HomeMy WebLinkAboutC&D Form_Hoyt Roofs.pdfC11f=� City of Diamond Bar -
DIAMOND BAR NAIIAN AN Ih 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: greendb(a),diamondbarea.zov
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 Title _&0,y—',AC-e
GtVAL_ Company ObUf _ 1 vim__
Address
3"
City al-Aalu; n.� 5tat CNJ- Zip ot-T_ t b
Phone�6
Email
Project Information:
Indicate
Waste Hauler for: ■
Permit No.
Valley Vista
El 1l M � Self Haul
Project Address ',ZA-VD C[JK—Sh'e- ynxR, v1d , pLa
c C-14k Lip W7 (o5
Project Type: ❑ New Construction a Addition/Alteration ❑
Demolition
Building Type: a Commercial iW Residential
Estimated Square Feet
1 °t R)
TO BE FILLED OUT BYCITY STAFF
u C&D Deposit Paid $ Q a
Estimated Start Date 10 1 b 9- 1
Staff Initials Date Paid
Estimated Completion Date
10 I t l
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 Self
g$nl (speck)
Certified Recycling
Facility or
Reuse or Recycle i Disposal (Trash)
Debris Quantity
Dis oral Destination
Asphalt & Concrete
0.00
Brick 1 Masonry 1 Tile
d,QO
Cabinets, Doors, Fixtures,
0 00
Windows (cycle all that ly)
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
t 410J; &&t -r-A "Ca 5
Mixed Inerts
0.00
Roofing Materials
0.00Li
Scrap Metal
0.00
Stucco
0.00
Unpainted Wood & Pallets
0.00
Garbage I Trash
0.00
Other:
0.00
TOTAL
0.00 E 0.00
0.00
To estimate Recycling Rate: (Total AlTotal Q x 100 = Recycling % 0.00%
Applicant Name:
dd Signature: Date: oL
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