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HomeMy WebLinkAbout5600 AUBURN Street_UST MINOR MOD 1.6.10Permit No. File Numbero Mite Rooiybdl: Permit No. uimu�u ,s IE New Mod. 0 Commercial al r 11HOO-d System 0 ❑ Fare6arm ystern 0 Fire Sprinkler System 3182��� 0 0 Ab6veground, Stooge Tank 0 0 UndO F" 9 "ro nd' torIg" e 1 Tank minor modificdtio U000r§rouhd Storbge TAIhk removal ''Unclerqround,Storzkge tank 13 U -:Other-: �Comments: Permit No. Permit No. Permit No. Permit 'No. Address:- Business Name: C 11 Ujbtiojj_Bjd ..CI 0 , i- Ft: q .5;T- 3O- 4. Signature �76 I E BAKERSFIELD CITY FIRE DEPARTMENT — INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work Insoection Reauest Phone No. (661) 326 -3979 BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAL -OFF CRASH POSTS OVERFILL PROTECTION ELECTRICAL SEAL -OFF SECONDARY CONTAINMENT MODIFICATIONSWINOR/ MAJOR AST DESCRIPTION DATE SIGNATURE PRIOR TO OPERATION OF ANY SYSTEM, ALL UST AND /OR AST SYSTEMS SHALL BE INSTALLED, COMPLETE AND ACCEPTED BY THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL) FD 1743 6i. JOB DESCRIPTION —7�7 I-Z -1 OCCUPANCY TYPE ?w'l OWNER ,,:,c-(Ie /-<. PERMIT NO. /D ©DD© /O CONTRACTOR %.^D. PHONE # S6 - 5.Z3- .3 73 1 FD 1743 BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT B H R S F I D Prevention Services PERMIT # 1501 Truxtun Avenue, 1st Floor ARfM r Bakersfield;.. CA 93301 Phnna• F,F,1'= 'I?A -lQ7Q . Fax• Ar%1 -RSA -7171 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 ❑ 1 Spray Booth (New & Modification) $470 ❑ boveground Storage Tank (1 inspection per installation) AST SITE INFORMATION LO ON OF PROJECT PROPERTY OWNER STARTING DATE COMPLETION DATE NAME P ECT NAME - WPLL `5 - -T7[VS LL M >) ADDRESS #:--t � C 11 Ar4-0b C"tS)5-a-7C5 ONE —51 PROJECT ADDRESS ,�u(�ue CITY STATE CA ZIP CODE 4q20 CONTRACTOR INFORMATION CONTRACTOR NAM CA LICENSE # TYPE OF LICENSE EXPIRATION DATE PHONE# CO CTO' C ONJPANY f ME LLc # ADDRESS, -74., Z: � t-QAiv ctc,— UN t CTIY CPWT;k 2 0 ZIP C DE L-749 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 ❑ 1 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 '6 % 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 • 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 TANK PERMIT APPLICATION TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Permit # BAKERSFIELD FIRE DEPARTMENT Prevention Services 1600 Truxtun Ave., Suite 401 Bakersfield, CA 93301 P/RE Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 ARIM t Page 1 of ,l TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY CHECK ONE ONLY ❑ MODIFICATION OF FACILITY X MINOR MODIFICATION OF FACILITY STARTING DATE / •� /® PROPOSED - COMPLETION DATP', FACILITY NAME OISTING FACILITY PERMIT # 6irdc K S{zf>r� `42 -70 SGo 5 FACILI'[Y ADDRESS CITY ZIP ODE 3 O Auburn Bo_kers F �Id TYPE OF BUSINESS APN # -Cx5 l -ri Di s an S}o TANK OWNER I i PHONE # C i rc. e- V Sto re 1, l Y, ADDRESS ^ "(so QTY�rono ZIP CODE U CONTRACTOR f 2 A'S,O� 1 C4 e i . c6 bu i- Gk'e- CA LICENSE # 7 - -(-o 5410 ICC # ADDRESS - '• `L47t�: S>h.. C3r� CITY - - .. ZIP CODE 9239 5- PHONE #' ' - "- `�" '� 9(j -42S .9373 BAKERSFIELD CITY BUSINESS LICENSE # lo": o 5 WORKMANS "COMP #. �- Vo55; ;INSURER Stu..Ar- Fu nd BRIEFLY DESCRIBE THE WORK TO BE DRONE: e,nl t-e UjI L-L.D S wt+k Y1P.l.) Vii I ML-0 S i n (J) ivrbi nP I WATER TO FACILITY PROVIDED BY I DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO ❑ YES ❑ NO THIS SECTION IS FOR MOTOR FUEL STORAGE TANKS TANK :# - VOLUME' .UNLEADED - - REGULAR - "." - PREMIUM _ DIESEL - AVIATION THIS SECTION IS FOR NON -MOTOR FUEL STORAGE TANKS TANKS' #.. - VOLUME' -. , UNLEADED'- . - REGULAR PREMIUM' :- .DIESEL - AVIATION 77 FOR OFFICIAL USE ONLY APPLICATION DATE FACILITY #. , �- ' #:OFTANKS : FEES $ THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,.AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. APP OVER BY APPLICANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FD2086 (Rev 06/07) CONSTRUCTION PERMIT BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES B E R S F I D 1501 TRUXTUN AVENUE, 1 ST FLR FIRE BAKERSFIELD, CA 93313 ARTIY T .:.� Office Phone: (661) 326 -3979 Application Number . . . . . 10- 10000010 Date 1 /11 /10 Property Address . . . . . . 5600 AUBURN ST ATN (11 Digits): 438 - 110- 03 -00 -2 Application type description FIRE DEPT Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . 0 Owner Contractor NIELSEN ENTERPRISES OWNER 5416 CASTILLO DE ROSAS CAMARILLO CA 93012 ---------------------------------------------------------------------------- Permit . . . . . . UNDGRND STR TANK MINOR MODIFY Additional desc Phone Access Code 971663 Permit Fee . . . . 83.50 Plan Check Fee 83.50 Issue Date . . . . 1 /11 /10 Valuation . . . . 0 Expiration Date . . 7/10/10 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------- - -- - -- - -- -- - - - -- ---- - - - --- ---- - - - - -- ---- - - - - -- Permit Fee Total 83.50 83.50 .00 .00 Plan Check Total 83.50 83.50 .00 .00 Grand Total 167.00 167.00 .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 afterl 80 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' e 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 ' '. a �� �.�x� x _ _ �,1Phone 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)): 1, 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). 1, 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 MR 37 Owner Signature 157a, .. , MaN k _�� . a . 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 ;_- 1 Date