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08-0992 (SOTB)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4bt 4 4 Q" Application Number: 08-00000992 Property Address: `79490 HIGHWAY 111 APN: 649=820-011- - - Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: REGIONAL COMMERCIAL Application valuation: 16000 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I licens nder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busines Prof si als Code, and my License is in full force and effect. License CI /sus'. _ C21 HAZ ice o.: 794519 a/i tractor: OWN R -BUILDER DECLARATION I hereby affirm under penaltyiof perjury hat I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5� usine and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, epair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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 _ 1 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' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). r ( 1 I am exempt under Sec. , B.&P.C. for this reason Date Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: 11� LQPERMIT Owner: TESORO 3450 S. AUBURN, WEST COAST CO 344TH WLV WA 980 Contractor: FUELING & SVC 7050 VILLAGE D BUENA PARK, CA (714)523-0194 Lic. No.: 7945 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/11/08 ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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 ddd 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: Carrier INS CO OF WEST Policy Number WSD5000271 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 b e subject t workers' compensation provisions of Section 7,000 of the Lab ode, I hat forthwith ply with those provisions. lO� cant: WARNING: AILURE TO S 0 KERS' COMPE TION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER T RIMINA PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN AD TION 0 THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN .SECTION 3706 OF THE LABOR C NTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the �- conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to buildin nstruc Perla d hereby authoriz esentatives of this co to enter upon th above-mentioned property nspe I' n rposes. to Sign re (Applicant or Agent): Application Number . . . . . 08-00000992 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 171.00 Plan Check Fee 111.15 Issue Date . . . . Valuation . . . . 16000 Expiration Date . . 2/07/09 Qty Unit Charge Per Extension BASE FEE 45.00 14.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------------------------------------- 126.00 Permit . . . MECHANICAL Additional desc . . HEALT TANK VENTS Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 2/07/09 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 4.5000 EA MECH VENT ---------------------------------------------------------------------------- INST/ DUCT ALT 18.00 Permit . . . WALL/FENCE PERMIT Additional desc . . 42' -LF BLK WALL Permit Fee . . . . 31.20 Plan Check Fee .00 Issue Date Valuation . . . . 16000 Expiration Date 2/07/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.80 9.0000 THOU BLDG 2,001-25,000 16.20 ---------------------------------------------------------------------------- Special Notes and Comments HEALY VAPOR RECOVERY SYSTEM INSTALLED ON CONCRETE SLAB W/ 5'-6" HGT. BLOCK WALL ENCLOSURE & SAFETY BOLLARDS PER ENGINEERED DESIGN. 2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . ... STRONG MOTION (SMI) - COM 3.36 Fee summary Charged Paid ---------- ---------- Credited ---------- ---------- Due ----------------- Permit Fee Total 235.20 .00 .00 235.20 Plan Check Total 119.40 .00 .0.0 -119.40 Other Fee Total 3.36 .00 .00 3.36 Grand Total 357.96. .00 . .00 357.96 - t Bin # City of La Quinta Building a Safety Division. , P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 I Building Permit Application and Tracking Sheet Permit # q 9 2. Project Address: 79l �iw /� Owner's Name:^ E�S'AIE27 40 Lo A. P. Number: Address:3 Y,5O S Y YM Legal Description: City, ST, Zip: 4(/8(11ZA1 W4. 