HomeMy WebLinkAbout4200 ASHE Road_UST FMC 1.31.11INMIN
55
SYSTEM:
BUILDING SQUARE FEET:
New
HOODS ALARMS SPG°3NKL R SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
6 /— /DOOiOt�
File Number: 3636
Date Received: /—B/—//
Address: 'V2.00 & (,t e.. !Z�
Bakersfield, CA 933 _ .
Business Name: a an t a —j�,Ne_aj AK -jv l � tj5 L->
Comments:
I.
2.
3.
4.
Date Time
Signature
Signature
SYSTEM:
BUILDING SQUARE FEET:
New
Mod.
❑
❑
Commercial Hood System Building Sq. Feet: �r
❑
❑
Fire Alarm System Calculation Bldg. Sq. Ft:
❑
❑
Fire Sprinkler System
❑
❑
Spray Finish System
❑
❑
Aboveground Storage Tank
❑
❑
Underground Storage Tank
minor
modification
Underground Storage Tank
removal
Underground Storage Tank
❑
CY
Other: 7- "4 C—
Comments:
I.
2.
3.
4.
Date Time
Signature
Signature
IE
CONSTRUCTION PERMIT
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
------------------ - - - ---
PANAMA UNION SCHOOL DISTRICT
4200 ASHE RD
BAKERSFIELD CA 93313
BAKERSFIELD FIRE DEPARTMENT
JXTPREVENTION SERVICES
1501 TRUXTUN AVENUE, 1sT FLR
BAKERSFIELD, CA 93313
Office Phone: (661) 326 -3979
11- 10000044 Date 2/09/11
4200 ASHE RD
384 - 370- 19 -00 -3
FIRE DEPT
0
Contractor
------------------ - - - - --
OWNER
----------------------------------------------------------------------------
Permit . . . . .
. MANDATED LEAK DETECT TEST
Additional desc
.
Phone Access Code
1072818
Permit Fee .. . .
. 96.00
Plan Check
Fee 96.00,
Issue Date . . .
. 2/09/11
Valuation
0
Expiration Date
8/08/11
-7--------------------------------------------------------------------------
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 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 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 1 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 Date
BILLING & PERMIT STATEMENT �µ��', BAKERSFIELD FIRE DEPARTMENT
S F I L D Prevention Service
P FIRE
ERMIT # dtl a1p1 S t�ET
AR7Yr Bakersfield, CA 93301
Phone : 661- 326 -3979 • Fax: 661-852-2171
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
❑
Alarm - New & Modification (minimum charge)
SITE INFORMATION
LOCATION OF PROJECT
Vanaffialt-lerr'.Q
TY OWNER
STARTING DATE COMPLETION DATE
NAME
PROJECT NAME V
V
ADDRE 5
PHONE '� 1
PROJECT ADDRESS
cm, gf} K �RS� I I✓ LD STATE CA
ZIP COD
CONTRACTOR INFORMATION
CONTRACTOR NAME CA LICENSE #
TYPE OF LICENSE
EXPIRATION DATE
3o ll
PHONE #
-��-(
CONTRACTOR COMPANY NAME
t �IVVt �v ►�EnmA �-
FAX #
3a(,, -gCt3�(
ADDRESS
156Lk3 69-00"
CITY
ZIP CODE
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
❑
Alarm - New & Modification (minimum charge)
$280
84
❑
Over 10,000 sq ft
$0 .028 x sq ft
84
❑
❑
Sprinkler - New & Modification (minimum charge)
$280
84
❑
Copying & File Research (File Research fee $50 /hr)
❑
Over 10,000 sq ft
$0 .028 x sq ft
❑
Miscellaneous
I
❑
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
Z�51)Mandated
Leak Detection (test) /Fu l MonjCe SB98 9
NOTE: $96 /hr for each type of tes n if
scheduled at the same time TT
$96 /hr (2 hrs minimu =$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 his min standby fee /insp) = $576
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
I
1
1 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
S B 9 P 1 D
P/RR
ARTN, T
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
a10t l-k S-mEET
Bakerstield, CA 93301
Phone: 661- 326 -3979 • Fax: 661-852-2171
Page 1 of 1
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
L MONITORING CE FICA
• SITE,INFORMATION
FACILITY NAME & P ONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
i ;a V-1
•rANK'TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
a Co - �ICQ
MAILING ADDRESS
�JLa� -13 -E><:Z-do\e.S GT. - F3Pt1«RSFI�t -p�Cf� °i33o�
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR p pQ
U t7�Q �" o�o O I.
CERTIFICATION # 1809 Q
so
DATE & TIME TEST O BE CONDUCTED
ICC #
5a�tat3 - L T
TEST METHOD
(MCONJ
APPLICANT SIGNA E � (f� •^
(WA (.� v
DATE
I
C, t
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
d1 VED BY
DATE
FD2095 (Rev 03/08)
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
UST REMOVAL
DESCRIPTION DATE SIGNATURE
EVR UPGRADE
REMARKS:
AST NEW INSTALL
DESCRIPTION DATE SIGNATURE
MODIFICATIONS MINOR / MAJOR
AST REMOVAL
DESCRIPTION DATE SIGNATURE
PRIOR TO OPERATION OF ANY SYSTEM,
ALL UST ANb /OR AST SYSTEMS SHALL BE
INSTALL, COMPLETE AND ACCEPTED BY
THE BAKERSFIELD CITY FIRE DEPARTMENT.
FIRE DEPARTMENT (FINAL)
BUILDING ADDRESS: 4rz. D O -saS .
JOB DESCRIPTION: F'&I-1 L
OCCUPANCY TYPE:
OWNER:
PERMIT NO. //— Q 4,cjC
CONTRACTOR: PHONE #,,3y4—;r6-V2
FD 1743