HomeMy WebLinkAbout20231212145306862.pdfo=rr eF
City of Diamond Bar
,.DIAMOND BAR Construction& Demolition (C&D) Debris Plan
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all covered projects, 1,000 sq. ft or more. The deposit shall be returned, to the applicant, without
Required for
interest, in total or proportion upon submittal of proof that no less than 75% of the C&D was diverted.
Use of unauthorized waste haulers ma also 1 exult. in forfeit of the de oslts.
Receints and weight tickets can be submitted to-.. greendb@dWaondlbarca.gov.
. Flfin
Compieto before obtaining a bnildiu9, emnbinstion ar demolision permit,
Submit this form and your deposit to the Building and Safety Division located at: 21010 Copley Dr. Diamond Bar, CA. 91765
Applicant Contact Inform 'On*
'i� r Ci(I 'Title � �� Company
Name ate G zip Q l
Address i �
City I�(J---
2 ''� ( ' 73 Email
Phone
project fllformation:
Permit No. �' ValleV Vista
i,Self Haui �'
WM
, 1 /�-R (9
Project Address 3,9j
0 zip
Project Type: 41 New Construction L7.4ddition/fllteration
Demolition
Building Type: 42 Commercial CY Residential
TO BE FILLED OUT BY CffY STAF
�•
Estimated Square Peet ��` 0A
3
"C&cD )e si#" P"id'
Date Ed
Estimated Start Date _ D -!_.. z—1—.-°2 --
Completion Date Z 2 1 23
Staff Xniti
,
Estimated. _. — ,l
in tons for ea.eb material that will be generated by your project. Note: A C
Fill out the table with estisraated quantities
A 's $
Applicant Self
Certified Recycling
Material Type
Estimated Salvage,; Estimated
Reuse or Recycle .Disposal (Trash)
A
Haul (check)
Facility or
Dis osal Destination
Asphalt & Concrete
0.00
Brick 1 Masonry I Tile
❑
Cabinets, Doors, Fixtures,
0.00
Windows (clrolesllthata ply)
0.00
Cardboard
0.00
Carpet, Padding /1�aam
0.00
Ceilialg Tile (acoustic)
D.00
]Dirt
0.00
Drywall
r
0.00
Landscape Debris
p 00
Mixed C&TA Debris
—
TOO
Mixed Tnerts
Roofi ag Materials
n s
0.00
0.00
scrap Metal
0.00
Stucco
Unpainted Wood & Pallets.
D,00
0.00
Garbage / Trash1111110.00
_
Other:
D.00
0.00
.�
�-
-Y'
TOTAL 0.Da
To estim o Rec ng Rate: (Total A/Total C) x i0 = Recycling % 0. 0%
P;
licant Name.
" Signature.
atP-b
For information on construction and demolition waste management plans contact the City of Diamond Bar
Services at 909.839.7015 or via email to greendb@diamondbarca.gov
Environmental
09128117
_t
Receipt Number:
Receipt Date:
Date Paid:
Full Amount:
Payment Details:
Amount Tendered:
Change / Overage:
Contact (Paid 13y):
Property Address:
FEE DETAILS:
21810 Copley Dr.
Diamond Bar, CA 91765
RECEIPT OF PAYMENT
2023064078
10/16/2023
10/16/2023
$562.48
Payment Method
Check
Amount Tendered Check Number
$562.48 700
$562.48
$0.00
NG EDDIE W, Address.232 PINTADO DR
232 PINTADO DR N, DIAMOND BAR, CA 91765
Fee Description
Building Admin Special Revolving Fund
(Residential)
Building Permit Fees Residential
SMIP Fee (residential)
Building Permit Issuance Fee
Records Retention Fee (per sheet plan)
Permit System Replacment
Recycling & Waste Reduction Deposit
Reference Number
PR20230001871
PR20230001871
PR20230001871
PR20230001871
PR20230001871
PR20230001871
PR20230001871
Amount Owing Amount Paid
$1.00 $1.00
$235.43
$235.43
$0.66
$0.6E
$54.20
$54.2C
$11.77
$11.77
$9.42
$9.42
$250.00
$250.00
This receipt only acknowledges payment of fees to the City. It is not proof that a
license, permit or other approval has been issued. This receipt does not authorize
the commencement or conduct of any activity for which a fee has been paid.