HomeMy WebLinkAbout4900 PANAMA Lane_UST FMC 6.16.10HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
File Number: 160 cty-N
Date Received:
Address:
Bakersfield, CA 933
Business Name: (�,6 s �C p
SYSTEM: BUILDING SQUARE FEET:
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
❑ Gl,,� Other: frW4G
Building Sq. Feet:
Calculation Bldg. Sq. Ft:
C--n)
1.
2.
3.
4.
INSPECTION LOG
Date Time
Signature
Comments:
6v�l�Gis F2.' /��/ its Lax �T
CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT
PREVENTION SERVICES
B E R s P i D 1501 TRUXTUN AVENUE, 1ST FLR
FIRE BAKERSFIELD, CA 93313
�RrN T Office Phone: (661) 326 -3979
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
------------------------
COSTCO WHOLESALE CORP
999 LAKE DR
ISSAQUAH WA 98027
10'10000182 Date 6/22/10
4900 PANAMA LN
499- 011- 10 -00 -5
FIRE DEPT
0
Contractor
------------------ - - - - --
OWNER
----------------------------------------------------------------------------
Permit . . . . . . MANDATED LEAK DETECT TEST
Additional desc
Phone Access Code . 1011782
Permit Fee . . . . 96:00 Plan Check Fee 96.00
Issue Date . . . . 6/22/10 Valuation 0
Expiration Date . . 12/19/10
------------------------------- ------- =-------------------------------------
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 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 w _ Date
WORKERS COMPENSATION DECLARATION
1 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:
I
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.. Pshall 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 constriction and hereby authorize representatives of the city to enter the above mentioned - property for inspection purposes.
Signature of Applicant or Agent F-.', s=' -. - f °s : r: ;� .. ..< . ,. Date
BAKERSFIELD CITY FIRE DEPARTMENT — INSPECTION RECORD
Post this Card at the Job Site and DO NOT Remove far Duration of Work
InsDection Reauest Phone No. (661) 326 -3979
DESCRIPTION DATE SIGNATURE
BACKFILL
PRIMARY PIPE
SECONDARY PIPE
SECONDARY CONTAINMENT
SENSORS
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK -OFF
TANK TFsTiNr. MODIFICATIONS MINOR/ MAJOR
UZIMIOVAL
DESCRIPTION DATE SIGNATURE
DATE
PRIOWTO-OPERATION -OF ANY SYSTEM,
(ALL UST AND /OR-AST SYSTEMS SHALL BE
1 STALLED, COMPLETE AND ACCEPTED BY!
[THE BAKERSFIELD CITY FIRE DEPARTMENTI
RIM DING ADDRESS 41'91917 _::tAgU4~4 G.✓.
JOB DESCRIPTION ?yl
OCCUPANCY TYPE
OWNER
PERMIT NO. /D -/d 2.
CONTRACTOR a.J 5 PHONE 3'/ qm - p.Z3
FD 1743
0 R NAM
OPERATOR NAME , PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES NO JAS
TANK # VOLUME CONTENTS
.�� 4`43 13 v
NT $ NA URE DATE
A0
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED QY DATE .
FD2095 (Rev 03/08)
ze
BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANKS
Prevention Services
^JVARrm
2101HStreet
APPLICATION
Bakersfield, CA 93301
TO PERFORM ELD /LINE TESTING/
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
0 R NAM
OPERATOR NAME , PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES NO JAS
TANK # VOLUME CONTENTS
.�� 4`43 13 v
NT $ NA URE DATE
A0
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED QY DATE .
FD2095 (Rev 03/08)
ze
BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT
B .H R S P[ 8.. D Prevention Services
PERMIT # F�R� p' 2101 H Street
O A81M T
Bakersfield, CA 93301
OR
I SITE LOCATION7 PROJECT
-
PROP OWN
STARTING D TE COMPLETION D TE
NAME
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PROJECf 14AME
• �' ODD. _ ,�,
P PR JE DD SS CITY gfkKERS�IELD STATE C�k
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CONTRACTOR NAME
CONTRACTOR INFORMATION
CA LICENSE #
TYPE OF LICENSE EXPI RA TION.D E
VMONE #
.3 42-3
CONT OR CO PAN N E � � - �
F .vim�rJe -
X #
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All
J
❑
permits must be°re ' wed, stamped, and approved PRIOR TO BEGINNING WORK.
PERMIT TYPE FEE CALCULATION TOTAL
•
Alarm - New & Modification (minimum charge)- $280
'
ONLY
•
.❑
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
❑
boveground 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 Mont Cert/SB989
'NOTE: $96 /hr for each type of test/per site even if
scheduled at the same time TT
$96 /hr (2 hrs minimum) =$192
82
p'
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 businessfturs) PY
NOTE: After hours Pyrotechnic event inspection is @ $121 /hr
$96 /hr + (5 hrs min standby fee /insp) =$576
5 hrs min standb .fee ins = 605
84
❑
Re- inspection /Follow -up Inspection
$96 /hr
84
0 .
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
FD2021 (Rev 04/,01