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HomeMy WebLinkAboutC&D Form_USA Builders.pdf�• Akk City of Diamond Bar n Fer� DIAMOND BAR Construction & Demolition (C&D) Debris Plan cn�ein 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 Iess 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: reendbQdiamondbarca. ov 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:: orler [ '' t-' 9 , F I Name rL v Title T ?AL-C, Ir - -ftAddress 1 ' _/ C r ity I ` 1-4 state Zip Phone f `I -- Email I :�,C T G - 1' Project Information: Indicate Waste Hauler for• ! Permit No Pop, axt — l 23 5 Q Vallev Vista ❑ WM Self Haul Project Address cj W G' } i j I - Zip f Project Type: ❑ New Construction ❑ AdditionlA Iteration Demolition Building Type: 0 Commereial d Residential Estimated Square Feet 1 = j TO BE FILLED OUT BY CITY STAFF u ;Z SC C311, C&D Deposit" Paid $ Estimated Start Date. 1 1 ram` y Staff Initials C�-� Date Paid � ':P. i• 2-`t Estimated Completion Date( [ 1 1 r � ' '� �y-� Fill out the table with estimated quantities in tons for each material that will be generated by your project Note: A + B - C A 9 B C Applicant Self Certified Recycling Material Type Estimated Salvage,; Estimated Estimated Total Haul (check) Facility or Reuse or Recycle : Disposal (Trash) Debris Quantity Disposal Destination As halt & Concrete 0.00 Brick 1 Masonry 1 Tile 0.00 Cabinets, Doors, Fixtures, 0.00 ❑ Windows (circle au that apply) Cardboard 0.00 Carpet, Padding 1 Foam 0.00 Ceiling Tile (acoustic) 0.00 Dirt D.00 Drywall 0.00 Landscape Debris 0.00 Mixed C&D Debris 0.00 Li Mixed Inerts + 1 0.00 Roofing Materials 0.00 Scrap Metal 0.00 Stucco 0.00 Unpainted Wood & Pallets 0.00 Garbage I Trash 0.00 Other: 0.00 TOTAL 10.00 :0.00 0.00 To estia Recycling Rate: (Total AlTotal C) x 100 Rotyjli g % 0.00% Zt-. - Applicant Name:' �1 Signature: _ Date: i For information on constriction and demolition waste management puns contact the City of Diamond Bar Environmental Services at 909.839,7015 or via email to greendb@diamondbarca.gov &C - 1 - 09/28/17