HomeMy WebLinkAbout3624 CALIFORNIA Avenue_DEL TACO UST FMC 11.12.10INIIIIIIII
❑
Commercial Hood System
❑
.9
IE
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HOODS ALARMS SPRNKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
File Number: Iovi3940
Date Received: / /tea -/0
Address:
Bakersfield, CA 933
Business Name: "7,6&
SYSTEM: BUILDING SQUARE FEET:
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
❑ LV Other: C.
Comments:
Building Sq. Feet: �f
Calculation Bldg. Sq. Ft: ,99�
1 d��
1.
a.
3.
4.
INSPECTION LOG
Date Time
Signature
Signature
inu
CONSTRUCTION PERMIT
Application Number . . .
Property Address . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
------------------------
GIBRALTAR 1031-RESTAURANTS
P O BOX 235169
92023
BAKERSFIELD FIRE DEPARTMENT
PREVENTION SERVICES
R S F I I) 1501 TRUXTUN AVENUE, 1sT FLR
FIRE BAKERSFIELD, CA 93313
4 R rilwy Office Phone: (661) 326 -3979
30- 10000365 Date 11/29/10
3624 CALIFORNIA AVE
020- 020- 05 -00 -7
FIRE DEPT
0
Contractor
--------------- --- - - - - --
OWNER
----------------------------------------------------------------------------
Permit . . . . . . MANDATED LEAK DETECT TEST
Additional desc .
Phone Access Code 1051754
Permit Fee . . . . 96.00 Plan Check Fee 96.00
Issue Date . . . . .11/29/10 Valuation . . . . 0
Expiration Date 5/28/11
------------------------------1---------------------------------------------
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 Agenj 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 PROVIDEE4011 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
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
CONTRACTOR: fa. 522 ,. H6 PHONE &jEpt9 —IV6
PRIMARY PIPE
SECONDARY PIPE
SECONDARY CONTAINMENT
SENSORS
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK -OFF
UST REMOVAL
DESCRIPTION DATE SIGNATURE
AST NEW INSTALL
DESCRIPTION DATE SIGNATURE
i MODIFICATIONS MINOR / MAJOR I
AST REMOVAL
DESCRIPTION DATE SIGNATURE
EVR UPGRADE
P� RIOR =TO OPERATION_ OF ANYCSYSTEM,
BALL UST A -- ND /_ORAST SYSTEMS SHALL BEL
�INSTi4LL,_ COMPLETE AND ACCEPTED:BY_i
MISC. ACTIVITY THE BAKER SFIELD_CITY_FIRE_DEPARTMENTI
( —FIRE DEP_ARTMENT-(FINAL)—
REMARKS:
BUILDING ADDRESS:
JOB DESCRIPTION:
OCCUPANCY TYPE:
OWNER:
PERMIT NO.
CONTRACTOR: fa. 522 ,. H6 PHONE &jEpt9 —IV6
FD 1743
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELQ/UNE 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
JIM-7. NW,01--
FIRE
A&rAlF,
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q10t
Bakersfield, CA 93301
Phofie: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ SB-989 SECONDARY CONTAINMENT
kFUEL:IMON�rrOPJNG�CERTIFI�CATIO�N
FD209S (Rev 03/08)
FACILITY 1
T&M
NAME & PHONE if OF CONTACT PERSON
ADDRESS
OWNER NAME
My
OPERATOR NAME
PERMIT TO OPERATE
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
VOLUME J
CONTENTS
X7
Q*-�PIAA-
TESTING COMPANY
C9c't ENV tA
NAME I PHONE # OF CONTACT PERSON
ku t k k -gato -
MAILING ADDRESS
Cam
NAME & PHONE * OF TESTER OR SPECIAL INSPECTOR
8(0 99
CERTIFICATION
$og SIS0
DATE & TIME TEST IrO BE CONDUCTED
Icc #
---nca(A
TEST METHOD
I Xj C-ONJ
APPLICANT SIGNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD209S (Rev 03/08)
BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT
Prevention Servimc
PERMIT # "A'"Iff oZ101 1't %TMV —T
Bakersfield, CA 93301
Phnna• fr,1 - 'A7f, -'3979 a Pay-
SITE F,C,1- fZS7_7171
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
E3. 1Alarm - New & Modification (minimum charge) 1 $280
0 Over 10,000 sq ft $0.028 x sq ft
0 Sprinkler - New & Modification (minimum charge) $280
O Over 10,000 sq ft $0.028 x sq ft
O' Minor Sprinkler Modification ( <10 heads) $96 (inspection only) '
1317 Commercial Hood (New & Modification) $470
0 1
Additional hood
INFORMATION
LOCATION OF PROJE
PROPERTY OWNER
STARTING DATE COMPLETION DATE
NAME
PROJECT NAME
ADDRESS �
PHONE #
PROJECT ADDRESS
' n
�Y 1jA�ER SFI Fi I .D STATE CA
� cODE �A Z.
82
CONTRACTOR INFORMATION
Additional Tank ATI
$96 /tank
CONTRACTOR NAME
CA UCENSE.#
TYPE OF LICENSE EXPIRATION DATE
PHONE #
S1�Yri ES :ctric
t 0 l
0
CONTRACTOR COMPANY NAME
t� Enna} �
FAX #
3ac� -8Q3 y
� �tvvt �v
82
ADDRESS �3 RoOIiC S
criY -CRS F _ LD `
ZIP aoDE G 37•� • -
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
E3. 1Alarm - New & Modification (minimum charge) 1 $280
0 Over 10,000 sq ft $0.028 x sq ft
0 Sprinkler - New & Modification (minimum charge) $280
O Over 10,000 sq ft $0.028 x sq ft
O' Minor Sprinkler Modification ( <10 heads) $96 (inspection only) '
1317 Commercial Hood (New & Modification) $470
0 1
Additional hood
$58
•
Spray Booth (New & Modification)
$470
98
•
Aboveground Storage Tank (1 inspection per installation) AST
$180 /tank
82
0
Additional Tank ATI
$96 /tank
82"
0
Aboveground Storage Tank (Removal, Mod,or Inspect'n) ATR
$109 /tank
82
0
Underground Storage Tank (Installation/Inspection) NI
$878 /tank
82
0
Underground Storage Tank (Modification) • MOD'$878
/site
89
0
Underground Storage Tank (Minor Modification) MTM
$167 /site
82
0
Underground Storage Tank (Removal TR
$573 /tank
84
Mandated leak Detection (test) uel Mont Ce 6989
NOTE: '$96 /hr for each type of tes per si even if
scheduled at the same time TT
$96 /hr (2 hrs minimu =$192
82
0
Oil well (Installation, Inspection, or re- inspection) X
$96 /hr
82
0
Tent #
$96 /tent
84
0
After -hours Inspection fee
$121 /hr (2 hrs minimum) =$242
O
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
0 '
Re- Inspection/Follow -up Inspection
$96/hr
84
O
portable LPG (Propane): # of Cages? _
$96 /hr
84
O
Explosive Storage
$266
84
0
Copying &File Research (File Research fee $50 /hr)
$0.25 /page
84
0
Miscellaneous
84
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