7-F, Contractor:/-/ — Address:70S7P V [L~ Oua- Telephone:253 876 9 70® Project Description: City, ST, Zip: 13t%C--01Jdk FAW.- CA _c]O4c`Z i /A/,S ;WL NE—W 6f, V Jv Telephone: 7/Y g-4g_o�'9"CityLic, A'2p6t7 �State Lic. #:7 �/,j (?: L7 44NC PAD PAP Arch., Engr., Designer:d 06V 1 4i is 4 /)—S o1V Address:,eO' Lrl XAMC-494 AvF- City, ST, Zip1 (fr-Q4001,-ee4 Telephonegr$ a y2 y Construction Type: Occupancy: P Y: State Lic. #: aX _ Name of Contact Person: �e-'�,I` Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: F#Uni;7: Telephone # of Contact Person: 1;2> Estimated Value of Project: /Zt O0 CD APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections (Z Plan Check Deposit Truss Calcs. Called Contact Person jr2 Plan Check Balance Energy Cales. Plans picked up(o/ Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°d Review, ready for correction ssue f. Electrical Subcontactor List Called Contact Person _ Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for. corrections/iss a Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees r , > Total Permit Fees -I �P G193 NlS RPc, c 13 iWs ¢Ec. 71A i --�* log John R. Hawkins Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of: Banning Beaumont S Calimesa Canyon Lake Coachella Desert Hot Springs Indian Wells Indio Lake Elsinore La Quinta Moreno Valley Palm Desert Perris Rancho Mirage Rubidoux CSD San Jacinto Temecula Board of Supervisors Bob Buster, District I John Tavaglione, District 2 Jeff Stone, District 3 Roy Wilson, District 4 Marion Ashley, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 210 West San Jacinto Avenue • Perris, California 92570 • (951) 940-6900 • Fax (951) 940-6910 June 26, 2008 Fueling and Services Tech. 7050 Village Dr. Buena Park, CA 90621 Re: Vapor Processing System LAQ-08-ABT-030 USA Gas Station Q94R_0 HWF-111- a Quirita, CA The following sections provided, unless stated otherwise, will be from the California Code of Regulations, Title 19 Chapter 11.5 and/or 2007 California Fire Code. The above referenced plans have been reviewed and are acceptable by the Riverside County Fire Department with the following conditions: 1) The unit shall be located not less than 50 ft from any fuel transfer and not less than 10 ft. from Any buildings or buildable property. 2) Vapor Processing Unit shall be protected against tampering trespassing and vehicular traffic and the area must be clear of combustibles at least 10 ft. 3) The following signs shall be posted at the dispenser and letters shall not be less than 3 inches in height and % inch stroke. a) "NO SMOKING OR OPEN FLAMES WITHIN 50 FEET' 4) The emergency shutdown device shall be readily visible, located no more than 75 ft. but no closer than 10 ft. from fuel dispensing. The installing company shall be responsible to contact the Fire Department to schedule a final inspection. Requests for inspections are to made at least 24 hours in advance and may be arranged by calling (760) 863-8886. Should there be need for further information and/or clarification, please contact the undersigned at (760) 863-8886. Jaso Stubble Fire Safety Specialist *SU I VAPOR RECOVERY CERTIFICATION ftsommumewm flock Fienm 1, 2044 CLEAN AIR SEPARATOR WSW MM tOMPLAM LiBTEE — Fialyc 3y ru ktc.17 liorrrpehks aft Fttrdwrt. WW210 0=1 aam —,nn W* Mwo sm QM P&,M arab W*b de tgmd tbrureat a 4 tuft. k i a�re0lnaor�urdioa v*h Ifs pkv" * rw w*v"sy w odes mmm w io eppr�oodnw1�104 Atlb� (�j �ta�ooear pardMavap�ors, ri��knb.e b�hebnorl�lrw. J�ta�ter�,trbrn rie bticsyalrrn b urd�ra rape�a praeeursoondSo� dreswW yr a as aewn brie PWMeia PNW 7N smarm aonbrkm rarrm�g a abol M M ens kill Wed h aloes p'w* tto b ptotrc *npe tack vent In aacordrrroetAMANk amorrlo. ��cATiO!!—Mfhiledaip�ed.b+�elcwAh E,tf�el�,q► � �t�pymY�pn wlh lmilyd at "°lame ro�rnml�a furAnp CRVR ��Pad+, rie Modtl�Zanrrork Mb aryvaporraoovorpyp�rn Ord matt pMock 1piredpdamgpors, "TALt.ATiOIi—iw b* M-irprllorr b dor* h ar000rdaroerdlttU ffavia*Me 4j*Ucjors..