HomeMy WebLinkAboutC&D Form_SoCal Roofing.pdfCity of Diamond Bar
DIAMOND BAR cAL119941c 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: areendbCa dlamondbarea.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:
Namet
Title t,�u l ` r ►^t : �; 1 vt Company
Address i t 2_ -&--t o i e ✓1 E t t,�e City� " 1.r (, j R "' `, State (• r Zip C 6
Phor��l 3 �. -
� yU Email 5 ' `' + C IC• v fr.(t t` ►7�
Project Information:
Indicate Wa5te Hauler for•
Permit No. 1" Ii2 ;t4
I ❑ Valley Vista ❑ WM [21 Self Haul
Project Address : `� _ _ _J r�, zip 117(_ r
Project Type: ❑ New Construction ❑ AdditionlAlteration 0 Demolition
Building Type: ❑ Commercial Residential
TO BE FILLED OUT BY CITY STAFF
Estimated Square Feet
" C&D Deposit Paid $ ��
Estimated Start Date
1 1
Staff Initials ?rYl Date Paid
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 B.
C
Applicant Self
Certified Recycling
Material Type
Estimated Salvage, Estimated
Estimated Total
Haul (check)
Facility or
Reuse or Recycle 9 Disposal (Trash)
Debris Quantity
Disposal Destination
Asphalt & Concrete
0.00
Brick 1 Masonry 1 Tile
0.00
Cabinets, Doors, Fixtures,
0.00
El
(circle all that apply)
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
C
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:-7
, ; Signature: -< 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 greendl>@diamondbarca.gov
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09/28/17