HomeMy WebLinkAbout3605 ROSEDALE Hwy_UST FMC 4.6.10HOODS
Permit No.
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ALARMS
Permit No.
IE _
File Number: rev y-u
Date Received: el- & _ /p
SYSTEM:
SPG°3NKLER SYSTEMS SPRAY BOOTH
New Mod.
❑ ❑ Commercial Hood System
❑ ❑ Fire Alarm yttem
❑ ❑ Fire Sprinkler System
❑ ❑ Aboveground Storage.Tank
❑ ❑Underground Storage Tank
minor
modification Underground Storage Tank
removal Underground Storage Tank
❑ ❑ Other:
Comments: � G
Permit No.
Address.
Permit No.
Bakersfield, CA 933
AST
Permit No.
44"1
UST
Permit No.
Business Name:
BUILDING SQUARE FEET: IINISPECTO N LOG
Building Sq. Feet:
Calculation Bldg. Sq., Ft:
I •,
2.
3.
Q
Date Time
Signature
CONSTRUCTION PERMIT
Application Number . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
------------------------
CC PROP LLC
15039 CHAMPIONSHIP WY
BAKERSFIELD CA 93314
BAKERSFIELD FIRE DEPARTMENT
10 %-eA
PREVENTION SERVICES
6 R �11 1501 TRUXTUN AVENUE, 1sT FLR
FIRE BAKERSFIELD, CA 93313
'A R TNI T
Office Phone: (661) 326 -3979
10- 10000112 Date 4/12/10
3605 ROSEDALE HWY
332- 470- 05 -00 -2
FIRE DEPT
0
Contractor
OWNER
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Permit . . . . . . MANDATED LEAK DETECT TEST
Additional desc .
Phone Access Code 992743
Permit Fee 96.00, Plan Check Fee 96.00
Issue Date . . . . 4/12/10 Valuation . . . . 0
Expiration Date 10/09/10
----------------------------------------------------------------------------
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 Agent ' * j. == ' .r. - 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 �'`.,: E tlx: ?v =.t_ �, - = _.` 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 perinit 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 _ '# - - -- - - = " <' -_�` "_= `�-``ti w ` w ° ' — Date
BAKERSFIELD CITY FIRE DEPARTMENT — INSPECTION RECORD
Post this Card at the Job Site and DO NOT Remove for Duration of Work
Inspection Reauest Phone No. (661) 326 -3979
BACKFILL
PRIMARY PIPE
SECONDARY PIPE
SECONDARY CONTAINMENT
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK -OFF
MODIFICATIONS MINOR/ MAJOR
PRIOR TO_OPERATION OF -ANY SYSTEM,
ALL-UST-AND /OR AST_SYSTEMS SHALL BE
- INSTALLED, COMPLETE AND ACCEPTED-BY _
THE BAKERSFIELD CITY FIRE - DEPARTMENT.
.:36,0-5- a
JOB DESCRIPTION F VA. C__
JOCCUPANCYTYPE d�
OWNER C%-e_C C
CONTRACTOR jc_ �� �p . PHONE # Z—
FD 1743
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SS989 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.)
�Wuvm!l
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
SO AAFx—it s 1501Truxtun Avenue 1t Floor
FIRM Bakersfield, CA 93301
w ='A F Phone: 661- 326 -3979 . Fax: 661- 852 -2171
�►
Page 1of1
❑ ENHANCED LEAK DETECTION : ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS EL MONITORING CE R CATION
SfTE INF+ORMAno
FACILITY
YYl
6 Y)
NAME & PHONE # OF C NTACT PERSON
0 �GLO 6'
ADDRESS 5. cL�
OWNER NAME
OA
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
LAJA t Z-7
Z
TANK TESTING COMPANY , , ; •.
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON .,
�r Cm
MAILING ADDRESS L lSZ�
C+"�\ 93�og
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
-93 3 -_
CERTIFICATION_*
�5 o°t55o
ICC it U Q p-' TEST METHOD
DATE & TIME TEST TO BE CONDUCTED
APPLICANT SIG E
DATE
3 12A 0
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED'
APPROVED BY
DATE
BILLING & PERMIT STATEMENT fA ''• BAKERSFIELD FIRE DEPARTMENT
s Prevention Services
PERMIT # IRifr
1501 Truxtun Avenue, 1st Floor
es Bakersfield, CA 93301
Dhnnn• F.F,1- 'A7F, -1Q7Q a Fax• F,F,1 -RS7 -7171
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
❑
Alarm - New & Modification (minimum charge)
SITE INFORMATION
LOCATION OF PROJECT C � �� � S�c�o
PROPERTY OWNER
1 1 `
Over 10,000 sq ft
STARTING DATE COMPLETION DATE
NAME
PROJECT NAME
ADDRESS _
I PHONE #
-13
oVW_V ('
aabS
❑
PROJECT ADDRESS � "w
cm &A V_ERS:F I E (.D STATE CA
ZIP CODE 9 35 08
CONTRACTOR INFORMATION
$0.028 x sq ft
Miscellaneous
CONTRACTOR NAME rr11 CA_ LICENSE _ _ _ _ __. _
TYPE OF LICENSE IXPIRATION DATE
PHONE #
'jO_YYL1°.S
$96 (inspection only)
CONTRACTOR COMPANY NAME J
c � r
FAX #
3--go -893
ADDRESS k5cw1 S
CRY
ZIPCOD�.3
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
❑
Alarm - New & Modification (minimum charge)
$280
84
•
❑
Over 10,000 sq ft
$0.028 x sq ft
84
•
Explosive Storage
❑
Sprinkler - New & Modification (minimum charge)
$280 .
❑
Copying & File Research (File Research fee $50 %hr)
$0.25 /page
❑
Over 10,000 sq ft
$0.028 x sq ft
Miscellaneous
•
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,or Inspect'n) 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 (Remo I TR
$573 /tank
84
Mandated Leak Detection (test) uel Mont C S6989
NOTE: $96 /hr for each type of to i e even if
scheduled at the same time TT
$96 /hr (2 hrs minim =$19
82
❑
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
$96 /hr + (5 hrs min standby fee /insp) =$576
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
94
i
&%D i
City of Bakersfield
x i CUSTOMER RECEIPT.
Oper: TVANI FOSSEN Type: 1 C .."Drawei i
Date: 4/12/10 01 - Receipt no:' 65348. ,
i Dessri iron Quantity ftount
21 10�D112
PID BUILDING PERMITS
1. U $192.6 i
Tender detail
. Get CHECK 2927 U92 N �
I Vaal tendered . 192: R;
Total payment 8192. @M
Trails date: 4/12:.10 Tise: 13:56: @6
HELP CONTROL THE PET POPULATION!
` PLEASE SPAY OR NEUTER
I.