HomeMy WebLinkAboutC&D Form_USA Builders.pdf�• Akk City of Diamond Bar
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DIAMOND BAR Construction & Demolition (C&D) Debris Plan
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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
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Applicant Contact Information:: orler [ '' t-' 9
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Name rL v Title T ?AL-C,
Ir
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-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
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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%
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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