% rurlb are bbndad b be irabrAedv ft cwmrh 8bb Finn MafdrolLad ad GarnpemleVlrpaReoorr9►rile�a OMVWAO poft aoh ar Horde% boew brarcaMrryv r, gun aouroN andhep asmoo tarenarrinp c d pre ww urn" Rail11 GwffwQor,, k aoow-� � �rrnber, and �I�ak:frrN epgran a iabr! aarerad bihasidodtt�a lenkh :.CEFRIF1CAttoH—Tha Hotly IkoQel � c2eeRAtsf4r,iorls C�rlMied ioruw atsabiand o�omrrran�et momrAta! �rpermirrg, ittl erase}�t,ther,evmporapo�ry(edreirsdarequh,�bylM►. T* Gorr is fieda pursuant b be ►fid b bre c4ft* ebb lora waatd to oorrbtned h Sadlarr 41965 brG* 41W off& a H@* erg Sftoode. Thacerm,,dm &baraedr4on bdape nRlesha ° "� �� aPP CSFMebll'freers+bv+ed be ldtr�wtban�iorol�erab�rtmtfm rd an Inds) opeoied, fitr aon� ' �ameaft brotanr IFIonmarntarteootrrrher�ddoel�mfo! :Irorrldnotbeupdbvr�taolnmt�� arkwbla0onatbrry, banctFE tJAR1r1,2005 Arrarorlad gIr C p, MPr+cgram Ooord mb E Califomia State Fire Marshal CODE INTERPRETATION Date Issued 9/01/2005 Interpretation # TWO -1 Topic Healy Ph— II enhanced vapor recovery system Code Section(s) 2001 CFC Section 223 Requested by Tom Waller Fire Marshal Oxnard Fire Dept. 251 South C St. Oxnard CA 93030 I am requesting an interpretation of the California Fire Code with respect to the Healy Phase 11 Enhanced Vapor Recovery System. The Healy Phase If EVR includes a vapor processor, also known as a Clean Air Separator (CAS). The CAS is 400 -gallon capacity vessel that will contain gasoline and gasoline vapors during operation. The CAS has come into question as to whether it will be regulated as an above ground storage tank (AS7). My request for c/arificadon4hterpretation includes the following: S 1. Is the Clean Air Separator an aboveground storage tank in . accordance with the California Fire Code? No. 2. If the Clean Air. Separator is not an aboveground storage tank, what is It? There is no clear definition in the CFC however, U.L. has certified the unit as a "Vapor Processing System! 3. If you call the CAS a vapor processor, or a processing vessel, what is the CFC definition of a vapor processor? Processing vessel? CFC Article 2, Section 223 best defines these as a "vapor processing unit". a 05-019 Waller Page Two 4. What are the installation requirements for secondary containmen4 vehicle crash protection and labeling? There are no requirements for secondary containment. However, protection against physical damage shall be provided in accordance with Article 52, California Fire Code, Section 5202.13.3.12. 5. Does draining of the bladder and/or tank (CAS) (see Healy Operating lns&ucdons) amount to dispensing as defined in the CFC? r No. r J Foot nota: The intent of this footnote Is for reference only and to provide clarification. It Is not the Intent of the State Fire Marshal to endorse any one specific product, device or methodology. Description of Operation of the Healy Clean Air Separator*': The Healy Systems, Inc., Model 9981 Healy Clean Air Separator" Is a stand-alone, completely mechanical device that assists in controlling the gasoline vapor emissions from a gasoline dispensing facility. It consists of a 400 -gallon storage vessel with integral bladder and associated valving. It connected to the ullage space of the GDF storage tanks vie the venting system of the under ground storage tanks. During normal operation of the GDF, with todays concentration of ORVR vehicles approximating 20°/6, the storage tank ullage space will usually operate in the V to negative (up to 8' WC PN cracking pressure) pressure range. During' closed' periods of the GDF, the ullage pressure will usually begin to Increase due to vapor growth inherent in the process of Introducing air into the UST's. If the pressure goes slightly above atmospheric the vapor from the UST's will flow Into the Internal bladder. Conversely, when ORVR refueling begins and the UST pressure falls below atmospheric, the vapor internal to the bladder will be drawn back into the UST until the bladder is fully collapsed waiting for the next cycle. The Clean Air Separator" in over two and one half years (installed late September of 2002) of being In operation