HomeMy WebLinkAbout4700 COFFEE Road_HMBP 7.30.10HOODS ALARMS SPRINKLER TEMS SPRAY BOOTH AST
-Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
File Number: //3/ Address:
Bakersfield, CA 933
Date Received: 36 ld
Business Name: _Ska. C C
SYSTEM: BUILDING SQUARE FEET: INSPECTION LOG
New Mod.
❑ ❑ Commercial Hood System Building Sq. Feet:
❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft:
❑ ❑ Fire Sprinkler System
❑ ❑ Spray Finish System_
❑ ❑ Aboveground Storage Tank jl-XQ161
❑ ❑ Underground Storage Tank �) �, P,.v�
minor
modification Underground Storage Tank
removal Underground Storage Tank
❑ a_ Other: r4 _7" C_
Comments:
Date Time
Signature
1E 50
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 Agenq 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 1 1 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
1 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
CONSTRUCTION PERMIT
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
------------------------
JEFFRIES BROS INC
145 VULTEE ST
SHAFTER CA 93263
BAKERSFIELD FIRE DEPARTMENT
PREVENTION SERVICES
E R S II D 1501 TRUXTUN AVENUE, 1sT FLR
FIRE BAKERSFIELD, CA 93313
ARTHA T Office Phone: (661) 326 -3979
10- 10000244 Date 8/17/10
4700 COFFEE RD
507- 030- 05 =00 -8
FIRE DEPT
0
Contractor
------7-----------------
OWNER
-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Permit . . . . . . MANDATED LEAK DETECT TEST
Additional desc . .
Phone Access Code . 1025642
Permit Fee . . . . 96.00 Plan Check Fee 96.00
Issue Date . . . . 8/17/10 Valuation . . . . 0
Expiration Date . . 2/13/11
----------------------------------------------------------------------------
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
L
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:
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
PERMIT # I i -
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
,4: din day..
`iwlt
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
1600 Truxtun Ave., Suite 401
Bakersfield, CA 93301
Phone: 661 - 326 -3979 e Fax: 661 - 852 -2171
Page 1 of 1
E] LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
E FUEL MONITORING CERTIFICATION
SITE4N1FORMATI0 N I -
r
FACILITY
NAME & PHONE # OF C. ONTACT4PERSON
MaAk 1 - a
ADDRESS L -j oO - FAf-.ER.S:FIE5L -D, aA
Qom, .
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
- TANK•'TESTING'COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
I, . 26 O , S Fi 2- CA �i 3
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
33 - -60
CERTIFICATION #
DATE & TIME TEST TO BE CONDUCTED
64-
ICC #
iS 2 64 -1 IT
TEST METHOD
APPLIehNT SIGNATURE
DATE
'7,7 2� (D
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
AP ED BY
DATE
FD2095(Rev 06/07)
BILLING & PERMIT STATEMENT
F PERMIT #
u�g l;u;a FAKERS,FIELD FIRE DEPARTMENT
:Prevention Services
{p;�! F /RE IIVT 1600 Truxtun Avenue, Suite 401
ARr
'Bakersfield, CA 93301
PhnnA- 661 -R76 -3979 • Fax: 661 - 852 -2171
All permits mush be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
❑
Alarm - New & Modification (minimum charge)
$280
■
■
84
98
❑
TEINFORM
$0 .028 x sq ft
•
84
98
LOCATION OF PROJECT
'
Sprinkler - New & Modification (minimum charge) {
$280
PROPERTY OWNER
84
98
STARTING DATE 6gt4P69FiGpLp/6lE
T1AM1rc
j
NAME
84
98
t �_ �1v
Octet
$96 (inspection only)
°
e
84
98
PROJE NAME
Commercial Hood (New & Modification)
I
+
ADDRESS
PHONE #
98
;I
Additional hood (
I
5
�
- 6
PROJECT ADDRESS - r �/}
+� kV-1 A.
