HomeMy WebLinkAboutC&D Form_Google Roofing.pdfCity of Diamond Bar
DIAMONCALiFORVkA D BAR 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 diamondbarca.l7ov
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: 0 _
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AAA
Name r. L� YI
Title Company
Address 7
I b City State C,' Zip �
Phone �I
G a
� .� Email ._ J o � ej 1 7f' 1 L�� ri mitt'
Project Information:
Indicate Waste Hauler for C&D:
Permit No. ❑ Valley Vista WM ❑ Self Haul
Project Address �_
1��fe-6 (r1r1,-C1 t--y► Zip
Project Type: ❑ New Construction ❑ AdditionlA teration ❑ Demolition
Building Type: ❑ Commercial ❑ Residential
Estimated Square Feet
q
TO BE FILLED OUT BY CITY STAFF'
"C&D Deposit" Paid $ c-A S 0
Estimated Start Date
s 1 1
Staff Initials Gry-) Hate Paid�-
Estimated Completion Date
1 1
Fill out the table with estimated quantities in tons for each material that will he generated by your project Note: A f B = C
Material Type
A i B
Estimated Salvage,' Estimated
C
Estimated Total
Applicant Self
Haul (check)
Certified Recycling
Facility or
Reuse or Recycle E Disposal (Trash)
Debris Quantity
Disposal Destination
Asphalt & Concrete
0.00
Brick 1 Masonry 1 Tile
0.00
Ll
Cabinets, Doors, Fixtures,
0 00
❑
Windows [circle all that apply)
Cardboard
0.00
Carpet, Padding 1 Foam
0.00
Coiling Tile (aeoustic)
0.00
Dirt
0.00
Drywall
0.00
Landscape Debris
0.00
L]
Mixed C&D Debris
0.00
Li
Mixed Inerts
0.00
Roofing Materials
Ca
0.00
Scrap Metal
0.00
Stucco
0.00
Unpainted Wood & Pallets
0.00
71
Garbage 1 Trash
0.00
71
Other:
0.00
TOTAL
0.00 :0.00
0.00
LTo
estimate Recycling Rate: (Total AlTotal C) x 100 = Recycling % 0.00%
Applicant Name:ESignature� Date:
_ 0 g
For information on construction and demolition waste managem t plans contact the City of Diamond Bar
Environmental Services at 909.83 9.70 15 or via email to greendb®diamondbarca.gov
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- I - 09/28/17