HomeMy WebLinkAbout6100 DISTRICT Boulevard_UST 3.10.1111IM11
35
IE
MOODS ALARMS SPRUKL ER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
/ / -/�0 /e 3
File Number: 3Y�73
Date Received: 3 --� p - if
Address: G 1-603 ;r> i S Nrc- % &Z�d •
Bakersfield, CA 933
Business Name: 4-vc .
Comments:
1.
a.
3.
4.
INSPECTION LOG
Date Time
vuvooceawoc
Signature
SYSTEM:
BUILDING SQUARE FEET:
New
Mod.
❑
❑
Commercial Food System
Building Sq. Feet:
❑
❑
Fire Alarm System
Calculation Bldg. Sq. Ft:'
❑
❑
Fire Sprinkler System
❑
❑
Spray Finish Systern
❑
❑
Aboveground Storage Tank
❑
❑
Underground Storage Tank
minor
modification
Underground Storage Tank
removal
Underground Storage Tank
❑
LAY Other: �'py! C-1
Comments:
1.
a.
3.
4.
INSPECTION LOG
Date Time
vuvooceawoc
Signature
IE
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD / LINE TESTING
/ SB989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO.
BAKERSFIELD FIRE DEPT.
B E R SF 1 8 D Prevention Services
FIRE
ARM T 2101 H Street
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION _ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT TESTING
❑ TANK TIGHTNESS TEST X TO PERFORM FUEL MONITORING CERTIFICATION ❑ Cathodic Protection Testinq
SITE INFORMATION
FACILITY Fed -Ex
NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS 6100 District Blvd. Bakersfield, Ca.
OWNERS NAME Same
OPERATORS NAME Same
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK#
VOLUME
CONTENTS
1
Diesel
TANK TESTING�COMPANY "' "' }
NAME OF TESTING COMPANY Cal - Valley Equipment
Bruce W.,Hinsley 661- 327 -9341
MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Bruce W. Hinsley 661- 327 -9341
CERTIFICATION* A25212
DATE & TIME TEST TO BE CONDUCTED
Icc #: 1064437 -UT _T
SIGNATURE OF APPLICANT W
DATE 3/1012011
APPLI TION COM S pipimirwilEN, APP . o vap
APPROVED B DATE 3 —,R ,
FD 2095 (Rev. 09/05)
t
BILLING & PERMIT STATEMENT . u' BAKERSFIELD FIRE DEPARTMENT
B 19 R S F [ L D Prevention Services
PERMIT # FiRe 210TH Street
werr r
Bakersfield, CA 93301
- C.v• GC1 _4C7_7� 71
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
❑ I 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
❑ 1 Additional hood ] $58
❑
Spray Booth (New & Modification)
I SITE INFORMATION
LOCATION OF PROJECT
PROPERTY OWNER
red— ,Ex
$180 /tank
STARTING DATE COMPLETION DATE
NAME
PROJECT NAME
ADDRESS
PHONE
PHONE#
PROJECT ADDRESS
igloo '0jytr,'C t 6,,V,9(, a(.
/ �p ^
CITY Pj�C i`Fi f�S�I E l� STATE C.h
ZIP CODE
Aboveground Storage Tank (Removal, Mod,or Inspect'n) ATR
CONTRACTOR INFORMATION
82
CONTRACTOR NAME
CA LICENSE #
TYPE OF LICENSE EXPIRATION DATE
PHONE #
�Ql -1/a
92!73
9 30 -2012
6c -:?2 -
CONTRACTOR COMPANY NAME
FAX #
% - a
f6/- 32S -2S2
ADDRESS
13soo G1' iffe-
CITY
/W
ZIP CODE
93301
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
❑ I 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
❑ 1 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
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
CONSTRUCTION PERMIT
Application Number . . . . .
Property Address . . . . . .
ATN (11 Digits):
Application.type description
Subdivision Name . . . . . .
Property Use . . . . . . . .
Application valuation . . . .
Owner
------------------ - - - - --
VIKING FREIGHT SYSTEM INC
3336 E 32ND ST STE 217
TULSA OK 74135
BAKERSFIELD FIRE DEPARTMENT
PREVENTION SERVICES
JFI 1501 TRUXTUN AVENUE, 1sT FLR
BAKERSFIELD, CA 93313
Office Phone: (661) 326 -3979
11- 10000103 Date 3/28/11
6100 DISTRICT BLVD
384- 381- 06 -00 -5
FIRE DEPT
0
Contractor
------------------ - - - - --
OWNER
----------------------------------------------------------------------------
Permit . . . . . MANDATED LEAK DETECT TEST
Additional desc .
Phone Access Code'. 1083252
Permit Fee . . . . 96.00 Plan Check Fee 96.00
Issue Date . . . . 3/28/11 Valuation. 0
expiration Date 9/24/11
-------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 Agerif Phone 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. 1 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 Date
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 TESTING
UST REMOVAL
DESCRIPTION DATE SIGNATURE
MISC. ACTIVITY
REMARKS:
AST NEW INSTALL
DESCRIPTION DATE SIGNATURE
MODIFICATIONS MINOR / MAJOR
AST REMOVAL
DESCRIPTION DATE SIGNATURE
PRIOR TO OPERATION OF ANY SYSTEM,
ALL UST AND /OR AST SYSTEMS SHALL BE
INSTALL, COMPLETE AND ACCEPTED BY
THE BAKERSFIELD CITY FIRE DEPARTMENT.
FIRE DEPARTMENT (FINAL)
BUILDING ADDRESS: a16 O ,!�'SlNIC. c.
JOB DESCRIPTION: W C,
OCCUPANCY TYPE:
OWNER: Aim <d <!F"K .
PERMIT NO. //- /,66nin 16.3
CONTRACTOR: (2^4 PHONE # '7..
if r FD 1743