HomeMy WebLinkAboutC&D Form_Hoyt Roofing.pdfa rY aAk City of Diamond Bar
DIAMOND BARConstruction & 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: greendbCa diamondbarca.aov
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��)Cbd� Title
f
Company1 1 `"�J[S
Address CitygL{1� sta��' zip_
Phone i4'- Email
Project Information: Indicate
Waste Hauler for C&D:
Permit No. FQ 2.eg- - l� ❑ Valley Vista
❑ WM ELSelf Haul
Project Address Zl[ `J �'�[/1{k-#r C�V;n�IJ�( ,��
Zip
Project Type: ❑ New Construction C41,0ditionlAheration ❑
Demolition
Building Type: 47 Commercial b 2esideniial
Estimated Square Peet
T F
TO BE FILLED OUT BY CITY STAFF
Estimated Start Date Oq I 2 '
C&D Deposit' Paid $ a �
Estimated Completion Date_I��1
Staff Initials e�-n Date Paid 'a/ Zia / 24
Fill out the table with estimated quantities in tons for each material that will be generated by your project. Note: A + B = C
Material Type
A B
Estimated Salvage,: Estimated
C
Estimated Total
Applicant Sell'
Haul (check)
Certified Recycling
Facility or
Reuse or Recycle : 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 that apply)
Cardboard
0.00
Car pet, Padding 1 Foam
0.00
Ceiling Tile (acoustic)
0.00
Dirt
0.00
Drywall
0.00
Landscape Debris
0.00
Mixed C&D Debris
713`5
0.00
t
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 0.00
0.00
To estimate Recycling Rate: (Total A/Total C) x 100 = Recycling % 0.00%
Applicant Name: pti qc(o 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@diamondbarca.gov
-1 - 09/28/17