HomeMy WebLinkAbout402 CHESTER Avenue_UST FMC 9.15.10I�lW�M ,9
HOODS ALARMS 5 SPRAY BOOTH AST UST
Permit No. Permit No.
File Number: �/atinn
Date Received: S' -15 _
SYSTEM:
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
❑ U- Other: c-,
Permit No. Permit No. Permit No. Permit No.
Address: yo -7- 5 - C,k'P-5; -q` '4 .
Bakersfield, CA 933..
Business Name: n o e, S cabo Uie,&O .
BUILDING SQUARE FEET: INSPECTION LOG
Building Sq. Feet:
Calculation Bldg. Sq. Ft:
2.
3.
4.
Date Time
Signature
Signature
Comments: �'� TuRS%A/ 50m p R'F'/2y 57%'c/c;�f
—'
i�,a�m�
ao
SITE INFORMATION
FACILITY
E & PHONE NUMBER OF CONTACT PERSO
ADDRESS
OWNERS NAME
OPERATORS NAME
UNDERGROUND STORAGE TANKS,
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
BAKERSFIELD FIRE DEPT.
VOLUME
.
FIRE
Prevention Services
Re
ARTN T
900 Truxtun Ave., Ste. 210
APPLICATION
''
Bakersfield, CA 93301
TO PERFORM ELD / LINE TESTING
Tel.: (661) 326 -3979
I SB989 SECONDARY CONTAINMENT TESTING
TANK TESTING COMPANY
NAME DF TEST!g COMPANY =
► IV V 120 Q 4-k C-A)
Fax: (661) 852 -2171
/TANK TIGHTNESS TEST AND TO PERFORM
NAME & PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR
'
CERTIFICATION #:
Fo9�Sa
ICC #: TEST METHOD
h e -o
FUEL MONITORING CERTIFICATION
SIGNATURE OF APPLICANT
DATE
Page 1 of 1
PERMIT NO.
❑ ENHANCED LEAK DETECTI LINE TESTING
❑ SB-989 SECONDARY CONTAINMENT TESTING
❑ TANK TIGHTNESS TEST J�KTO PERFORM F11EL MONITORING CERTIFICATION
,
SITE INFORMATION
FACILITY
E & PHONE NUMBER OF CONTACT PERSO
ADDRESS
OWNERS NAME
OPERATORS NAME
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK#
VOLUME
CONTENTS
Re
TANK TESTING COMPANY
NAME DF TEST!g COMPANY =
► IV V 120 Q 4-k C-A)
NAME & PHONE NUMBER OF CONTACT PERSON
-
MAILING ADDRESS
NAME & PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR
'
CERTIFICATION #:
Fo9�Sa
ICC #: TEST METHOD
h e -o
DATE & TIME 1WST TO BE CONDUCTED -
SIGNATURE OF APPLICANT
DATE
APPROVED B r *- DATE S -Z r-- to
FD 2095 (Rev. 09/05)
TE�i ; Ad�lLopV i �P cC# SD 2° 379 4!5�ci 5-1261
BILLING & PERMIT STATEMENT
PERMIT NO.:
BAKERSFIELD FIRE DEPT.
B 8 R S %."%1 D Prevention Services
FIRE j
T
RT
ABf1/ 1600 Truxtun Ave Ste 401
Bakersfield CA 93301
Tel.: (661) 326 -3979 • Fax: (661) 852 -2171
FD 2021 (Rev. 06/07)
1 - ORIGINAL WHrTE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer)
SITE INFORMATION
LOCATION OF PROJECT ne
PROPERTY OWNER
STARTING DATE COMPLETION DATE
NAME y� p
Dr \l"_._
PROJECT NAME ^ ^a�r
ADDRESS, ,I_
PHONE NO
PROJECT ADDRESS � �
CITY STATE �
ZIP CODE
CONTRACTOR
CONTRACTOR NAME CA LICENSE NO.
J141'Y1�cS��c� 8d� SCE
INFORMATION
TYPE OF LICENSE. EXPIRATION DATE
1�40�NA 30 ��
PHONE NO.
92-88%
CONTRACTOR COMPANY NAME �-- • _
1G rvU
FAX NO.
«�'9z`OiOO`LI
ADDRESS
CITY
ZIP CODE
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. ■
■
9 • •
❑ Alarms - New & Modifications - (Minimum Charge) $280.00 , ■
■
•
84 •
9@, „ .
❑
Over 10,000 Sq. Ft.
