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Home My WebLink About420 34TH Street_UST FMC 3.11.10A Permit No. Permit No. IE File Number: 16,66&qC- DAte Received:- New Mod. ❑ ❑ Commercial Hood System 0 ❑ FI-r-e.AlArWSytt6m 0 0 Fire Sprinkler System ❑ Aboveground Storage Tank ' minor Modification removal 0 ❑ Comments: Underground Storage Tank Underground Storage Tank Underground Storage Tank Other, Permit No. Address: Business Name: '��,WLPIN.G MI S din- tSq. Bl.,. Building Calculation B109, 1,94, Ft' - , Permit No. Sc. — eld, CA 933 Feet --l- FEE AST Permit No. Sp s (A6- 2. I 4. Permit No. WOW ft nature 70 IE UNDERGROUND STORAGE TANKS �� BAKERSFIELD FIRE DEPARTMENT Prevention Services 3 F 1110D 1501Truxtun Avenue 1st Floor APPLICATION •fe/ Bakersfield, CA 93301 TO PERFORM ELD /LINE TESTING/ w` 44011► Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 SB989 SECONDARY CONTAINMENT Page 1 of 1 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 ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT ❑ TANK TIGHTNESS FUEL MONITORING CERTIFICATION ;r SITE ON FACILITY f f NAME & PHONE # OF CONTACT PERSON o ADDRESS OWNER NAME J OPERATOR NAME `�- -� - - - PERMIT TO OPERATE # # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO TANK # VOLUME CONTENTS �tr—Se- TESTING COMPANY NAME & PHONE # OF CONTACT PERSON �cn `fin v pro �nrv�+MQ aax,n�e Yvt cc - o a MAILING ADDRESS q3-3108 yo0 5 Cam-. `"�3k-� \c\ C� NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR CERTIFICATION # DATE & TIME TEST 0 BE CONDUCTED ICC # TEST METHOD APPLICANT SIGNAT E DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPR VED BY � DATE e. FD2095 (Rev 03/08) BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT BB I B R S F L D Prevention Services PERMIT # pie# 1501 Truxtun Avenue, 1"L Floor dR1Y T Bakersfield, CA 93301 DhnnP• F,F,1- 17F, - 'AQ7Q a Fay- F,F,1 -RS7 -7171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. C ❑ Alarm - New & Modification (minimum charge) SITE INFORMATION LOCATION OF PROJECT .-,� ^ ` (� � , (�COMPLETION PROPERTY OWNER ", t • d STARTING DATE DATE NAME 0r $0.028 x sq ft t� o -VVt0T LoA s PROJECT NAME ( c,y\_L%oY- ADDRESS I - - ` . "- ......... f+L 5-� , I PHONE # - 321-1-4 (c PROJECT ADDRESS ^ cm >A _' ER.�SFI ELD ' STATE CA ZIP CODE Explosive Storage CONTRACTOR INFORMATION ❑ Over 10,000 sq ft CONTRACTOR NAME e5 CA LICENSE # TYPE OF LICENSE EXPIRATION ATE GU1( o R o fc�"$ PHONE # 02 CONTRACTOR COMPANY NAME FAX # 2 �rQ y1 U O I ADDRESS 5 r CA 84 ZIP COD �O Commercial Hood (New &- Modification) . $470 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. C ❑ Alarm - New & Modification (minimum charge) $280 • ❑ Over 10,000 sq ft $0.028 x sq ft 84 • Portable LPG (Propane): # of Cages? — ❑ Sprinkler - New & Modification (minimum charge) $280 ❑ Explosive Storage $266. ❑ Over 10,000 sq ft $0 .028 x sq ft Copying & File Research (File Research fee $50 /hr) $0.25 /page • Minor Sprinkler Modification ( <10 heads) $96 (inspection only) 84 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 Tanki 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) /Fue ont Ce B989 NOTE: $96 /hr for each type of to a even if scheduled at the same time Tr $96 /hr (2 hrs minim )=$192 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 NOTE: After hours Pyrotechnic event inspection is @ 121 /hr 5 hrs min standby fee ins = 605 • 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 CONSTRUCTION PERMIT Application Number . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . Property Use . . . . . . . . Application valuation . . . . Owner ------------------------ BAKERSFIELD MEMORIAL HOSPITAL 420 34TH ST BAKERSFIELD CA 93301 BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES E R'S F I D 1501 TRUXTUN AVENUE, 1ST FLR FIRE BAKERSFIELD, CA 93313 'ARTM T Office Phone: (661) 326 -3979 10- 10000087 Date 3/17/10 420 34TH ST 120 - 310- 34 -00 -4 FIRE DEPT 0 Contractor OWNER ----------------------------------'----------------------------=------------- Permit . . . . . . MANDATED LEAK DETECT TEST Additional desc . . Phone Access Code 986158 Permit Fee . . . . • 96.00 Plan Check Fee 96.00 Issue Date . . . . 3/17/10 Valuation . . . . 0 Expiration Date . ---------------------------------------------------------------------------- . 9/13/10 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 after 180 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 AgentF� 4 . : " . d - 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 P!, � .,�,�3 ., ° f � ,c: >kL � :�: i.,`>� � = . �,+4..N �' .� s �sc Fc - 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 " a;= e -' -,:_ a_' _ 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 DESCRIPTION DATE SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF TANK TFSTINt; _ i I MODIFICATIONS MINOR/ MAJOR 1 DESCRIPTION I DATE I SIGNATURE 1 PRIOR-TO-OPERATION-OF-ANY - SYSTEM, ALL -U.ST ANDI_OR AST SYSTEMS SHALL BE INSTALLED,._COMPLETE_AND ACCEPTED BY AHE_BAKERSFIELD CITY -FIRE DEPARTMENT. S` JOB DESCRIPTION r L," OCCUPANCY TYPE OWNER t X, 0 1-r PERMIT NO. 16 —1 % CONTRACTOR PHONE # 3c2G – Wd Z FD 1743 0 Uty of Baker- field Cif Tili =, R kKMPT -k ** iJaer° tih'MFORD Type: ' Ur Drawer: 1 e: Fat 3/17/10.01 Receipt no; 75445 Oescriation Quantity Asount X16 1.0000087 l p _,UILDINS RRNI i S 1, uA $152.00 Tender detail Total +.errd ?'r' ?d �15?.00. T0ta1 paynent 19'2.@0 Trans date: 3/11110 Time: 11.381,09 HELP.WNTRUL THE RIEE.POPULATION PLEPISE SPAY OR NEUTER