_A3�p%
i
�
— —�– – n
CITY 15�� 4_Q�1� a�QSTATE CA
ZIP CODE
[�
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Oy KUCiG
Aboveground Storage Tank (Installation /One Inspection)
$180
°
82
❑
CONT ACTOR NAME
CA LICENSE �/ CONTRACTOR
INFORMATION
TYPE OF LICENSE EXPIRATION DATE
PHONE #
Aboveground Storage Tank (Removal /Inspection)
—�, �>z.
�U�
82
C5
C
1 3� 10
CONN!T�1RACT R COMPANY NAME
L. c�i �'1C:e l tST�e.r_v ► Cej_ -l_C�
82
FAX #
Underground Storage Tank (Modification)
ZIP CODE
C`
l�
iiiiii■
ADDRESS CITY f� (
iJC \V J 1 L_ i
All permits mush be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
❑
Alarm - New & Modification (minimum charge)
$280
■
■
84
98
❑
Over 10,000 sq ft i
!
$0 .028 x sq ft
■
84
98
❑
Sprinkler - New & Modification (minimum charge) {
$280
■
■
84
98
❑
Over 10,000 sq ft (
$0 .028 x sq ft
`
°
84
98
❑
Minor Sprinkler Modification ( <10 heads)
$96 (inspection only)
°
e
84
98
❑
Commercial Hood (New & Modification)
I
$470
s
■
98
_
❑
Additional hood (
$58
■.
84
98
•
Spray Booth (New & Modification)
$470
■
■
84
98
•
Aboveground Storage Tank (Installation /One Inspection)
$180
°
82
❑
Additional Tank (
$96
°I
82
•
Aboveground Storage Tank (Removal /Inspection)
$109
;
82
•
Underground Storage Tank (Installation /Inspection) ;
$878 /tank
;
82
•
Underground Storage Tank (Modification)
$878 /site
..
82
❑
Underground Storage Tank (Minor Modification) {
$167
■
82
❑
Underground Storage Tank (Removal) j
$573 /tank
■
. 84
❑
Oil well (Installation)
$96
■
84
Mandated Leak Detection (test) /Fuel Mont Cert /SB989
NOTE: $96 for each type of test /per site even if
scheduled at the same time
$96 /site
■
■
82
❑
Tent
$96 /tent
:
r
84
❑
After -hours inspection fee j
$121
'•
a
❑
Pyrotechnic (per event, plus inspection fee of $96 /hr)
$96 -F (5 hrs min standby fee /insp) =$576
84,
❑
Re- inspection /Follow -up Inspection
$96 /hr.
o
84
❑
Portable LPG (Propane):' # of Cages?
$96
■
84
❑
Explosive Storage
$266
■
84
❑
Copying & File Research (File Research. fee $34 /hr)
$0.25 /page
■
84•
❑
Miscellaneous i
84
FD2021(Rev 06/07)
1 - ORIGINAL WHITE (Treasury) 1!- YELLOW (File) 1 -PINK (Customer)
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
SIGNATURE
BACKFILL
PRIMARY PIPE
SECONDARY PIPE
SECONDARY CONTAINMENT
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK -OFF
DESCRIPTION DATE SIGNATURE
AST N S ALL
DESCRIPTION DATE SIGNATURE
MODIFICATIONS MINOR/ MAJOR
1 DESCRIPTION I DATE I SIGNATURE 1
PRIOR TO OPERATION OF.ANY SYSTEM,I
ALL UST AND /OR ASS' SYSTEMS SHALL BEi
iINSTALLED,_COMPLETE AND ACCEPTED BY
THE BAKERSFIELD CITY FIRE DEPARTMENT.
R[Iii DING AnnRF-RS Al-)605 tt
JOB DESCRIPTION �' Cr
OCCUPANCY TYPE
OWNER
PERMIT NO. Q —16666 a2cfq
CONTRACTOR p cuE�G2. PHONE # 3 — 6 0 — -
FD 1743