at our C.A.R.B. test site in Sacramento has been evaluated repeatedly to see If there Is any liquid condensation in either the bladder or the space between the Inner wall of the vessel and outer wall of the bladder. To date there has been no liquid found in either area. 10/1.9/2007 10:52 5624384036 ABT SERVICES' PAGE 01/03 File MH15389 Project 04NK04880 July 20, 2004 REPORT on VAPOR RECOVERY SYSTEM ACCESSORIES, FLAMMABLE LIQUID Healy Systems, Inc. Hudson, NH Copyright ® 2004 Underwrite rs•Laboratories Inc. Underwriters Laboratories Inc. authorizes the above named company to reproduce this Report provided it is reproduced in its entirety. 10/29/2007 10:52 5624384036 File MH15389 Vol. 2 ABT SERVICES Sec. 12 Page 1 and Report PAGE 02/03 Issued: 2004-07-20 Revised: 2007-06-30 DESCRIPTION PRODUCT COVERED: .USL - Modals 9961 and 9961H Clean Air Separators. • A GENERAL: *This device is for use with flammable liquid storage tanks and is intended to be connected in parallel with the existing pressure vacuum vent connected to the tank. The bladder within the Model 9961 and 9961A is intended to expand and contract with the changing pressure within the storage tank to prevent the pressure vacuum vent from opening and releasing gasoline vapors. The bladder within the tank has notbeen evaluated by Underwriters Laboratories for material compatibility requirements. The area around the Air Breather Assembly, Healy Part No. 9948 should be considered to have the same hazardous locations as that of tank vent., The performance characteristics of this device with regard to its intended function have not been evaluated by Underwriters Laboratories. USL indicates evaluation to the Standard for Electrical _A aratus for Explosive Gas Atmospheres - Part 1: Flameproof Enclosuresd", first edition; and the Standard for Steel Aboveground Tanks for Flammable and Combustible Liquids, UL 142, eighth edition. SIZE AND INSTALLATION: All f=ield connections are made through 1 inch NPT pipe fittings. The devices are intended for installation and use in accordance with NFPA 30, Flammable and Combustible Liquids Code and NFPA No. 30A, Code for Motor Fuel Dispensing Facilities and Repair Garages. .MARKING: Listee`s name, model designation and the statement, ^Onlyy for use as Specified in the installation instructions." Marking material is R/C Marking and Labeling System (PGDg2) that is suitable to the material to which it is affixed and exposure to high humidity, outdoors use, occasional splashing of gasoline, -40C and +100C. Healy Label and ASHD data plates) may be alternatively placed on the tank shell. INSTALLATION INSTRUCTIONS: *.Each device is provided with the installation instructions shown in ILL. A. Model 9961 is installed as indicated in Fig. 1 and ILLS. 6 through B. bbda1 9961H is installed as indicated in Fig. 2 and xLT.g, 9 through 12. , it IEW19/2007 10:52 5624384036 ABT SERVICES PAGE 03/03 File MH15389 Vol. 2 Sec.. 12 Page 2 Issued: 2004--07-20 and Report Revised: 2007-06-30 MODEL, 9961 and 9961H - FIG. 1 & 2 General - Only those components specified below are provided: Tb a models 9961.and 99618 vise idaoatioal its. The Model 9961 is installed ver-tcally and the Model 99618 is installed horizontally. 7. Tank - ASME Certified with a working pressure of 137 psi. Overall shape and dimensions are -as shown in ILL. 1 for Model. 9961 and ILL. IA for Model 9961B. Provided with upper assembly as shown in ILL 2 and 2A reapectivd].y. . 2.. PV Vent Valve - UL Listed, with pressure and vacuum ratings of +3" WC/- 8- WC. 3. Ball Valves -.UL Listed, locking type, suitable for gasoline service. 4: Pad Lotks - Four keyed alike, must fit item 3, ball valves. 5. Breather Assembly - See ILL. 3 for assembly. 6. Vapor Inlet Assembly - See ILL. 4 for assembly. 7. Float Check Valve -Sealy Systems Model 9644G, see ILL. 5 for details, 8. Gasket - All gaskets are UL Listed and suitable for use,with gasoline. 9. 'Pipe Joint Compounds - All pipe joint compounds are UL Classified and suitable for use with gasoline. 3