HomeMy WebLinkAboutC&D Form_12 Towers.pdf,F� City of Diamond Bar ;,
DIAMOND BAR
CAt...."IA Construction & Demolition (C&D) Debris Plan ILOT
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 wei-aht tickets can be submitted to: areendbQdiamondbarca.eov
Complete before obtaining a building, combination or demolition permit.
Submit this form and your deposit to the Building and Safety Division located at: 21910 Copley Dr. Diamond Bar, CA. 91765
Applicant Contact Information:
Name --n �1 6%�k f'1 Title �"
Y' ►' Company , 2— I - ltL ►�
Address �J` �— - �T" ��- _ ..
City State(' , zip 7
Phone �d� �� t.�3 �(� Email)
Project Information: Indicate
Waste Hauler for C&D-
Permit No. f�M A .4 � 1 la g ❑ Vallev Vista
rE.71 WM ❑ Self Haul
_
�,�`
Project Address C t s
v e Zip �-
Project Type: ❑ New Construction L7 Additionl lieration ❑
Demolition
Building Type: 0 Commercial IrRe..denttal
Estimated Square Feet ,7
TO BE FILLED OUT BY CITY STAFF
^
Estimated Start Date
"C&D Deposit" Paid S a 5 is, ,
Staff Initials lan Date Paid
Estimated Completion Dater
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 c B
Estimated Salvage,: Estimated
C
Estimated Total
Applicant Self
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
Carpet, Padding 1 Foam
0.00
Ceiling Tile (acoustic)
0.00
Dirt
0.00
Drywall
0.00
Landsca a Debris
0.00
Mixed C&D Debris
0.00
Mixed Inerts
0.00
Roofing Materials
0.00
W
Scrap Metal
0,Q0
Stucco
0.00
Unpainted Wood & Pallets
0.00
Garbage 1 Trash
0.00
Other:
00
TOTAL 0.00 :0.00
0.00
To estimate Recycling Rate: (Total
AlTatal C x 100 = Recycling % 0.00%
Applicant Name: Signature:
Date:
flL
For information on construction and demolition waste manageme& plans contact the City of Diamond Bar
EnvironmentaI Services at 909.839.7015 or via email to green db@diamondbarea.gov
- 1 - 09/28/17