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" .1 - .-­ I .. - -. :,� I ,,,. �,, 1-9 .1 -,, -,e -, ", -� , ,-,- , . ., - - • z 1: - - i I - 1. � , , , ,��, �� �. , .� .. ,.j. .,. , " �% - - . , ,; , , - , 4, � -, . - � "7 -, � - , - - - - -�--`�111---,�i-, , ! ��,, ��j- ,,f C, I I �:,� - , - - ,:, . .1 - � , - , � . , ,4, �2� 1 -- - - .-I-- - - I., � -, ." . . � - . .: ,,-%�,�6- , f . , � � . - I - � I 0. -;*,-', - , � - � I L, � - ; �z � I , � �r: � ., ,r, - , .� - , � - -!� ,- - - - -,- - - - , ---, - -:�,, I -- I FIAIIII!I1I�IIIIIII 26 � I � 1E - I BILLING &- PERMIT STATEMENT ;00NP11 BAKERSFIELD FIRE DEPARTMENT E R S F 1 D Prevention Service- PERMIT # FIRE , � S -tR��T wesa r Bakersfield, CA 93301 Phnna- AA1- 37F -';U79 a Fax- 6ES1 -R57 -7171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. ❑ Alarm - New & Modification (minimum charge) SITE INFORMATION LOCATION OF PROJECT c ,�A- PROPERTY OWNER XTAI STARTING DATE COMPLETION DATE NAME PROJECT NAME �\ ADORES PHONE # ` w PROJECT ADDRESS - CIfY . F-A EIR SFI El_D STATE G�4 ZIP CODE CONTRACTOR INFORMATION CONTRACTOR NAME CA LICENSE # S�,n CS :G1-V TYPE OF LICENSE EXPIRATION DATE t - t PHONE # -g�-( CONTRACTOR COMPANY NAME FAX # ADDRESS 5(2 �-k3 2DOa(�S C CITY $ A- kCCV -Sf-(E- C.) : ZIP CODE �� g 6 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. ❑ Alarm - New & Modification (minimum charge) $280 ❑ 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,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 (Removal) TR $573 /tank 84 Mandated Leak Detection (test) /Fuel ont Ce SB989 NOTE: $96 /hr for each type of test/pe even i cheduled at the same time TT $96 /hr (2 hrs minimu =$192 2 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 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 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 P /B/ AjRS•r r BAKERSFIELD FIRE DEPARTMENT Prevention Services Q10l 1-k S'GRf�ET" Bakerstield,,CA 93301 Phone: 661 -326 -3979 • Fax: 661-852-2171 Page 1 of 1 ❑ LI TFC77 � SB -989 SECONDARY CONTAINMEN FUEL MONITORING CERTIFICATION • SITE INFQRMATION FACIL NAME & PHONE # OF CONTACT PERSON ADDRESS C ^ „ \J � - w`- OWNER NAME OPERATOR NAME PERMIT TO OPERATE # # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO TANK # VOLUME CONTENTS uur\� .% O TANK TESTING COMPANY ` TESTING COMPANY �C iJV \`EZpN Ot L NAME & PHONE # OF CONTACT PERSON 10 " 402 MAILING ADDRESS �jla� -l3 �Ctoo�c.S GT. — F3A\G.ER.SFI t-D CA 933c>8 NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR RN ��c� -8(0 9 CERTIFICATION # S09eso DATE &TIME TEST OBE CONDUCTED ICC # 7 uT tN11(2.0Xj EST METHOD APPLICANT SIGNAT DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APP ED BY DATE FD2095 (Rev 03/08) 1, (print) to pay in full upon completion of this job. agree Signature Date PAST DUE ACCOUTS ARE SUBJECT TO A FINANCE CHARGE OF 1.5% PER MONTH O Tease qP��y Ck�k 322-1 T1�iS Gr�� �S �lovrv�l U y Sect _ '� �u; Iscv� YVic�l�� 1, 3(�zo w Gh vd. d� 5 Ca.�c�Q�d . ��{- aA CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B S R S P I D 1501 TRUXTUN AVENUE, I ST FLR *FIRE BAKERSFIELD, CA 93313 ARYN t Office Phone: (661) 326 -3979 Application Number . . . . . 11- 10000122 Date 5/02/11 Property Address . . . . . . 4050 GOSFORD RD ATN (11 Digits): 385- 430- 07 -00 -2 Application type description FIRE DEPT Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . 0 Owner Contractor S & H GOSFORD LLC OWNER 1631 17TH ST BAKERSFIELD CA 93301 ----------=----------------------------------------------------------------- Permit . . . . MANDATED LEAK DETECT TEST Additional desc . Phone Access Code 1086487 Permit Fee . . 96.00 Plan Check Fee 96.00 Issue Date . . . . 4/08111 valuation 0 Expiration Date 10/05/11 -------------'----------------- - ------------------------ - ------------------- Fee summary Charged i 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- gen 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 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 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 PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF TANK TESTING w4- C-, UST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE MISC. ACTIVITY REMARKS: AST NEW INSTALL DESCRIPTION DATE SIGNATURE 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: Fyy4 L OCCUPANCY TYPE: OWNER: Q-Lc I PERMIT NO. 6/-- 1669 C5 /ZZ CONTRACTOR: c ,N8 PHONE # 362a FD 1743