HomeMy WebLinkAboutC&D Form_II Shea Roofing.pdfL City of Diamond Bar W .
DIAMOND BAR Construction & Demolition (C&D) Debris Plan V
GA L510 R+IA —
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 way also result in forfeit of the deposits.
Remi-M and weikht tickets can be submitted to: a freendbkdiamondbarre 9nv
Complete before obtaining s building, combination or demoftm permit.
5ubmlt this form and your deposit to the Baling mad Safety Division located at- 2181D Copley Dr. Diamond Bar, CA. 91765
Applicant Contact informati
Name VVi 0AIJV Title hc-A. Company
Address�jp % P "• City 0 Statet� Zip _111 L Q
Phone yZEmail--
Project Information: Indicate Waste HaLder for
Permit No. ❑ Valley Vista ❑ WM E2telf Haul
Project Address Z4y q t-200 zd Zip '1 E 76-
Project Type: W.New Construction ❑ AddrlioxlAlleration L7 Demolition
Building Type: 0 Commercial GYKesidential
Estimated Square Feet = TO BE FILLED OUT BY CITY STAFF
Estimated Start Bata
ieC&D Deposit" Paid $ 450-00
I �
Estimated Completion Date t t 1 7 - I staff Initials AV Date Paid 10/31 /24
FM out the table with estimated quantities in tons for each material that will be generated by your project Note: A f B = C
Material Type
A B
Estimated Salvage,': Estimated
Reuse or Recycle E Disposal (Trash)
C
Estimated Total
Debris Quantity
Applicant Self
Haul (check)
Certified Recycling
Facility or
Disposal Destination
Asphalt & Concrete
0.00
Brick 1 Masonry 1 Tile
00
Cabinets, Doors, Fb tetres,
Windows (drde all that apph')
Q.GG
❑
Cardboard
0.00
Carpet, Padding/ Foam
0.00
Ceiling Tile (acoustic)
0.00
Dirt
0.00
Drywall
0.00
Landscape Debris
0.00
Li
Mixed C&D Debris
( L
0,00 1
Mixed Inerts
G.OG
Roofing Materials
0.00
Scrap Metal
G.GO
Stucco
0.00
Un aimed Wood & Pallets
0.00
Garbage 1 Trash
Elmo
4
0.00
El
Other,
0.00
TOTAL
E O.OQ GI
2 06 q Isiz
fWas
in
To estimate Recycling Rate: (Total A/Total C) x 100 = Recycling % 0.00%
n# Name: _ ti p111.e, WSignature:�4,Date: 9 • 2-I{
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 greendW diatnondbarca.gov
elf
-1 - 09/28/17