES ❑ NO TANK # VOLUME CONTENTS 12 000 t-4 . a 11000 S� 121,000 �' 1 ;a •�I TANK TESTING.COMPANYi °': IY-:- 'IH:•:' - '':��r': YS * J�i' "_ _" .,'I:. -, - y .i TEST NG COMPANY G NA E & PHONE # OF C NTACT PERSON MAILI A[�pR S( 0 Vr � P 1& ,INSPE NA PPHOO)` E # OF TE ER OR SPECIAL OR otp-i6s 31 CERTIFICATION DATE &TIM EST CSDUCTE �3 ICC# ��] ��JlllY7 TES METHOD APP CA T SIGNATUORRE DATE H S A P ATION BECOMES A PERMIT WHEN APPROVED APP OVED BY DATE i FD2095 (Rev 03/08) �L BILLING & PERMIT STATEMENT MARrN BAKERSFIELD FIRE DEPARTMENT H Prevention Services PERMIT # 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. :. PERMIT TYPE FEE CALCULATION TOTAL DUE 11 Alarm - New & Modification (minimum charge) $280 • USE TREASURY! ACCT NO SITE INFORMATION Over 10,000 sq ft LOCATION OF PROJECT (�� �� M d C VIVe 1' , `COMPLETI"OC�N/+l� PROPERTY OWNER p� �o `�> V STARTING DATE � � 2 NAME p '' r CJV of PROJE ME p�� ` e on S� I ADDRESS (��� • ` �LJ I \VI PHONE ��' ` l`J�L'1 PROJECT• D SS CITY g�4ICERS�IEI_D STATE l^i� ZIP CODE 3313 CONTRACTOR INFORMATION CONTRACTOR NjkMIE n CA LACE �� I-A `� TYPE OF LICE�N EXPIRATION DATE _l, V PHONE # . �� • ���� '�'l[' CONTRACTOR COMPANY NAME � � FAX # � - �l�Y•������ ADDRESS \i CITY ZIP CODE All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. :. PERMIT TYPE FEE CALCULATION TOTAL DUE 11 Alarm - New & Modification (minimum charge) $280 • USE TREASURY! ACCT NO ❑ 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 • 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) NI $878 /tank 82 ❑ Underground Storage Tank (Modification) MOD $878 /site 82 ❑ Underground Storage Tank (Minor Modification) MTM $167 /site 82 ❑ Underground Storage Tank (Removal) TR $573 /tank 84 Mandated Leak Detection (test) /Fuel Mont Ce B989 TT NOTE: " $96 /hr for ea type of test/per site even if scheduled at he same time $96 /hr (2 hrs minimum) =$192 1 Z 1 82 . p 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 ' NOTE: After hours Pyrotechnic event inspection is @'$121 /hr $96 /hr ± (5 hrs min standby fee /insp) =$576 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 05/10) Mary Young From: Mary Young Sent: Wednesday, April 27, 2011 10:03 AM To: 'David Weirather' Subject: SB989 3yr Testing Permit Apps - Chevron - Wayne Perry Inc. Attachments: Chevron 203576 - 1125 Coffee Rd.pdf; Chevron #98109 -1131 Oak St.pdf; Chevron #205673 - 13003 Rosedale Hwy.pdf; Chevron #206561 - 3360 Panama Lane.pdf; Chevron 201527 —6601 Ming Ave.pdf Hi Dave, I'm sending out via Fex -Ex the attached permit applications plus fees to your attention today. Based on our conversation yesterday and the busy schedules of your inspectors, I am requesting to test these sites during the week of 5/23/11 so I can send a crew up to test all sites in one week. I've listed below the sites and their, respective due dates for the 3yr testing. Since your scheduling is so full, please let me know if testing these sites at the proposed times is a problem. Site Due Date Proposed Testing Date 3360 Panama Lane. 5/19/11 5/23/11 1131 Oak St 5/20/11 5/24/11 6601 Ming Avenue 5/21/11 5/25/11 1125 Coffee Rd 5/22/11 5/26/11 13003• Rosedale Hwy 5/23/11_ 5/27/11 Thank you, .teary Toung Wayne Perry, Inc. 8281 Commonwealth Avenue Buena Park, CA 90621 (714) 826 -0352 myoung @wpinc.com 'Tor today, 1 wif .. " From: David Weirather jmailto: Dweirather(&bakersfieldfire.us] Sent: Tuesday, April 26, 2011 11:09 AM To: Mary Young Subject: Bakersfield Fire Prev. Forms for tank testing Here are the forms you would need. Fee is $192 1 � WAYNE PERRY INCORPORATED ' 094000 -)VENDOR ID VENDOR NAME PAYMENT NUMBER CHECK DATE >' I�BAKERSFI BAKERSFIELD FIRE DEPARTMENT 115700 4/27/2011 /; J VOUCHER NUMBER INVOICE NUMBER INV. DATE INVOICE AMOUNT AMOUNT PAID _ JOB # /DESC. 'NET AMOUNT 1200983 '-,94000CK u 4/27/2011 $192.00 1 $192.00 11128 J $192.00 i t ? 0 L $192.00 $192.00 / $19200 CONSTRUCTION PERMIT Application Number . . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . Owner ------------------------ DELAWARE MC DONALDS CORP P O BOX 182571 COLUMBUS OH 43218 BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES R S P [ D 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 1 RTM T Office Phone: (661) 326 -3979 11- 10000150 Date 5/02/11 3360 PANAMA LN 371 - 020- 65 -00 -0 FIRE DEPT 0 Contractor OWNER ------------------------=-----------------------=- Permit . . . . . - - - - - . MANDATED LEAK DETECT TEST - - - - - - - - - - - - - - - - - - - - - Additional desc . Phone Access Code 1093012 Permit Fee 96.00 Plan Check Fee ." 96.00 Issue Date 5/02/11 Valuation . . . .. 0 Expiration Date .10/29/11 -----------------------------------`----------------------------------------- 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 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. 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 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 purpose' urposes.,, Signature of Applicant or Agent Date . CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B R S P 11 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 bbb. T Office Phone: (661) 326 -3979 Application Number . . . . . 11- 10000150 Date 5/02/11 Property Address . . . . . . 3360 PANAMA LN ATN (11 Digits): 371 - 020- 65 -00 -0 Application type description FIRE DEPT Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . 0 Owner Contractor DELAWARE MC DONALDS CORP OWNER P O BOX 182571 , COLUMBUS OH 43218 --------------------------'-------------------------------------------------- Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . Phone Access Code 1093012 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date 5/02/11 Valuation . . . . 0 Expiration Date 10/29/11 ---------------------------------------------------------------------------- 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 afterl80 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 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 1 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 I Date Post this C BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD Inspection Request Pl�one 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 I 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: JOB DESCRIPTION: OCCUPANCY TYPE: OWNER: k," Ye r") PERMIT NO. CONTRACTOR: PHONE # 7�Cp pie Ir FD 1743