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Home My WebLink About400 OLD RIVER Road_UST FMC 5.7.101111911 07 Commercial Hood System ❑ HOODS ALARMS SpG°3NKLER SYSTEMS SPRAY BOOTH H AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. Zj File Number: /6d3-5rg3 Address: cJ-2!1 Bakersfield, CA 933 Date Received: '7 — /D Business Name: -L�e,,,+e -cam S. tc, • �DS,O. SYSTEM: BUILDING SQUARE FEET: INSPECTION LOG 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 ❑ Other: f [,40,f C' Comments: Building Sq. Feet: Calculation Bldg. Sq. Ft: I. 2. 3. 4. Date Time Signature-,"- Signature 7 IE- CONSTRUCTION PERMIT Application Number . . . . Property Address . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . Owner ------------------------ CATHOLIC HEALTHCARE WEST P 0 BOX 119 BAKERSFIELD CA 93302 BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES R S P I D 1501 TRUXTUN AVENUE, 1ST FLR FIRE BAKERSFIELD, CA 93313 =RTM T Office Phone: (661) 326 -3979 10- 10000129 Date 5/11/10 400 OLD RIVER RD 390 - 300- 05 -00 -6 FIRE DEPT 0 Contractor ------------------ - - - - -- OWNER ---------------------------------------------------------------------------- Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code . 1000355 Permit Fee . . . . 96.00 Plan Check Fee 96.00 Issue Date . . . . 5/11/10 Valuation . . . . 0 Expiration Date . . 11/07/10 ---------------------------------------------------------------------------- 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: 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 ' °' _ - ''- 'r, ° °` ".i °' -•. _ _ _ -_ 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 %b; s : x'- , u; �a� s• #' - - -# •sv�r rr. Date x1 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. 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 InsDection Reauest Phone No. (661) 326 -3979 DESCRIPTION DATE I SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF UST RE 10VAL DESCRIPTION DATE SIGNATURE DATE MODIFICATIONS MINOR/ MAJOR DESCRIPTION PRIOR TO OPERATION OF ANY SYSTEM, ALL UST AND /OR AST SYSTEMS SHALL BE INSTALLED, COMPLETE AND ACCEPTED BY THE BAKERSFIELD CITY FIRE DEPARTMENT. Iii DING ADDRESS =71 667 77 1) 47— __ JOB DESCRIPTION ??�lL. OCCUPANCY TYPE =o?, / IRt OWNER . et) . PERMIT NO. /C) — /Q CONTRACTOR PHONE #,061— �i x777 FD 1743 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 # I ❑ ENHANCED LEAK DETECTION ❑ TANK TIGHTNESS Ali % MSF I cn * FIRE ARrm, r BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501Truxtun Avenue 1st Floor Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page 1 of 1 ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT GRUEL MONITORING CERTIFICATION kk TION FACILITY m e ZC-1 igoWr"ujiEST 14 0 S R -r r5 L I NAME & PHONE # OF CONTACT PERSON C-" A fZ j_ IF ea�j LC- <; ADDRESS 460 01-b Z%,J E TZ- Z6 OWNER NAME OPERATOR NAME PERMIT TO OPERATE # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO TANK # VOLUME CONTENTS T t000 L K PANY TESTING COMPANY SS-1Z %'V'3 C. NAME & PHONE # OF CONTACT PERSON MAILING ADDRESS 6630 R 0 SE L A LF H W #-S' 50VET-ZV%ELb CIA ,X3308 NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR D A-4 k -V C V- E— -r CERTIFICATION # 5 DATE & TIME TEST TO BE CONDUCTED 0 ICC # 5;L6 TEST METHOD APPLICANT SIGNATURE DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE An FD2095 (Rev 03/08) -' -. - - -- - -- -- -- • . . . . ... ...... ■ PERMIT # I Prevention Services FIRE ! ARTM r 1501 Truxtun Avenue, 111 FLR pake_rsfield, CA 93301 Phone: 661 - 326 -3979 • Fax: 661- 852 -2171 INFORMATION UTIE LOCAT]ON OF PROJECT mT SO�T�w��T L,O � I 1 C l I7 PROPERTY OWNER ' STARTING DATE COMPLETION DATE NAME PRO1Fr7 NAME T}it�i.K, rYIOf -3 _r02 CE2'r�"F%CAT10r.1 ADDRESS 40o OI-� IZ\d 'EQ R� PHONE Y 661 - 632 -59 -4� , PROJECTADD0.ESS yop o�l� iZ1�t1�L i?�� CITY gAI— 'eRS1-IC -L-D STATE CA TYPE OF LICENSE EXPIRATION DATE R61 yo I�wZ 6• 0 -11 ZIP CODE PHONE i 8 2 66t - 58S - CONTRACTOR NAME Qn 1 TAC K�TT VIC CONTRACTOR INFORMATION CA LICENSE • 12 Ia- CONTRACTOR COMPANY NAME �3SSz ItivC•• FAX # 6 J b (ADDRESS C- \ t I 1 `, 6630 1Z0'5GbRLF NW 1 1*5 C� VAkE2S Cz L_-b j�p ZIP CODE �i33o8 All permits must be reviewed,, stamped, and approved PRIOR TO BEGINNING WORK. PERMIT TYPE O Alarm - New & Modification (minimum charge) 0 Over 10,000 sq ft $0 .028 x sq ft 0 Sprinkler - New & Modification (minimum charge) $280 0 Over 10,000 sq ft $0 .028 x sq ft ❑, Minor Sprinkler Modification (<10 heads) $96 (Inspection only) 84 O Commercial Hood (New & Modification) $470 0 Additional hood $58 F-0 Spray Booth (New & Modification) $470 98 0 boveground Storage Tank (1 Inspection per installation) AST $180 /tank 82 0 Additional Tank ATI $96 /tank 82 O Aboveground Storage Tank (Removal /Inspection) ATR $109 /tank 82 O Underground Storage Tank (Installatlon /Inspection) NI $878 /tank 62 0 Underground Storage Tank (Modification) MOD $878 /site 82 Underground Storage Tank (Minor Modiflcation) MTM $167 /site 82 O Underground Storage Tank (Removal) TR $573 /tank 84 91' Mandated Leak Detection (test) /Fuel Mont Cert/58989 NOTE: $96 /hr for each type of test/per site even if scheduled at the same time TT $96 /1r (2 hrs minimum) 192 5 ❑ Oil well (Installation, Inspection, or re- inspection) s ; X $96 /hr 82 O Tent' # $96 /tent 84 ❑ 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/h r $96 /hr + (5 hrs min standby fee /insp) =5576 5 hrs min standby fee ins = 605 84 0 Re- inspection /Follow -up Inspection $96 /hr 84 ❑ Portable LPG (Propane): # of Cages? _ $96 /hr 84 ❑ Explosive Storage $266 84 0 Copying & File Research (File Research fee $50 /hr) $0.25 /page 84 0 Miscellaneous 8 4