Sq. Ft x.028 = Permit fee
98
❑
Sprinklers - New & Modifications - (Minimum Charge)
$280.00
■
■
84
98
0
Over 10,000 Sq. Ft.
Sq. Ft. x.028 = Permit fee
■
■
84
98
•
Minor Sprinkler Modifications (< 10 heads)
$ 96.00 [Inspection Only]
■
■
84
98
•
Commercial Hoods — New & Modifications
$ 470.00
■
84
98
❑
Additional Hoods
$ 58.00
■
■
84
98
❑
Spray Booths - New & Modifications
$470.00
84
98
❑
Aboveground Storage Tanks (lnstallationllnsp. -l" Time)
$180.00
82
❑
Additional Tanks
$ 96.00
;
82
❑
Aboveground Storage Tanks (RemovaUlnspection)
$109.00
;
82
❑
Underground Storage Tanks (Installation. /Inspection)
$878.00 (per tank)
■
82
❑
Underground Storage Tanks (Modificafion)
$878.00`(persite)
■
82
❑
Underground Storage Tanks (Minor Modification)
$167.00
■
82
❑
Underground Storage Tanks (Removal)
$573.00 (per tank)
■
84
❑
Oilwell (Installation)
$ 96.00
;
84
Mandated Leak Detection (Testing) Fuel Monit.0 SB989.
Note. $96.00 for each type of test /pe "te (even ' edu/ed
at the same time)
$'sit % 9 ,O C)
;
■
•
82
❑
Tents
$ 96.00 (per tens
'
84
❑
Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour)
$ 96.00 + (5 hrs. min. standby fee /inspection)= $576..00
;
84
❑
After hours inspection fee
$121.00
;
84
•
RE- INSPECTIONS) /FOLLOW -UP INSPECTION(S)
$ 96.00 (per hour)
■
84
•
Portable LPG (Propane): NO. OF CAGES?
$ 96.00
■
84
•
Explosive Storage
$266.00
■
84
•
Copying & File. Research (File Research Fee $50.00 per hr)
250 per page
;
84
❑
Miscellaneous
8a
FD 2021 (Rev. 06/07)
1 - ORIGINAL WHrTE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer)
CONSTRUCTION PERMIT
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
------------------ - - -- --
GILL SATWANT S & GIAN K
3015 MONACHE MEADOWS DR
BAKERSFIELD CA 93313
10- 10000301 Date 9/22/10
402 S CHESTER AVE
011 - 161- 01 -00 -7
FIRE DEPT
0
Contractor
------------------ - - - - --
OWNER
----------------------------------------------------------------------------
Permit . . . . MANDATED LEAK DETECT TEST
Additional desc . .
Phone Access Code . 1035179
Permit Fee . . . . 96.00 Plan Check Fee 96.00
Issue Date . . . . 9/22/10 Valuation . . . . 0
Expiration Date . . 3/21/11
-----------------=------------------------------------------------------
=---
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:
BAKERSFIELD FIRE DEPARTMENT
PREVENTION SERVICES
R S F ID
1501 TRUXTUN AVENUE, 1sT FLR
FIRE
BAKERSFIELD, CA 93313
�IRTM r
Office Phone: (661) 326 -3979
10- 10000301 Date 9/22/10
402 S CHESTER AVE
011 - 161- 01 -00 -7
FIRE DEPT
0
Contractor
------------------ - - - - --
OWNER
----------------------------------------------------------------------------
Permit . . . . MANDATED LEAK DETECT TEST
Additional desc . .
Phone Access Code . 1035179
Permit Fee . . . . 96.00 Plan Check Fee 96.00
Issue Date . . . . 9/22/10 Valuation . . . . 0
Expiration Date . . 3/21/11
-----------------=------------------------------------------------------
=---
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 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 I 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
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 Reauest Phone No. (661) 326 -3979
DA
BACKFILL
PRIMARY PIPE
SECONDARY PIPE .
SECONDARY CONTAINMENT,
SENSORS -
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK -OFF
i�
e
u
PRIOR TO_OP_ERATION_OF_ANY- SYSTEM,1
tALL_UST AND /OR ASTUSTEMS SHALL BE
W&T- ALLED,_COMPLETE AND-ACCEPTED BY
(THE BAKERSFIELD_CITY FIRE_ DEPARTMENT:
(-FIRE DEPARTMENT FIN L
PANCY TYPE
IT klf% //I -
E# c YYZ -