HomeMy WebLinkAboutJ 1 PRO ROOFING - C&D.pdfaifr ��
DIAMOND BAR
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City of Diamond Bar
Construction & Demolition (C&D) Debris Plan
Required for all covered projects, 1,000 sq. ft or more. The deposit shall be returned, to the applicant, without
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 may also result in forfeit of the deposits.
Receipts and weight tickets can be submitted to: greendb(a),dlamondbarca.zov
Complete before obtaining a building, combination or demolition permit.
Submit this form and your deposit to the Building and Safety Division located at: 21810 Copley Dr. Diamond Bar, CA. 91765
Applicant Contact Information:
Name y� 6P� �rci Title [. t
t4 Company J1. PcV tZIKjvi!
Address c1 1A Ecu-4 -S+ .
City C'� r %k State Zip -i i
Phone 90q) q`+ �'L3 Email �'
G rc o Y� e i l
Project Information: Indicate
Waste Hauler for C&D-----
Permit No. K2.`} -an ❑ Valley Vista
❑ WM Self Haul
Project Address 151 V-�,J 0 00(i U v.
Zip
Project Type: ❑ NVew Construction APAdditionlAlteradon
❑ Demolition
Building Type: ❑ Commercial Residential
Estimated Square Feet 1 G4 -�
TO BE FILLED OUT BY CITY STAFF
C&D Deposit a U
Estimated Start Date i -3 S 1 `'%V1
Paid $ c7
Staff Initials hate Paid
Estimated Completion Date�) j / C'f�l_
Fill out the table with estimated quantities in tons for each material that will be generated by your project. Note: A f B = C
Material Type
A B
Estimated Salvage, Estimated
C
Estimated Total
Applicant Self
Haul (check)
Certified Recycling
Facility or
Reuse or Recycle E Disposal (Trash)
Debris Quantity
Disposal Destination
Asphalt & Concrete
0.00
Brick 1 Masonry 1 Tile
0,00
Cabinets, Doors, Fixtures,
0 00
❑
Windows {circle all tha apply}
Cardboard
0.00
Carpet, Padding 1 Foam
0.00
Ceilin Tile (acoustic)
0.00
Dirt
0.00
Drywall
0.00
Landscape Debris
0.00
Mixed C&D Debris
0.00
Mixed Inerts
0.00
❑ofing Materials
0.0
Scrap Metal
0.00
Stucco
0.00
Unpainted Wood & Pallets
0.00
Garbage 1 Trash
0.00
Other:
10.00
0.00
TOTAL
0.00 1-1 0.00
To estimate Recycling Rate: (Total A/Total C) x 100 = Recycling % 0.00%
APocant Name: .A.Signature: Date:
For information on construction and demolition waste management plans contact the City of Diamond Bar
Environmental Services at 909.839.7015 or via email to greendb®diamondbarea.gov
09/28/17