HomeMy WebLinkAboutC&D Form_AA Roofing.pdfCity of Diamond Bar'
DIAMOND BAR
C.L.fS� A 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(),dialnondbarca.eov
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 Wn
2 �, L — Title / ►�'�'� Company WAddresr��L ^'1 City Gt Start Zip
Phone �_} f0 -41), '^ (]�m � Email 04Z }-ou Q rivW �, C-"
Project Information:
Permit No, a zr ^ q ! ❑ Valley Vista
Project Address -I 7 0
❑ WM ❑ Self Haul
A e-%- 1 !7
Project Type: ❑ New Construction ❑ AdditionlAlteration ❑ Demolition
Zip
Building Type: ❑ Commercial ❑ Residential
Estimated Square Feet �_ TO BE FILLED CUT BY CITY STAFF
Estimated Start Date � 1��1 2� "C&D Deposit" Paid $ a r � �
Staff Initials 4n Date Paid (30C 2-er
Estimated Completion Date � IX-�> 1 `�lA
Fillout the table with estimated quantities in tons for each material that will be generated by your project Note: A + B = C
Material Type
A 9 B
Estimated Salvage„ Estimated
Reuse or Recycle Disposal ('Trash)
C
Estimated Total
Debris Quantity
Applicant Self
Haul (check)
Certified Recycling
Facility or
Disposal Destination
Asphalt & Concrete
0.00
Brick 1 Masonry 1 Tile
0.00
Cabinets, Doors, Fixtures,
Windows (cin'!e all that ly)
0 00
❑
Cardboard
0.00
Carpet, Padding 1 Foam
0.00
Ceiling Tile (acoustic)
0.00
Dirt
0.00
Drywall
0,00
Landscape Debris
0,00
Mixed C&D Debris
0 00
Mixed Inerts
0.00
Roofing Materials
0, 00
Scrap Metal
0.00
Stucco
0.00
Unpainted Wood & Pallets
0.00
Garbage 1 Trash
0.00
Other:
0.00
TOTAL
0,00 E 0.00
0.00
Applicant Name:
To estimate Recycling Rate: (Total A/Total C) x 100 = Recycling % 0.00%
Signature: -, [ram- I Date:
! For inforrmtion on construction and demolition waste management plans contact the City of Diamond Bar
J Environunental Services at 909-839.7015 or via email to Rreendbadiamondbarca.eov I
- 1 - 09/28/17