HomeMy WebLinkAboutC&D Form_Grace Morales.pdfABA-
= City of Diamond Bar -
DIAMOND BAIL
fALIF*AnIA 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: greendbta"7,diamondbarca.eov
Complete before obtaining a buildinpN combination or demolition permit.
Submlt this form and your deposit to the Building and Safety Division located at: 21910 Copley Dr. Diamond Bar, CA. 91765
Applicant Contact Information:
Name [ JL fJC [' JylD � 4k � I Title Company
Address d
City S'lI M a-) Ap c State Zip 9 / 2 t
Phoned y 72,y I y I Email
Project Information: Indicate
Waste Hauler for C&
Permit No. 'P►2 Sk ti- 1 9 ❑ valley Vista
❑ WM ❑ Self Haul
Project Address ` $ �-'� -a)n La22Q Sa
Zip
Project Type: ❑ New Construction AAdditionlAlteration ❑
Demolftion
Building Type: ❑ Commercial ❑ .Residential
Estimated Square Feet l
TO BE FILLED OUT BY CITY STAFF
c--
C&D Deposit Paid $ a
Estimated Start Date S 1 14P 1 �- r
g
Staff Initials awy% Date Paid c- 4e
Estimated Completion Date 1 1
Fill out the table with estimated quantities in tons for each material that will be generated by your project. Note: A + B = C
A t B
C
Applicant Self
Certified Recycling
Material Type
Estimated Salvage, Estimated
Estimated Total
Haul (check)
Facility or
Reuse or Recycle E Disposal (Trash)
Debris Quantity
Disposal Destination
As halt & Concrete
0.00
Brick 1 Masonry 1 Tile
0.00
Cabinets, Doors, Fixtures,
00
El
(circieau that apply)
Cardboard
0.00
Carpet, Padding 1 Foam
U0
CeilingTile (acoustic)
0.00
Dirt
0.00
Drywall
0.00
Landscape Debris
0.00Li
Mixed C&D Debris
0.00
Li
Mixed Inerts
0.00
Roofing Materials
0.00
Scrap Metal
0.00
Stucco
0.00
Unpainted Wood & Pallets
0.00
Garbage/ Trash
0,00
Other
0.00
TOTAL 10.00
.0.00
0.00
To estimate Recycling Rate: (Total A/Total Cry x 100 = Recycling % 0,00%
Applicant Name: .,- 1 Signature: L- . Date: 1
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®diarnondbarca.gov
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- 1 - 09/28/17